Normalization of Morning Testosterone Levels in Men With Secondary Hypogonadism (Low Testosterone), That Wish to Maintain Their Reproductive Status

• Change in Follicle Stimulating Hormone and Luteinizing Hormone Levels [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Changes in values from baseline in FSH and LH at months 1.5 and 3, comparing Androxal 12.5 and 25 mg to placebo and Testim
• Measure of Safety Via Physical and Visual Acuity Examination, Slit Lamp Eye Exam, Clinical Laboratory Tests and Adverse Event Reporting [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
• Reproductive Safety [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  Reproductive safety will be assessed by changes in values from baseline of semen volume, and sperm concentration, total count, morphology and motility at month 3 comparing Androxal 12.5 and 25 mg to placebo and Testim

The Purpose of the study is to determine the effects of Androxal on morning testosterone and reproductive status in men with secondary hypogonadism(confirmed morning Testosterone less than 250 ng/dL), compared to changes with placebo, or Testim (topical testosterone). The effects of Testim versus placebo on reproductive status will also be examined. Study subjects must not be currently using a topical testosterone.

This study is a phase IIb, 4 arm study with three month active dosing period. Three of the four treatment groups will be randomized to either Androxal or placebo in a double-blind fashion, and the fourth treatment group will receive open-label Testim. The doses of Androxal in the blinded portion of the study will be 12.5 mg and 25 mg, in capsule form.

• Secondary Hypogonadism
• Preservation of Reproductive Status

• Drug: Placebo
  Placebo capsule 1x daily for 3 months
• Drug: topical testosterone
  testosterone gel applied 1x daily for 3 months
  Other Names:

  • Testim
  • AndroGel
• Drug: enclomiphene citrate
  Capsule of either 12.5 mg or 25 mg, 1x daily for 3 months
  Other Name: Androxal

• Placebo Comparator: Placebo
  Intervention: Drug: Placebo
• Active Comparator: Testim (topical testosterone)
  Intervention: Drug: topical testosterone
• Experimental: Androxal 12.5 mg
  Intervention: Drug: enclomiphene citrate
• Experimental: Androxal 25 mg
  Intervention: Drug: enclomiphene citrate

Inclusion Criteria:

• Healthy males between the ages of 21 and 65 years of age
• All clinical laboratory tests within normal ranges (any clinically significant deviation of laboratory results will require approval of sponsor)
• Previously or concurrently diagnosed as having secondary hypogonadism and confirmed morning testosterone <250ng/dL (two assessments at least 10 days apart)
• Ability to complete the study in compliance with the protocol
• Ability to understand and provide written informed consent
• Agreement to use double barrier contraception if with a fertile female partner
• Agreement to provide a semen sample in the clinic

Exclusion Criteria:

• Use of an injectable, oral, topical, or subcutaneous pelleted testosterone within 6 months prior to study
• Use of spironolactone, cimetidine, Clomid, 5α-reductase inhibitors, hCG, androgen, estrogen, anabolic steroid, DHEA, or herbal hormone products during the study
• Use of Clomid in the past year
• Uncontrolled hypertension or diabetes mellitus based on the Investigator's assessment at baseline. Subjects treated for Type II diabetes but exhibiting glycemic control will be allowed into the study
• A hematocrit >50% or a hemoglobin >17 g/dL
• Clinically significant abnormal findings on screening examination
• Use of an investigational drug or product, or participation in a drug or medical device research study within 30 days prior to receiving study medication
• Known hypersensitivity to Clomid
• Symptomatic cataracts (nuclear sclerosis cataract or cortical cataract grade > 2 based on 0-4 scale or any trace of posterior subcapsular cataract)
• Any condition which in the opinion of the investigator would interfere with the participant's ability to provide informed consent, comply with study instructions, possibly confound interpretation of study results, or endanger the participant if he took part in the study
• Irreversibly infertile or compromised fertility (cryptorchism, Kallman Syndrome, primary hypogonadism, vasectomy, or tumors of the pituitary)
• Current or history of breast cancer
• Current or history of prostate cancer or a suspicion of prostate disease unless ruled out by prostate biopsy, or a PSA>3.6
• Presence or history of hyperprolactinemia with or without a tumor
• Chronic use of medications use such as glucocorticoids
• Subjects with cystic fibrosis (mutation of the CFTR gene)
• Subjects unable to provide a semen sample in the clinic
• Subject has a BMI >36 kg/m2