TRT supplies testosterone directly and reliably raises levels, but it can suppress your own production and sperm count. Enclomiphene is a pill that signals your body to make more of its own testosterone, which studies suggest preserves sperm production, but the effect is usually milder and it isn't FDA-approved in the US. Online, both start at about $99.99 a month at Maximus.
Two very different mechanisms
TRT (testosterone replacement therapy) gives your body testosterone directly: injections, creams, gels or oral capsules. Your levels go up because you’re adding the hormone.
Enclomiphene works upstream. It’s a pill that blocks estrogen’s “we have enough” signal in the brain, so the brain asks the testes to make more testosterone. Your levels go up because your body is producing more.
Fertility: the deciding factor for many men
This is where they split most clearly:
- TRT can suppress sperm production. When testosterone arrives from outside, the brain turns down the signals that drive both testosterone and sperm production in the testes. The Endocrine Society’s guideline advises against testosterone therapy for men who want to father a child soon.
- Enclomiphene is studied as a way around that. Research comparing it with topical testosterone (Kim et al., 2016) found enclomiphene raised testosterone while sperm counts stayed in the normal range, whereas sperm counts fell with the testosterone gel.
If having kids in the next few years is even a maybe, raise it in the very first conversation with any clinic. It changes which options make sense.
Strength of effect and FDA status
TRT usually produces a larger, more predictable rise in testosterone. Enclomiphene’s effect depends on your body still being able to respond, so it tends to suit men whose testes work but aren’t being signaled strongly enough.
On regulation: TRT products are FDA-approved; enclomiphene is not, and when prescribed it typically comes from a compounding pharmacy.
What it costs online
At Maximus, enclomiphene, injectable testosterone and testosterone cream all start at $99.99 a month; oral testosterone starts at $149.99; combinations of cream or oral testosterone with enclomiphene run $149.99–$199.99.
Safety notes
Either route needs proper lab work before and during treatment. On heart safety, the large TRAVERSE trial (2023) found testosterone therapy did not increase major cardiac events compared with placebo in men with low testosterone and heart risk, though it did see more atrial fibrillation and some other events. That’s a conversation to have with your clinician, not a reason to skip the labs.
Services mentioned in this guide
Maximus
Testosterone telehealth with at-home labs. Leads with enclomiphene and "fertility-friendly" combinations alongside classic TRT.
- Enclomiphene from $99.99/mo Compounded
- Injectable testosterone from $99.99/mo Prescription
- Testosterone cream from $99.99/mo Prescription
Frequently asked questions
Is enclomiphene better than TRT?
Not across the board. Enclomiphene is designed to raise testosterone while preserving your own production and fertility; TRT replaces testosterone directly and usually has a stronger, more predictable effect but can suppress sperm production. Which fits depends on your levels, symptoms and whether fertility matters to you — a clinician with your labs should make that call.
Does TRT make you infertile?
TRT can lower sperm production because supplying testosterone from outside tells the body to make less of its own. The Endocrine Society guideline advises against testosterone therapy in men planning fertility in the near term. Effects are often reversible after stopping, but not guaranteed.
Is enclomiphene FDA-approved?
No. Enclomiphene is not an FDA-approved medication in the US. When prescribed, it is generally supplied by compounding pharmacies.
How much does enclomiphene cost online?
Maximus lists enclomiphene from $99.99 a month, the same starting price as its injectable testosterone and testosterone cream.
Sources
- Endocrine Society — Testosterone Therapy in Men With Hypogonadism (2018 guideline)
- PubMed — enclomiphene vs topical testosterone and sperm counts (Kim et al., BJU International, 2016)
- NEJM — TRAVERSE trial: Cardiovascular Safety of Testosterone-Replacement Therapy (2023)
- Maximus — Testosterone (prices)