Thus, Maximus does NOT use a lab test in advance to see if you qualify as “Low T.” Rather, we use a validated questionnaire to assess your symptoms and areas for improvement. Your doctor uses this info, along with your medical history and goals, to assess if the protocol is right for you.
If so, your doctor can prescribe an at-home lab test at the same time as personalized medications & supplements, to ensure you can get treatment in as soon as one week. Thus, the purpose of third-party lab testing is to provide you with an objective “before & after” 30 days to prove the protocol is working, and provide your doctor with additional info to optimize your treatment over time.
Testosterone Replacement Therapy (TRT) shuts down your body’s own production of testosterone and replaces it with synthetic testosterone that is typically injected, which results in testicular shrinkage, infertility, and dependence. However, a newer, cutting-edge approach is testosterone restoration, using oral medications to restore your body’s own natural production of testosterone without these adverse effects.3
Selective Estrogen Receptor Modulators (SERMs) act as estrogen antagonists—they block estrogen from binding to the estrogen receptor in the brain, at the hypothalamus and the pituitary gland.
So when the brain thinks that it’s not getting enough estrogen, it stimulates the production of the hormones luteinizing hormone (LH) and Follicle Stimulating Hormone (FSH), which increases the testes production of testosterone and sperm, respectively. This cleverly stimulates your body into producing more of its own natural testosterone!
Enclomiphene is the purified isomer of Clomid (Clomiphene Citrate), which has been FDA approved since 1967 for fertility in women, and has been commonly used off-label in men. Many research studies suggest Clomid “is safe and effective with few side effects when used as long-term treatment of hypogonadism (low testosterone)”⁴ and is an “effective and safe alternative to testosterone supplementation in [young] men wishing to preserve their fertility”.2
However, Clomid is actually made up of a mixture of two isomers: 38% zuclomiphene and 62% enclomiphene. Zuclomiphene is an estrogen receptor agonist (increases estrogen) that stays in your system a long time and accumulates much more over time than enclomiphene.⁵
Clomid is believed to cause some minor side effects such as mood swings, depressed mood, irritability, anxiety, gynecomastia, and libido issues that can develop in a small percentage of patients over time.⁶
The literature has suggested that most of the beneficial effects of clomiphene are due to the trans-isomer enclomiphene. Zuclomiphene contributes little to the intended outcomes.“⁷ Maximus’ cutting-edge innovation is purifying clomid to maximize the amount of enclomiphene present. Thus, using this new, purer form “maintains the androgenic benefit of clomiphene citrate without the undesirable effects attributable to zuclomiphene”, and has been shown to yield increased testosterone levels and maintain sperm concentration (unlike TRT).⁷
Experts believe enclomiphene should “become the primary medication for men with secondary hypogonadism (low T) who wish to preserve spermatogenesis (fertility)” and is “a very promising drug for patients with secondary hypogonadism and who are concerned about the negative effects of exogenous testosterone.”⁷
Studies using enclomiphene for testosterone restoration vs. testosterone gel for testosterone replacement therapy show why this approach is superior in individuals who still have normal testicular function. In obese, hypogondal (low T) men, enclomiphone increases testosterone more than testosterone gel and keeps levels more consistently stable:
In addition, enclomiphene stimulates the testes (and actually increases their size) to produce Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH), which is how the body naturally and endogenously produces testosterone and sperm.
In contrast, testosterone gel has the opposite effect: significantly impairing LH & FSH production, thus inhibiting endogenous production of testosterone & sperm, which causes testicular shrinkage and external dependence on testosterone gel.⁸
The adverse effects of enclomiphene have been extensively studied during phase II and phase III clinical trials. The drug is generally well tolerated with side-effects occurring relatively rarely⁷
Increasing testosterone naturally increases estrogens like estradiol. Instead of using aromatase inhibitors (AIs) to control estradiol, which can cause adverse effects, leading testosterone experts like Dr. John Crisler promoted a safer and gentler approach of using a detoxifying, antioxidant supplement called Calcium Saccarate (aka Calcium D-Glucarate) to balance hormone levels and is “many times helpful” for libido.
Calcium Saccharate (Calcium D-Glucarate) is the calcium salt of D-glucaric acid, a substance produced naturally in small amounts in your body and found in fruits and vegetables.
Oral supplementation of Calcium Saccharate inhibits beta-glucuronidase, an enzyme involved in liver detoxification, and allows the body to excrete hormones such as estrogen before they can become reabsorbed. Oral administration of calcium saccate has been shown to lower serum estrogen levels by 23 percent.⁹
Thus, Calcium Saccharate is useful in removing excess estrogens (including those toxic xenoestrogens absorbed from the environment). Thus, as enclomiphene increases testosterone, calcium saccharate decreases estrogen levels, to create a synergistic combination that results in optimal hormonal balance.
*Maximus makes no promise or guarantee of what medications or supplements are prescribed, as these are always determined by the judgement of your clinician to decide what is appropriate care for you.
- Soares AH, Horie NC, Chiang LAP, et al. Effects of clomiphene citrate on male obesity-associated hypogonadism: a randomized, double-blind, placebo-controlled study. Int J Obes (Lond). 2018;42(5):953-63.
- Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int. 2012;110(4):573-8.
- McCullough A. Alternatives to testosterone replacement: testosterone restoration. Asian J Androl. 2015;17(2):201-5.
- Krzastek SC, Sharma D, Abdullah N, et al. Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism. J Urol. 2019;202(5):1029-35.
- Huang ES, Miller WL. Estrogenic and antiestrogenic effects of enclomiphene and zuclomiphene on gonadotropin secretion by ovine pituitary cells in culture. Endocrinology. 1983;112(2):442-8.
- Choi SH, Shapiro H, Robinson GE, et al. Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin. J Psychosom Obstet Gynaecol. 2005;26(2):93-100.
- Earl JA, Kim ED. Enclomiphene citrate: A treatment that maintains fertility in men with secondary hypogonadism. Expert Rev Endocrinol Metab. 2019;14(3):157-65.
- 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):677-85.
- Calcium-D-glucarate. Altern Med Rev. 2002 Aug;7(4):336-9. PMID: 12197785.