Elevate-T: A Capsule-Based Approach to Testosterone Optimization and Fertility Preservation

By Joey Elkins, PharmD

Need to Knows

• Endogenous Stimulation – Elevate-T leverages enclomiphene with supportive cofactors to stimulate endogenous testosterone production, avoiding the long-term suppression associated with exogenous testosterone replacement therapy (TRT).¹
  
  
• Preserving Spermatogenesis – By maintaining luteinizing hormone (LH) and follicle-stimulating hormone (FSH) signaling, Elevate-T helps sustain intratesticular testosterone and sperm production—addressing one of the most critical drawbacks of traditional TRT.¹
  
  
• Clinical Outcomes Without Injections – Case experience shows serum testosterone levels can nearly triple in six months, delivering impact comparable to TRT without dependency, controlled substance hurdles, or adherence barriers.
  
  

Testosterone Optimization and Fertility Preservation: How Elevate-T Expands Options for Providers

In clinical practice, TRT has long served as the primary option for men with low testosterone. While widely used, it comes with significant limitations: exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis, reduces fertility by lowering intratesticular testosterone, and creates dependency that can make discontinuation difficult.² Many providers and patients are also cautious about controlled substances, injection-based regimens, and long-term adherence challenges.

Elevate-T was developed to address these pain points. Instead of adding testosterone externally, Elevate-T leverages a selective estrogen receptor modulator (SERM)—enclomiphene—along with supportive precursors (DHEA, pregnenolone, and zinc) to stimulate the body’s own endogenous testosterone production. The result is a clinically meaningful increase in testosterone levels without the drawbacks of exogenous replacement.³

In my own case, Elevate-T nearly tripled my serum testosterone over six months—from the mid-300s to just under 1000 ng/dL—without a single injection. This case experience reflects what the mechanism and literature already suggest: endogenous stimulation can be a viable, practical option for men with low testosterone, as well as a valuable adjunct for those already on TRT who wish to preserve fertility.

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How Elevate-T Stimulates Endogenous Testosterone Production

Enclomiphene: The Workhorse

Enclomiphene is the primary active ingredient in Elevate-T. It is one of the isomers of clomiphene citrate, a SERM long used in reproductive medicine.⁵ Unlike clomiphene, which contains both enclomiphene and zuclomiphene, enclomiphene alone offers a cleaner pharmacologic profile with fewer estrogenic side effects.⁶

Mechanistically, enclomiphene acts at the hypothalamic estrogen receptor, blocking estrogen’s negative feedback.⁵ This “tricks” the body into sensing low estrogen levels, prompting the hypothalamus to release gonadotropin-releasing hormone (GnRH). This results in a functional perception of low estrogen, prompting the hypothalamus to release GnRH. In turn, the anterior pituitary secretes LH and FSH.⁷ Elevated LH stimulates Leydig cells to produce testosterone, while FSH supports spermatogenesis.⁸

The outcome is an endogenous testosterone boost, achieved by restoring the body’s own regulatory loop rather than bypassing it.

Supportive Cofactors: DHEA, Pregnenolone, Zinc

• DHEA: Serves as an adrenal androgen precursor, contributing to downstream testosterone production.⁹
  
  
• Pregnenolone: A steroidal precursor that supports the synthesis of multiple hormones, including testosterone and cortisol¹⁰, while also being studied for neurocognitive benefits.¹¹
  
  
• Zinc: An essential mineral cofactor in testosterone biosynthesis and sperm production; deficiencies are associated with hypogonadism.¹²
  
  

Together, these cofactors (DHEA, pregnenolone, and zinc) provide precursors essential for enclomiphene to drive a sustained increase in testosterone synthesis.

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Key Patient Populations Who May Benefit from Elevate-T

1. Younger Men with Low Testosterone Who Are Not Ready for TRT

For younger patients, committing to TRT often raises concerns about long-term dependency and fertility. Elevate-T provides a compelling alternative: meaningful increases in testosterone via endogenous stimulation, while preserving gonadal function. For many men in their 20s and 30s with borderline or symptomatic low T, this represents an entry point to T support without committing patients to lifelong TRT.

2. Men on TRT Who Want to Maintain Fertility

Exogenous testosterone predictably suppresses the HPG axis. Spermatogenesis declines as intratesticular testosterone falls, and many patients face infertility within months of starting TRT.¹³ The enclomiphene in Elevate-T addresses this by keeping LH and FSH “lights on,” sustaining sperm production even in the presence of exogenous testosterone.¹⁴

For couples concerned with family planning, this is a critical differentiator. Providers can present Elevate-T as a fertility-preserving adjunct to TRT—a way to maintain in-range testosterone levels while supporting reproductive health.

Suggested Dosing and Administration

Elevate-T is prescribed as a capsule taken five days per week, typically in the evening. Key considerations include:

• Flexibility: The five days do not need to be consecutive. Some providers instruct patients to take it every other day, enhancing adherence.
  
  
• Breaks: Two off-days each week allow the body to reset and minimize unwanted effects. After 3–4 months, a longer break (two weeks to one month) is recommended to manage estrogen buildup.
  
  
• Adjuncts: In cases of unwanted estrogen-related effects (water retention, mood changes, gynecomastia), pairing with an aromatase inhibitor can be considered.
  
  

This simplicity—no injections, no mixing, no complex schedules—supports adherence and broadens provider comfort in prescribing.

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Clinical Considerations and Potential Side Effects

Elevate-T is generally well tolerated. Reported unwanted effects are minimal, with the most notable being estrogen elevation due to increased testosterone aromatization⁵. This can manifest as:

• Water retention
  
  
• Mood swings
  
  
• Gynecomastia
  
  

Other potential side effects mirror those of testosterone, such as acne or hair thinning, though the endogenous regulation provided by enclomiphene may mitigate severity.

Unlike exogenous testosterone, Elevate-T does not fully suppress natural production. This reduces dependency risk and allows patients to discontinue use more easily if desired.

How Elevate-T Compares to Other Testosterone Support Options

Clomiphene Citrate

Clomiphene (Clomid) has been used for decades to induce ovulation in women and to boost testosterone in men. However, enclomiphene’s cleaner isomer profile reduces the unwanted estrogenic effects associated with zuclomiphene.¹⁵

Human Chorionic Gonadotropin (HCG)

HCG is a bioidentical analog of LH, directly stimulating testosterone production.¹⁶ It’s widely used but costly (often >$200 per vial) and requires injection. Elevate-T offers an oral alternative.

Gonadorelin

Another option for stimulating gonadotropins, gonadorelin requires frequent injections and is less practical for long-term use.¹⁷

Elevate-T consolidates the positive aspects of these alternatives into a convenient, oral capsule with broad provider and patient appeal.

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Advantages for Clinical Practice

For providers, Elevate-T offers several key advantages:

• Non-Controlled Status: Unlike testosterone, Elevate-T is not a DEA-scheduled controlled substance.
  
  
• Fertility Preservation: Sustains LH and FSH, mitigating one of TRT’s greatest drawbacks.
  
  
• Convenience: Capsule format improves adherence and expands patient acceptance.
  
  
• Tolerability Profile: Well-tolerated in practice; minimal unwanted effects..
  
  
• Versatility: Useful both on its own and as an adjunct in combination with another medication.
  
  

Elevate-T enables providers to expand their care plan toolkit, offering patients a fertility-conscious alternative to traditional testosterone replacement.

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Clinical Summary: Elevate-T as a Non-TRT Testosterone Option

Testosterone support is evolving. While exogenous TRT remains a cornerstone, its drawbacks—fertility suppression, dependency, controlled status—create significant challenges for patients and providers alike. Elevate-T offers a capsule-based alternative that harnesses the body’s own capacity to produce testosterone, while also serving as a valuable adjunct for men on TRT who wish to preserve fertility.

By combining the powerful potential  of enclomiphene with supportive cofactors, Elevate-T provides a practical and patient-friendly approach to testosterone optimization. Providers ready to flip the script on hypogonadism management will find Elevate-T to be a powerful addition to their practice.

Strive for more than replacement—strive for restoration.

Ready to Learn More?

Watch this Strive Sessions webinar to review the science, prescribing considerations, and fertility-preserving role of Elevate-T in testosterone optimization.

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Quick FAQ on Elevate-T

What can Elevate-T be used for?

Elevate-T is intended for men with low testosterone who wish to raise serum levels while maintaining fertility. It stimulates the HPG axis rather than bypassing it with exogenous replacement.

What are the potential advantages of Elevate-T?

Elevate-T offers a capsule-based approach that avoids complete suppression of spermatogenesis, making it a consideration for younger men or those planning for fertility.

Can Elevate-T be taken with TRT?

Yes. When used in conjunction with TRT, enclomiphene may help sustain intratesticular testosterone and sperm production, though response is patient-dependent.¹⁸

What ingredients are in Elevate-T?

Elevate-T contains enclomiphene (a selective estrogen receptor modulator), DHEA, pregnenolone, and zinc—ingredients that support natural testosterone production.

What are the potential side effects of Elevate-T?

Potential side effects associated with increased estrogen levels include water retention, mood changes, and gynecomastia. Some men may also experience acne or hair thinning, though generally expected to be less than with TRT.

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References

1. Kaminetsky J, Werner M, Fontenot G, Wiehle RD. Oral enclomiphene citrate stimulates the endogenous production of testosterone and sperm counts in men with low testosterone: comparison with testosterone gel. J Sex Med. 2013;10(6):1628-1635. doi:10.1111/jsm.12116
2. Liberto R, Katlowitz N, Sagalovich D, Davila J. Strategies for reversing exogenous testosterone–induced infertility. Cureus. 2025;17(9):e91975. doi:10.7759/cureus.91975. PMCID: PMC12513088.
3. Khodamoradi K, Khosravizadeh Z, Parmar M, Kuchakulla M, Ramasamy R, Arora H. Exogenous testosterone replacement therapy versus raising endogenous testosterone levels: current and future prospects. F S Rev. 2021;2(1):32-42. doi:10.1016/j.xfnr.2020.11.001
4. Hill S, Arutchelvam V, Quinton R. Enclomiphene, an estrogen receptor antagonist for the treatment of testosterone deficiency in men. IDrugs. 2009;12(2):109-119.
5. Rodriguez KM, Pastuszak AW, Lipshultz LI. Enclomiphene citrate for the treatment of secondary male hypogonadism. Expert Opin Pharmacother. 2016;17(11):1561-1567. doi:10.1080/14656566.2016.1204294
6. Saffati G, Kassab J, Orozco Rendon D, Hinojosa-Gonzalez DE, Kronstedt S, Lipshultz LI, Khera M. Safety and efficacy of enclomiphene and clomiphene for hypogonadal men. Transl Androl Urol. 2024;13(9):1984-1990. doi:10.21037/tau-24-238
7. Wiehle R, Cunningham GR, Pitteloud N, et al. Testosterone restoration by enclomiphene citrate in men with secondary hypogonadism: pharmacodynamics and pharmacokinetics. BJU Int. 2013;112(8):1188-1200. doi:10.1111/bju.12363
8. Lei T, Yang Y, Yang WX. Luteinizing hormone regulates testosterone production, Leydig cell proliferation, differentiation, and circadian rhythm during spermatogenesis. Int J Mol Sci. 2025;26(8):3548. doi:10.3390/ijms26083548
9. Buendía-González FO, Legorreta-Herrera M. The similarities and differences between the effects of testosterone and DHEA on the innate and adaptive immune response. Biomolecules. 2022;12(12):1768. doi:10.3390/biom12121768
10. Chakraborty S, Pramanik J, Mahata B. Revisiting steroidogenesis and its role in immune regulation with the advanced tools and technologies. Genes Immun. 2021;22:125-140. doi:10.1038/s41435-021-00139-3
11. Lin YC, Cheung G, Espinoza N, Papadopoulos V. Function, regulation, and pharmacological effects of pregnenolone in the central nervous system. Curr Opin Endocr Metab Res. 2022;22:100310. doi:10.1016/j.coemr.2021.100310
12. Prasad AS, Mantzoros CS, Beck FW, Hess JW, Brewer GJ. Zinc status and serum testosterone levels of healthy adults. Nutrition. 1996;12(5):344-348. doi:10.1016/s0899-9007(96)80058-x
13. Coviello AD, Bremner WJ, Matsumoto AM, et al. Intratesticular testosterone concentrations comparable with serum levels are not sufficient to maintain normal sperm production in men receiving a hormonal contraceptive regimen. J Androl. 2004;25(6):931-938. doi:10.1002/j.1939-4640.2004.tb03164.x
14. Earl JA, Kim ED. Enclomiphene citrate: a treatment that maintains fertility in men with secondary hypogonadism. Expert Rev Endocrinol Metab. 2019;14(3):157-165. doi:10.1080/17446651.2019.1612239
15. Huang ES, Miller WL. Estrogenic and antiestrogenic effects of enclomiphene and zuclomiphene on gonadotropin secretion by ovine pituitary cells in culture. Endocrinology. 1983;112(2):442-448. doi:10.1210/endo-112-2-442
16. Choi J, Smitz J. Luteinizing hormone and human chorionic gonadotropin: distinguishing unique physiologic roles. Gynecol Endocrinol. 2014;30(3):174-181. doi:10.3109/09513590.2013.859670
17. Schoemaker J. The role of the GnRH dose and the route of administration on treatment outcome and complications. Eur J Obstet Gynecol Reprod Biol. 1996;65(suppl):S13-S16. doi:10.1016/0301-2115(96)02412-8
18. Kim ED, McCullough A, Kaminetsky J. Oral enclomiphene citrate raises testosterone and preserves sperm counts in obese hypogonadal men, unlike topical testosterone: restoration instead of replacement. BJU Int. 2016;117(4):677-685. doi:10.1111/bju.13337

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_{The information provided in this article is for informational and educational purposes only. Refer to the cited references for more information regarding the content presented. The creators of this content disclaim any liability for decisions made based on the information presented. The information provided relates to patient-specific compounding. Compounded medications are specially prepared for individual patient needs and, as such, have not been reviewed or approved by the U.S. Food and Drug Administration (FDA). Prescribers should use their independent clinical judgment when determining appropriateness for individual patients.}

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