Hormone Optimization

Enclomiphene Citrate

Non-Steroidal Selective Estrogen Receptor Modulator (SERM) for HPTA axis modulation. Stimulates endogenous testosterone production without testicular shutdown.

Enclomiphene Citrate

Non-Steroidal Selective Estrogen Receptor Modulator (SERM)

ICD-10: E29.1 (Hypogonadism) Off-Label Use
Half-Life
10 hours

vs. Zuclomiphene (30 days)

Primary Target
Pituitary ER

Antagonism increases LH/FSH

Mechanism of Action

HPTA Axis Modulation

Baseline Hypogonadism: Often characterized by inappropriate feedback inhibition. Even with low Testosterone, the hypothalamus perceives adequate levels due to estrogenic signaling (aromatization), resulting in low LH/FSH.

Enclomiphene Effect: Acts as an antagonist at estrogen receptors in the pituitary and hypothalamus. It "blinds" the system to circulating estrogen.

Result: The pituitary perceives a sex-hormone deficit and pulsatilely releases GnRH, LH, and FSH, stimulating the Leydig cells to produce endogenous Testosterone.

Pituitary
ER Receptors
Testes
Leydig Cells
Low LH
E2 Feedback
✖ Enclomiphene

Protocol Generator

Dosing & Duration Logic

  • Standard Dosing: 12.5mg to 25mg Daily. Due to the short half-life (~10h), daily dosing maintains stable LH pulses.
  • Alternative (EOD): 12.5mg - 25mg Every Other Day. Used for patients who hyper-respond (TT > 1100 ng/dL) or experience side effects.
  • Cycling: Unlike TRT, "cycling off" is less critical for HPTA suppression (as it stimulates it), but some practitioners use a "3 Months On, 1 Month Off" protocol to reassess baseline function.

Clinical Pearl

Enclomiphene avoids the accumulation of Zuclomiphene (found in Clomid), which is estrogenic and anti-gonadotropic over time. This allows for longer-term continuous use compared to Clomid.

Comparative Analysis

Enclomiphene vs. Clomiphene vs. TRT

Relative Side Effect Risk Profile

Based on aggregate clinical observations

Active Drug Concentration (7 Days)

Enclo
Clomid (Zuclo Accumulation)

Monitoring Timeline

START Week 0

Baseline Labs

Essential to establish HPTA status.

TITRATION Week 4-6

Response Check

Assess LH pulse and T response.

MAINTENANCE Month 3+

Long-term Safety

Monitor E2 and IGF-1 levels.

Select a timeline stage above to view required lab panels.

Contraindications

  • • Unexplained uterine bleeding (standard label) or liver disease.
  • • Visual Disturbances: History of scotoma or blurry vision with Clomid.
  • • Pituitary Tumors: Functional HPTA axis required.
  • • Primary Hypogonadism (Testicular failure) - Enclo requires functional Leydig cells.

Management of Side Effects

Estrogen Elevation

Enclo raises T, which raises E2 via aromatization. However, ERs are blocked centrally. Monitor for peripheral symptoms (water retention, mood). DIM or lower dose if needed.

IGF-1 Reduction

SERMs can lower IGF-1. Monitor in athletes or those concerned with growth factors. Consider MK-677 or Sermorelin adjunct if clinically indicated.