So, we are a bit more conservative in that we don't feel like the science has proven any benefit for use of a SERM and TRT concurrently.

We understand why this new practice of using enclomiphene is now so common. It has to do with the dwindling availability of hCG. Other clinics are using enclomiphene as a workaround when they are unable to source hCG for those that wish to maintain fertility.

SERMs were never designed for long-term use, and the FDA has never approved them for use longer than 3 months. We have actually had hundreds of patients transfer to us from other practices that have made the claim that SERMs are "more natural" because they increase your natural production. They do indeed increase natural production in those with secondary hypogonadism (not those with primary hypogonadism). However, they are not natural at all, in that they are chemicals that are unnatural and are not normally found within the human body, unlike testosterone and hCG.

As is true of nearly all medications that aren't bioidentical (like testosterone), enclomiphene has unwanted and unexpected downstream effects. You are correct that clomid and enclomiphene both block the production of IGF-1, and both have the potential to cause vision problems. We still don't know what long-term effects they could have.

Is lowering IGF-1 problematic? It certainly could be if your goal is to maintain or gain muscle mass.

The reality is, we continue to get more patients every day that report to us that they tried enclomiphene, and while the testosterone numbers looked good, they ended up feeling worse.