Fertil. Steril 2014 Jan 01;101(1)64-69, MK Samplaski, Y Loai, K Wong, KC Lo, ED Grober, KA Jarvi
Research · February 03, 2014
TAKE-HOME MESSAGE
- Testosterone therapy generally leads reduced sperm production, although sperm counts will usually rebound within 6 to 12 months of discontinuation. Analysis of data of men evaluated at a male infertility clinic over a 4-year period determined that 1.3% (59/4400) were taking testosterone, approximately 80% for hypogonadism. Over 88% of the men were azoospermic while taking testosterone; two-thirds recovered spermatogenesis within 6 months of testosterone discontinuation.
- Men taking testosterone should be informed that their fertility will be negatively affected during the course of therapy and for several months after stopping treatment.
Commentary By
The authors have provided an overview of testosterone use in men with infertility. Fertility and potency issues are commonly confused by non-urologists. Practitioners are typically aware of the dramatic increase in testosterone use by men, and a greater understanding of the relationship between testosterone use and suppression of spermatogenesis raises concerns about androgen treatment causing male infertility.
Samplaski et al have quantified the prescribing patterns for testosterone, and the potential adverse effects on male fertility using population-based data obtained from Canada. Of men presenting for infertility, 1.3% were taking testosterone. Most (88%) of these men were azoospermic, and, although many recovered sperm production within 6 months of stopping testosterone, about one-third remained azoospermic.
Knowledge of the fertility suppression effects of testosterone are critical in management of men with low testosterone and infertility/impaired spermatogenesis. Men with infertility and low testosterone may be treated with estrogen receptor antagonists such as clomiphene or tamoxifen as well as the aromatase inhibitor anastrozole to enhance endogenous testosterone production.
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.