The treatment of hypogonadism in men of reproductive age

Capsule:
Testosterone therapy has a reversible suppression of spermatogenesis. Selective estrogen receptor modulators represent an alternative therapy for men who desire to maintain future potential fertility. Human chorionic gonadotropin therapy may be considered.

Authors:
Edward D. Kim, M.D., Lindsey Crosnoe, B.S., Natan Bar-Chama, M.D., Mohit Khera, M.D., Larry I. Lipshultz, M.D.

Volume 99, Issue 3, Pages 718-724, 1 March 2013

Abstract:

Objective:
To review the mechanisms of testosterone 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.

Patients:
Pubmed search from 1990-2012.

Interventions:
A literature review was performed.

Main Outcome Measure(s):
Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular testosterone levels.

Results:
Exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve hCG therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. Off-label use of SERMs, such as clomiphene citrate, are effective for maintaining testosterone 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.

Conclusions:
Exogenous testosterone 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 testosterone supplementation represents an alternative treatment.

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