Enclomiphene Vs. TRT
Two ways to raise testosterone. One keeps sperm production running. Here is how they compare, with the evidence and the catches.
If you want kids in the next few years, TRT isn't the place to start: testosterone from outside turns off the signal your testes need to make sperm1,2. Enclomiphene is a daily pill that raises your own testosterone by keeping that signal on, and in trials sperm counts held up3. The tradeoffs: enclomiphene is compounded and not FDA-approved, and it only works if your testes can still respond.
Side by side
| Enclomiphene | TRT | |
|---|---|---|
| How it works | Gets your brain to send a stronger signal, so your testes make more testosterone | Replaces testosterone directly |
| Sperm production | Maintained in trials | Reduced, and can stop while you're on it |
| How you take it | Oral capsule | Injection at home, typically weekly |
| Needs working testes | Yes | No |
| Dose control | Limited by what your body can make | Dose-controlled and more predictable |
| FDA status | Not FDA-approved. Compounded, prescribed off-label. | FDA-approved testosterone products |
| Key labs | Testosterone plus LH and FSH | Testosterone, hematocrit, PSA |
| Price at AZTRT | $159 a month | $149 a month, 90-day terms |
We offer both, so we don't care which one you pick. We care that it fits your labs and your plans. See enclomiphene at AZTRT and TRT at AZTRT for the full program details.
How each one works
Your brain runs your testosterone. The hypothalamus and pituitary send two hormones, LH and FSH, to the testes. LH drives testosterone. FSH drives sperm. When testosterone and estrogen run high, the brain turns the signal down.
TRT turns the signal down
Put testosterone in from outside and your brain sees plenty in circulation. LH and FSH drop. Your testes make less of their own testosterone and less sperm. That's the loop working as designed, and it's strong: in a World Health Organization study, weekly testosterone injections given as a male contraceptive made 65% of healthy men azoospermic (no sperm in the sample) within six months2. That was a contraceptive dose, but the direction holds. It's why the Endocrine Society recommends against starting testosterone in men planning fertility in the near term1.
The good news from the same study: after stopping, sperm counts came back, with a median of about 3.7 months to reach 20 million/mL2. Those were healthy men on a fixed course, so talk through your own situation with your provider. More in TRT and fertility and does TRT shrink your testicles.
Enclomiphene keeps the signal on
Enclomiphene is a selective estrogen receptor modulator (SERM). It's one of the two isomers that make up clomiphene4. It blocks estrogen's feedback at the brain, so the brain keeps sending LH and FSH. Your testes keep working: testosterone goes up, and sperm production keeps going. More in understanding enclomiphene and Clomid vs. TRT.
The catch: it only works if the problem is the signal (secondary hypogonadism), not the testes themselves (primary). That's what LH and FSH on your labs tell your provider. See primary vs. secondary hypogonadism.
What the evidence shows
Here are the main trials, in plain terms:
- Phase IIB, 12 men coming off testosterone gel. Enclomiphene and gel raised testosterone to similar levels by six months. Only enclomiphene raised LH and FSH, and it lifted sperm counts in every man tested at three and six months. The gel didn't5.
- Phase II randomized trial. Enclomiphene raised morning testosterone similar to a testosterone gel, raised LH and FSH, and kept sperm counts up6.
- Two phase III trials, overweight men aged 18 to 60, 16 weeks. Both enclomiphene and gel raised testosterone. Enclomiphene kept sperm in the normal range. The gel group saw a marked drop in sperm production3.
The honest limits. These trials were short, at most six months. They were run by the drug's developer. They measured hormone levels and sperm counts, not long-term outcomes. TRT has decades more data behind it. Enclomiphene's evidence is promising, and narrower.
Enclomiphene isn't FDA-approved. Here's what that means.
No enclomiphene product is FDA-approved. AZTRT's enclomiphene is made by a compounding pharmacy and prescribed off-label by your provider. Compounded drugs aren't FDA-approved, which means FDA doesn't verify their safety, effectiveness or quality before they're sold7.
FDA still lists enclomiphene citrate as a compounding ingredient under evaluation8. In 2022, an FDA advisory committee voted 8 to 4 against adding it to the official compounding list, with members citing a lack of efficacy evidence9. You should know that going in. See compounded vs. FDA-approved.
The tradeoffs, plainly
Enclomiphene
- Keeps your own production running, and with it, sperm production.
- A pill, not an injection.
- Needs working testes. It won't help primary hypogonadism.
- Your ceiling is your own output. You can't simply dial the dose up the way you can with TRT.
- Estradiol can rise along with testosterone, so it gets checked on follow-up labs6.
- Side effects reported in trials include headache, abdominal discomfort and raised estradiol4. Visual changes are a known effect of the clomiphene drug class. Tell your provider right away if you notice any.
TRT
- Predictable. Your dose is set and adjusted from your labs.
- Works whether the problem is the brain or the testes.
- FDA-approved testosterone products with decades of data.
- Lowers sperm production, and it can stop entirely while you're on it2.
- Raises hematocrit, which is why it's monitored10,1. See TRT and hematocrit.
Which one fits you
Enclomiphene usually fits if you want kids now or in the next few years, your LH and FSH say the signal is the problem, you'd rather not inject, or you're not ready to commit to long-term TRT.
TRT usually fits if fertility isn't a priority, your testes aren't responding, or you want tighter dose control. Plenty of men use enclomiphene while kids are on the table and revisit TRT later. Your provider plans that with you.
The call is made from your labs, not a menu. A morning, fasted draw with testosterone plus LH and FSH tells your provider which camp you're in1. Initial labs are included for new patients. Read how low testosterone is diagnosed.
What each costs at AZTRT
| Enclomiphene | TRT | |
|---|---|---|
| Price | $159 a month | $149 a month, in 90-day terms |
| Free video consult | Yes | Yes |
| Initial labs | Included for new patients | Included |
| Follow-up labs | Billed separately | Billed separately |
Not a fit? Refunded minus $50 for labs (refund policy). See full pricing and what TRT costs in Arizona. Already on TRT and thinking about switching? Read what happens if you stop TRT, and don't stop on your own. Talk it through at your consult. Our blog's enclomiphene vs. TRT explainer covers more background.
Before You Book
Enclomiphene At AZTRT
$159 a month. How it works and what gets watched.
Read more →TRT In Arizona
How treatment works, start to finish.
Read more →TRT & Fertility
What testosterone does to sperm, and recovery.
Read more →Estrogen On TRT
What estradiol does and when it matters.
Read more →Is TRT Right For Me?
What a provider weighs, and when the answer is no.
Read more →All Treatments
Every option, side by side.
Read more →Common questions
Does enclomiphene preserve fertility?
In trials, yes for the length of the studies. In two 16-week phase III trials, enclomiphene kept sperm concentration in the normal range while testosterone gel caused a marked drop3. Individual results vary, and longer-term data is limited.
Is enclomiphene FDA-approved?
Does TRT make you infertile?
TRT lowers sperm production and can stop it while you're on it. In a WHO study, weekly testosterone injections made 65% of healthy men azoospermic within six months. After stopping, counts recovered, with a median of about 3.7 months to reach 20 million/mL2.
Is enclomiphene as effective as TRT at raising testosterone?
Who shouldn't take enclomiphene?
Men whose testes aren't responding (primary hypogonadism), because there's no signal for it to boost. LH and FSH on your labs help your provider tell. She'll also weigh your history and other medications.
Can I switch from TRT to enclomiphene?
Sometimes. In one small trial, men who came off testosterone gel and started enclomiphene saw both testosterone and sperm counts rise5. Don't stop TRT on your own. Plan the switch with your provider.
How much does enclomiphene cost at AZTRT?
$159 a month. TRT is $149 a month in 90-day terms. Both start with a free video consult, and initial labs are included for new patients. Not a fit? Refunded minus $50 for labs (refund policy).
Family Nurse Practitioner · Arizona APRN-RNP license #261957
Sources
- Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. pubmed.ncbi.nlm.nih.gov
- World Health Organization Task Force on Methods for the Regulation of Male Fertility. Contraceptive efficacy of testosterone-induced azoospermia in normal men. Lancet. 1990;336(8721):955-959. pubmed.ncbi.nlm.nih.gov
- Kim ED, McCullough A, Kaminetsky J. Oral enclomiphene citrate raises testosterone and preserves sperm counts in obese hypogonadal men, unlike topical testosterone: restoration instead of replacement. BJU Int. 2016;117(4):677-685. pubmed.ncbi.nlm.nih.gov
- Rodriguez KM, et al. Enclomiphene citrate for the treatment of secondary male hypogonadism. Expert Opin Pharmacother. 2016;17(11):1561-1567. (Free full text, PMC5009465.) pmc.ncbi.nlm.nih.gov
- Kaminetsky J, et al. Oral enclomiphene citrate stimulates the endogenous production of testosterone and sperm counts in men with low testosterone: comparison with testosterone gel. J Sex Med. 2013;10(6):1628-1635. pubmed.ncbi.nlm.nih.gov
- Wiehle RD, et al. Enclomiphene citrate stimulates testosterone production while preventing oligospermia: a randomized phase II clinical trial comparing topical testosterone. Fertil Steril. 2014;102(3):720-727. pubmed.ncbi.nlm.nih.gov
- U.S. Food and Drug Administration. Compounding and the FDA: Questions and Answers. www.fda.gov
- U.S. Food and Drug Administration. Bulk Drug Substances Nominated for Use in Compounding Under Section 503A (Category 1 list, updated May 14, 2026). www.fda.gov
- U.S. Food and Drug Administration. Final Summary Minutes of the Pharmacy Compounding Advisory Committee Meeting, June 8, 2022 (enclomiphene citrate vote). www.fda.gov
- Ohlander SJ, Varghese B, Pastuszak AW. Erythrocytosis Following Testosterone Therapy. Sex Med Rev. 2018;6(1):77-85. pubmed.ncbi.nlm.nih.gov
Prices are current as of October 2026 and subject to change; the price at checkout governs. Third-party prices (labs, pharmacies, insurers) are published figures from the sources listed and will vary. Laboratory locations and hours are operated by Sonora Quest Laboratories and Labcorp and are subject to change. AZTRT LLC does not practice medicine; all clinical decisions are made solely by independent, Arizona-licensed providers. Telemedicine services are available exclusively to residents of Arizona who are located in Arizona at the time of each visit. This page is general education, not medical or legal advice. Individual results vary and no outcome is promised or implied.
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