An unusual case of vascular hypogonadism treated with clomiphene citrate and testosterone replacement

Many male patients are discovered on screening to suffer from hypogonadism and age related hypogonadism is being increasingly recognized. However, secondary causes of hypogonadism should not be overlooked, especially in patients who may have concomitant morbidity as highlighted in this case. Our patient with vascular hypogonadism was treated with testosterone and clomiphene citrate in cycles; with a hope of improving not only androgen levels but overall pituitary function as there were co-existing endocrine pathologies of albeit primary hypothyroidism and low IGF-1 levels. Treatment with exogenous testosterone is fairly well established; but there is also increasing evidence of the effectiveness and short-term safety of clomiphene citrate in restoring not only biological levels but functional states in males as well. As such, we report an unusual case of a patient seen at our Men's Health & Andrology clinic in which both the cause of some otherwise unremarkable symptoms and the treatment, using a combination of clomiphene citrate and testosterone, were remarkable.