Medications we prescribe

Testosterone replacement therapy (TRT), whether by injection, cream, or oral tablet, replaces the hormone directly. Enclomiphene works upstream. It blocks estrogen receptors in the hypothalamus and pituitary, which removes the brake estrogen puts on the system: the hypothalamus releases more GnRH, the pituitary releases more LH and FSH, and those two hormones tell your testes to make your own testosterone and produce sperm.

TRT is the right tool for primary hypogonadism, actual testicular failure, where LH and FSH are elevated because the testes are not responding to the signal. Most men with low testosterone do not have that problem. Their testes still work, and the pituitary signal is suppressed by extra body weight, poor sleep, chronic stress, sleep apnea, type 2 diabetes, or certain medications. This pattern is called secondary or functional hypogonadism, and about 86% of men with low testosterone have it (European Male Ageing Study, Tajar et al., Journal of Clinical Endocrinology & Metabolism, 2010).

For these men, exogenous testosterone shuts down the pituitary signal entirely. Over months on TRT the testes atrophy, sperm production is suppressed, and fertility is compromised, sometimes for good. Coming off TRT is much harder than starting it. Veedma's workup separates the primary from the secondary pattern from your labs and history before any treatment starts.

Clomiphene (Clomid) is a fertility drug developed for women. It triggers ovulation with a 5-day course once per cycle, and it works well for that. It is a mix of two molecules: about 62% enclomiphene and 38% zuclomiphene (FDA prescribing information).

Enclomiphene is the half that is useful for men. It blocks estrogen receptors in the brain, so the pituitary releases more LH and FSH and your testes make more of your own testosterone. Zuclomiphene is the problem half for men. It acts like a weak estrogen, works against the effect you want, and clears very slowly: detectable levels last more than a month, while enclomiphene is gone in about 10 hours. On a 5-day course that does not matter. A man with low testosterone takes the drug every day for months, so zuclomiphene builds up. The side effects men report on long-term Clomid, mood swings, hot flashes, breast tenderness, and visual disturbances, are thought to come from that estrogen-like build-up. Clomid is a poor fit for daily, long-term use in men.

Enclomiphene was isolated from that mix and developed as a standalone drug specifically for men with secondary hypogonadism. In trials it raised testosterone into the normal range while keeping sperm counts normal (Wiehle et al., Fertility and Sterility, 2014; Kaminetsky et al., BJU International, 2016), and a 2025 meta-analysis of 10 randomized trials found SERM therapy raised total testosterone by 274 ng/dL over placebo while preserving sperm production (Hohl et al., Archives of Endocrinology and Metabolism, 2025).

Enclomiphene is available only from compounding pharmacies, so no insurance covers it and most primary care doctors never prescribe it. Veedma prescribes it as the first-line testosterone treatment, works with compounding pharmacies that make it, and monitors every man on it with follow-up labs after the first month and every 6 months.

The Enclomiphene + Tadalafil combination tablet is a single daily oral medication compounded by our NABP-accredited partner pharmacy. It combines two evidence-supported components:

• Enclomiphene. Blocks estrogen receptors in the hypothalamus and pituitary, so the pituitary releases more LH and FSH, stimulating your body's own testosterone production and supporting sperm production. Not an FDA-approved drug; supported by the American Urological Association (AUA) as SERM therapy for men with secondary or functional hypogonadism.
• Tadalafil 5 mg. A PDE5 inhibitor that improves blood flow for erections. FDA-approved for daily use to treat erectile dysfunction and the urinary symptoms of benign prostatic hyperplasia (BPH).

The combination tablet is prescribed when low testosterone comes with erection difficulties or urinary symptoms. One tablet, once a day, no separate prescriptions to manage.

Then the report says so, and it says what is. The same symptoms often come from a thyroid problem, insulin resistance, iron deficiency, low vitamin D, or sleep apnea, and the two lab panels are built to find them: the Optimal panel covers the hormone axis and safety markers, and the Biohacking panel adds thyroid, insulin resistance, inflammation, nutrients, and heavy metals.

When we find one of these, we can treat it as an add-on to your plan: thyroid medication, metformin for insulin resistance, iron or vitamin D repletion, or a referral for sleep apnea testing. Where testosterone is normal and erections or urinary symptoms are the problem, daily Tadalafil on its own is an option your doctor can discuss.

Our medical team treats testosterone deficiency when free testosterone is below 100 pg/mL, measured by LC-MS/MS or calculated from SHBG and albumin, and you have persistent symptoms. Both are required; a number alone is never a diagnosis. LH and FSH show whether the pituitary signal is low (secondary or functional hypogonadism, which Enclomiphene can address) or the testes themselves are failing (primary hypogonadism, where replacement therapy is the right tool).

Safety markers can rule treatment out: hematocrit, PSA for men 40 and older, and prolactin when it was measured. In that case the report explains the finding and who should evaluate it.

If your free testosterone is 100 pg/mL or above, raising it further rarely helps, and our medical team says so. Either way, you get the report and a recommendation.

Membership is $79 a month on an annual plan, $129 a month on a quarterly plan, or $159 a month with no commitment. The price is flat for any dose, and it starts only when a doctor prescribes treatment.

Every plan includes:

• Daily medication. Enclomiphene, or the Enclomiphene + Tadalafil combination tablet, at whatever dose your doctor sets.
• Additional medication when your labs call for it. Anastrozole for high estradiol, for example, is included; there is no separate charge.
• Doctor reviews. Your doctor reads every follow-up panel, adjusts the dose, and reissues your prescription; no separate visit fees.
• Lab interpretation. A written report from our medical team after each follow-up panel, on what changed and what it means.
• Unlimited messaging with your care team.
• Delivery from our NABP-accredited partner pharmacy.

Lab work is separate: your initial Optimal panel is $59, and follow-up panels are billed at lab cost or replaced by results you upload. There is no hidden cost. Membership and labs are both FSA/HSA eligible.

Veedma is a direct-pay clinic and does not bill insurance. Enclomiphene is generally not covered by insurance for hypogonadism because it is not an FDA-approved drug, and a flat membership is often less than the copays for separate doctor visits, labs, and medication combined.

Both the membership and the lab panels are FSA/HSA eligible: they qualify as medical expenses, so you can pay with pre-tax dollars from a Flexible Spending Account or Health Savings Account.