Safety of Clomiphene Citrate and Its Impact on Serum Tumor Markers in Hypogonadal Testicular Cancer Patients After Chemotherapy

Introduction Clomiphene citrate (CC) is used to treat secondary hypogonadism. This study aimed to assess the impact of CC on hypogonadal testicular cancer survivors' serum testosterone, luteinizing hormone (LH), and beta-human chorionic gonadotropin (beta-HCG) levels. Methods Following institutional review board (IRB) approval, we performed a retrospective chart analysis of all patients who had undergone a radical orchiectomy from 2004 to 2022. Inclusion criteria were males >18 years of age who had undergone a radical orchiectomy and chemotherapy for testicular cancer, who were subsequently treated with CC due to symptomatic hypogonadism (serum testosterone < 300 ng/dL). Mean serum testosterone levels were compared using a paired, two-tailed t-test. Mean serum LH and beta-HCG levels were compared using a one-tailed, two-sample t-test assuming equal variance. Results In total, 476 radical orchiectomies were performed, with 10 patients meeting the inclusion criteria. CC was associated with a 273 ng/dL mean increase in serum testosterone (215-486 ng/dL). The mean follow-up after commencing CC therapy was 52.5 months. No side effects or evidence of disease recurrence occurred. No false-positive elevations in beta-HCG tumor marker levels related to the CC-induced rise in serum LH levels occurred. Conclusion This is the first study to assess the use of CC in hypogonadal testicular cancer survivors following chemotherapy. CC was associated with an increase in serum testosterone levels with no associated side effects, false-positive elevation of beta-HCG tumor marker levels, or disease recurrence.