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The treatment of hypogonadism in men of reproductive age
Edward D Kim1, Lindsey Crosnoe, Natan Bar-Chama
1University of Tennessee Graduate School of Medicine, Knoxville, Tennessee 37920, USA. ekim@utmck.edu
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.
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