Testosterone use in the male infertility population prescribing patterns and effects on semen and hormonal parameters

Capsule:
In Canada, testosterone is not commonly used by men presenting for fertility investigation (1.3%). Testosterone cessation generally resulted in an increase in sperm counts. A subset of men remained azoospermic.

Authors:
Mary K. Samplaski, M.D., Yasir Loai, B.S., Kimberly Wong, Kirk C. Lo, M.D., Ethan D. Grober, M.D., Keith A. Jarvi, M.D.

Volume 101, Issue 1, Pages 64-69, January 2014

Abstract:

Objective:
To analyze how frequently and why men presenting with infertility take testosterone (T) and if negative effects of T on semen parameters are reversed following cessation.

Design:
Analysis of a prospectively collected database.

Setting:
Male Infertility clinic.

Patient(s):
Men presenting for fertility evaluation from 2008 to 2012.

Intervention(s):
None.

Main Outcome Measure(s):
The frequency and reason for T use in the infertile male population, and semen and hormonal parameters while on T and following discontinuation.

Result(s):
A total of 59/4,400 men (1.3%) reported taking T. T was prescribed by a variety of physicians, including endocrinologists (24%), general practitioners (17%), urologists (15%), gynecologists (5%), and reproductive endocrinologists (3%). Only one of the men admitted that he had obtained T from an illicit source. More than 82% of men were prescribed T for the treatment of hypogonadism, but surprisingly, 12% (7/59) were prescribed T to treat their infertility. While on T, 88.4% of men were azoospermic, but by 6 months after T cessation, 65% of the men without other known causes for azoospermia recovered spermatogenesis.

Conclusion(s):
In Canada, T was not commonly used by men presenting for fertility investigation (1.3%). Close to 2/3 of infertile men using T recovered spermatogenesis within 6 months of T discontinuation.

  • Jason Kovac

    Overall a great study. Given the previously described phenomenon of Anabolic Steroid Induced Hypogonadism, this would be an ideal cohort to follow throughout the years. Especially since it is possible that spermatogenesis will never return in some males. This population would give a good description of men who experience this phenomenon. Furthermore, the finding that only one man in this cohort was using anabolic steroids seems a little low based on previous studies and numbers. Perhaps a sign of population bias?

  • José Martínez-Jabaloyas

    Congratulations to the authors for the article. Spermatogenesis
    inhibition secondary to testosterone treatment is a problem not very frequent
    in the consult but it is increasing because of the use in body builder men. So,
    it is surprising the low frequency reported in this manuscript for this
    finality. In general, men using testosterone for athletic purposes lie and they
    deny that they are taking it until the blood test uncover the reality. In the
    other hand, it is surprising the FSH level during testosterone treatment (2.6 ± 7.11
    IU/L) because, in my experience, FSH is also supressed on testosterone.
    Finally, I agree with the authors that it is necessary to include in the
    endocrine guidelines the effect of testosterone therapy on spermatogenesis.
    Frequently, I see in the consult patients trying to have offspring with
    testosterone treatment prescribed by endocrinologists, sometimes with the
    finality of improving their fertility.

  • Good article highlighting several aspects of testosterone and fertility. First of all, testosterone supplementation does not universally render its users azoospermic. Therefore, it is a poor form of contraception. Second of all, it is reassuring that up to 2/3 of men can regain spermatogenesis by 6 months after cessation if they do not have other known causes for azoospermia. Third, this study also highlights the importance of educating all physicians treating men with infertility given 12% of this patient population was treated with testosterone specifically for infertility.

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