OBJECTIVE: To review the mechanisms of T replacement therapy's inhibition of spermatogenesis and current therapeutic approaches in reproductive aged men.
DESIGN: Review of published literature.
SETTING: PubMed search from 1990-2012.
PATIENT(S): PubMed search from 1990-2012.
INTERVENTION(S): A literature review was performed.
MAIN OUTCOME MEASURE(S): Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular T levels.
RESULT(S): Exogenous T suppresses intratesticular T production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve hCG therapy or selective estrogen receptor (ER) modulators, but may also include low-dose hCG with exogenous T. Off-label use of selective ER modulators, such as clomiphene citrate (CC), are effective for maintaining T production long term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data.
CONCLUSION(S): Exogenous T supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without T supplementation represents an alternative treatment.
Written by:
Kim ED, Crosnoe L, Bar-Chama N, Khera M, Lipshultz LI. Are you the author?
University of Tennessee Graduate School of Medicine, Knoxville, Tennessee.
Reference: Fertil Steril. 2012 Dec 6. pii: S0015-0282(12)02430-2.
doi: 10.1016/j.fertnstert.2012.10.052
PubMed Abstract
PMID: 23219010
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