Enclomiphene Eligibility & Contraindications, OPTML

✓You are likely a fit if

Enclomiphene is best suited for men with intact testicular function whose problem is upstream, the brain isn't sending enough LH/FSH.

Adult man with secondary hypogonadism, low T with normal or low LH/FSH (testes can respond, brain isn't signaling).
You want to preserve fertility, now or in the future.
You want to avoid injections and prefer a daily oral pill.
You're early in the testosterone-decline curve, lower-end of normal or mildly low T with symptoms.
You're coming off TRT and need to restart endogenous production.

Primary hypogonadism, if your testes can't make testosterone (high LH/FSH with low T), enclomiphene won't work.
Active or history of liver disease with significant impairment.
History of thromboembolic events (DVT, PE, stroke).
Active visual disturbances, clomiphene-class drugs can cause visual changes; this is a stop signal.
Pituitary tumor or other untreated pituitary disease.
Active prostate cancer or breast cancer in men.
Hypersensitivity to enclomiphene or clomiphene.

Mood disorder, some men report mood effects on clomiphene-class drugs; we'll monitor.
Migraine history, rare but real association with visual symptoms.
Significantly elevated estradiol on baseline, we'll monitor more closely.
Borderline-low T with mild symptoms, lifestyle should be optimized first.
Older men (60+), response rates are lower; we'll set realistic expectations.
Failed prior trial of enclomiphene, we may route to TRT instead.

Lab	Why
Total T (AM, fasting) × 2	Confirm low baseline.
Free T & SHBG	Bioavailable T.
LH & FSH	Confirms secondary, the key data point for enclomiphene.
Estradiol (sensitive)	Baseline before therapy that raises endogenous E2.
Prolactin	Rule out pituitary cause.
TSH	Rule out thyroid cause.
CBC, CMP, lipids	General baseline.
PSA (if ≥ 40)	Prostate baseline.