The arguments against long term use of Clomid:

1. There are no good long-term studies on its use. There is only 1 study on its use for up to 3 years, and it showed that many men in that study had to drop out due to vision changes. We don’t know how safe or effective it is for prolonged use.

2. Clomid and its cousin enclomiphene both lower IGF-1 levels. They block its production directly. IGF-1 is the most important hormone (even more than testosterone) for muscle growth. Many men on prolonged Clomid therapy report loss of strength and muscle mass.

3. In head to head studies of Clomid vs testosterone, Clomid has never been shown to increase or improve libido like testosterone does.

4. Clomid elevates estradiol levels, often to a level that requires additional medication to control high E2 symptoms.

5. Clomid only works in men who have secondary hypogonadism. Considering the majority of men have either primary hypogonadism or mixed hypogonadism, Clomid only works in a subset of men with low T.

Considering testosterone replacement uses a bioidentical hormone (exactly identical to the hormone your body produces) it does not have unintended or unknown issues that natural production of testosterone would not also cause. Clomid shits down the production of IGF-1 and causes cholesterol deposits inside the eyes and has less symptom reduction than TRT. There are greater risks with long term use of SERMs, with less rewards.

TL;DR: Clomid works in a subset of men who have hypogonadism. But since hypogonadism is a life long condition, why also go blind?