Key takeaways
- Diagnosis requires compatible symptoms and consistently low testosterone. Confirm the result with a repeat morning fasting test. Endocrine Society guidance.
- Testosterone replacement can suppress sperm production. The Endocrine Society recommends against starting it when fertility is planned in the near term. Clinical guideline.
- The EnCyzix application included 4 studies and 588 patients. Testosterone rose, but the studies did not establish symptom improvement or successful pregnancies. EMA assessment.
- South African access to an unregistered medicine requires a Section 21 application from the treating practitioner through the online portal; a product listing does not supply that authorisation. SAHPRA Section 21 information.
EnCyzix was proposed for overweight men with hypogonadotropic hypogonadism and a BMI of at least 25. The European application concerned that particular diagnosis: insufficient hormonal stimulation of the testes. A single low testosterone result does not establish it, and someone planning children also needs to discuss the effect of treatment on sperm production. EMA assessment.
Clomid and enclomiphene appear together in online searches because they are related medicines. That does not make them interchangeable.
Are enclomiphene and Clomid the same medicine?
No: Clomid contains clomifene, a mixture of two isomers, whereas enclomiphene is one of those isomers.
An isomer is a form of a molecule with the same chemical formula but a different arrangement. You may see the spellings clomiphene and enclomifene in international sources. The name on the prescription should still match the active ingredient on the pack.
Both belong to a group called selective oestrogen receptor modulators. In selected men, changing this hormone feedback can encourage the body’s own testosterone production. That is different from supplying testosterone directly.
| Option | What distinguishes it | Important limit |
|---|---|---|
| Clomid / clomifene | Contains enclomiphene and zuclomiphene | Use in men is separate from its established ovulation-induction use |
| Enclomiphene | Contains one isomer | Long-term symptom and safety evidence is limited |
| Testosterone replacement | Supplies testosterone | Can interfere with sperm production |
Does enclomiphene have better evidence for men?
It has evidence for raising testosterone, but that is not the same as proving better wellbeing or a successful pregnancy.
On 25 January 2018, the EMA committee recommended refusing the EnCyzix application. Its assessment covered 4 main studies with 588 patients and included placebo and testosterone-gel comparisons. The studies measured sperm production and testosterone. They did not establish benefits for libido, impotence, bone strength or weight gain, and the committee identified a risk of venous thromboembolism: clots forming in veins. That is a specific European assessment, not a statement about every country’s regulatory decision. EnCyzix assessment.
A higher testosterone result does not answer the symptom questions the EMA raised. Nor does this assessment establish that using a single isomer reliably avoids mood, visual or breast-related adverse effects. A treatment review needs to record what happened to the original symptoms as well as the blood-test result.
What should be checked before choosing treatment?
Confirm the diagnosis and discuss fertility before choosing any hormone treatment.
The Endocrine Society recommends repeating a morning fasting testosterone measurement and investigating the cause of a confirmed deficiency. Luteinising hormone (LH) and follicle-stimulating hormone (FSH) help distinguish a problem in the testes from a problem in the pituitary or hypothalamic signals controlling them. Fatigue and reduced sexual interest can have other explanations, so a result needs to fit the symptoms. Diagnostic recommendations.
Bring previous results, current medicines and a clear account of your symptoms. If conception is a goal, ask whether semen testing or a fertility referral belongs in the plan. Do not assume that maintaining a sperm count in a trial guarantees fertility for an individual couple.
Regulatory note
South Africa, checked 8 September 2026: Off-label prescribing and access to an unregistered product are different questions. SAHPRA’s Section 21 process concerns unregistered medicines and involves an application by a treating practitioner. It is not automatic permission to import anything sold overseas. SAHPRA guidance.
Do and don’t
Do:
- Keep the original symptoms in the follow-up plan, including libido or erectile problems where relevant, alongside the repeat testosterone result.
- Discuss fertility before testosterone treatment; take previous blood tests, medicines and any semen results to the appointment.
Don’t:
- Substitute enclomiphene for Clomid: Clomid contains both enclomiphene and zuclomiphene.
- Copy a bodybuilding hormone regimen or treat a higher testosterone number as proof that fertility has improved.
For related reading, our finasteride comparison and oral minoxidil guide cover separate decisions about hair-loss treatment.
