Elevated baseline LH, prior ADT predict poor response to clomiphene citrate

Higher luteinizing hormone (LH) at baseline and a history of prior androgen-deprivation therapy (ADT) are associated with worse response to clomiphene citrate (CC) therapy in men with low testosterone, a study has shown.

A total of 292 men (median age 60 years) with a median baseline total testosterone (TT) of 264 ng/dL and a median baseline LH of 3.5 mIU/mL were included in this study. Comorbidities among participants were as follows: diabetes (18 percent), hyperlipidaemia (46 percent), hypertension (44 percent), prior radical prostatectomy (41 percent), prostate radiotherapy (12 percent), and ADT (4.5 percent).

Of these men, 136 (47 percent) responded to treatment, while 156 (53 percent) failed to meet the response criteria within 12 weeks.

In multivariable analysis, baseline LH (increase per mIU/mL) was significantly predictive of poor treatment response (odds ratio [OR], 0.82, 95 percent confidence interval [CI], 0.71‒0.95; p=0.008), as was prior ADT (OR, 0.11, 95 percent CI, 0.01‒0.6; p=0.039). On the other hand, baseline TT and age at CC initiation were not predictive.

Men diagnosed with low testosterone and treated with CC were analysed in this retrospective study. Initial CC dosing was 25 mg every other day (QOD), with escalation to 50 mg QOD if TT remained <400 ng/dL. Labs were redrawn every 4 weeks following dose changes until TT was at goal or until treatment discontinuation. Discontinuation within 12 weeks with no response indicated treatment failure.

The researchers assessed TT using liquid chromatography-mass spectrometry. They identified the predictors of treatment response using multivariable models.

“CC is an established treatment for men with low testosterone,” the researchers said.