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Theoretically with appropriate stimulation from the pituitary, the aging testis should be able to produce eugonadal levels of testosterone. The strategies for the treatment of late onset hypogonadism (LOH) have focused on replacement with exogenous testosterone versus restoration of endogenous production. The purpose of this article is to review existing peer-reviewed literature supporting the concept of restoration of endogenous testosterone in the treatment of LOH. Keywords: aromatase inhibitor; clomiphene citrate; enclomiphene; secondary hypogonadism How to cite this URL: Mc Cullough A. Alternatives to testosterone replacement: testosterone restoration. Asian J Androl [serial online] 2015 [cited 2019 Feb 23];1-5. 2015/17/2/201/143736 - DOI: 10.4103/1008-682X.143736 The etiology of late onset hypogonadism (LOH) has been attributed to a decrease in the secretion of hypothalamic and pituitary gonadotropins and a decrease in Leydig cell numbers and responsiveness in the aging male. 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