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Stimulation of Leydig and Sertoli Cellular Secretory Function by Anti-Oestrogens: Clomiphene

Author(s):

Lionel A. Micol*, Ömer O. Cakir, Philippa Sangster and David J. Ralph   Pages 1 - 13 ( 13 )

Abstract:


Leydig and Sertoli cells are essential for the testicular homeostasis. Clinically, the testicular homeostasis is impaired in hypogonadal and subfertile men. Therapeutically, the selective oestrogen receptor modulator clomiphene citrate (CC) is frequently used to treat these patients. In men, the mechanism of action of CC has long been thought to be limited to inhibition of the retrocontrol by oestrogen on the pituitary gland. However, oestrogen receptors are also expressed in the testis. Therefore, we will explore in this review the systemic effects as well as its action on reproductive function. We will describe in particular the possible effects of CC on the secretory functions of Leydig and Sertoli cells and their implication on testicular microenvironment. CC is a cost-effective and relatively safe off-label treatment for young hypogonadic men actively trying for a child or subfertile men with low testosterone with positive effect on sperm concentration. Nevertheless, its effects on the oestrogen receptors and other signalling pathways at testicular level remain poorly investigated. Further research, including with combined treatment, could allow improving sperm morphology and sperm motility which do not seem to be significantly enhanced by CC alone.

Keywords:

Clomiphene, male infertility, hypogonadism, adverse effect, spermatogenesis, testosterone, Leydig cell, Sertoli cell

Affiliation:

Department of Andrology, Institute of Urology, University College Hospital, London, Department of Andrology, Institute of Urology, University College Hospital, London, Department of Andrology, Institute of Urology, University College Hospital, London, Department of Andrology, Institute of Urology, University College Hospital, London



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