Low testosterone: Abnormally low levels of the male sex hormone testosterone in the blood. Testosterone is produced by the testes and to a lesser extent by the adrenal glands. Testosterone encourages the development of male sexual characteristics at puberty , stimulates the activity of the male secondary sex characteristics, drives the production of sperm, and is involved in regulation of muscle mass and sex drive. Testosterone levels are highly regulated by a complex glandular system. Abnormally low testosterone levels can occur due to a number of conditions affecting the glands that regulate and produce this hormone. Symptoms of low testosterone include decreased libido, impotence or erectile dysfunction , breast enlargement, and a lowered sperm count. Low testosterone levels may be treated with hormone therapy .
For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy.  This therapy has only been shown helpful for men with secondary hypogonadism. Recent studies have shown it can be safe and effective monotherapy for up to 2 years in patients with intact testicular function and impaired function of the HPTA( http:///ijir/journal/v15/n3/full/ ). Clomifene blocks estrogen from binding to some estrogen receptors in the hypothalamus, thereby causing an increased release gNRH and subsequently LH from the pituitary. Clomifene is a Selective Estrogen Reuptake Modulator (SERM). Generally clomifene does not have adverse effects at the doses used for this purpose. Clomifene at much higher doses is used to induce ovulation and has significant adverse effects in such a setting.
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