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Infertility in Males01:23

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Male infertility affects millions of couples worldwide, arising from various factors that impact different stages of the reproductive process. An endocrine imbalance resulting from conditions like hypogonadism, Klinefelter syndrome, or pituitary disorders can disrupt hormone levels and reduce sperm production. Testicular defects, such as tumors, cryptorchidism, atrophic testes, abnormal sperm morphology, and low sperm count or motility, may arise due to genetic factors, structural...
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The intricate hormonal interplay essential for male reproductive health begins with the release of gonadotropin-releasing hormone (GnRH) by the hypothalamus. This hormone prompts the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). LH targets the Leydig cells in the testes, stimulating them to produce and release testosterone. In concert with testosterone, FSH acts on the Sertoli cells within the seminiferous tubules to facilitate the release of...
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Vasectomy is a surgical form of male sterilization that involves severing and sealing the vasa deferentia, preventing sperm from mixing with semen during ejaculation. Because a vasectomy does not impact the testes' ability to produce testosterone, hormone levels, libido, and sexual function generally remain unchanged. While vasectomy is highly effective in preventing pregnancy, with a success rate near 99.85%, rare cases of recanalization (spontaneous reconnection) can occur. Although...
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Female infertility is defined as the inability to conceive after a year of regular, unprotected intercourse and affects about 10–15% of couples worldwide. The primary cause of female infertility is ovulatory disorders, which hinder the release of eggs. These disorders can be classified as hypothalamic amenorrhea, polycystic ovarian syndrome (PCOS), premature ovarian failure, and hyperprolactinemic anovulation disorders.
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Strategies for Reversing Exogenous Testosterone-Induced Infertility.

Robert Liberto1, Nachum Katlowitz1, Daniel Sagalovich1

  • 1Urology, Northwell Health, Staten Island, USA.

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Summary

Exogenous testosterone use can cause male infertility by disrupting the hypothalamic-pituitary-gonadal (HPG) axis. This review covers management strategies for men seeking fertility after testosterone use.

Keywords:
hpg axishypogonadisminfertilityspermatogenesistestosterone

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Men's Health

Background:

  • Exogenous testosterone use in men of reproductive age can lead to hypothalamic-pituitary-gonadal (HPG) axis suppression.
  • This suppression often results in infertility, a risk frequently underestimated by users.
  • Limited literature addresses the management of infertility in this specific patient population.

Purpose of the Study:

  • To review the impact of exogenous testosterone on the HPG axis and male fertility.
  • To examine pharmacological interventions for managing testosterone-induced infertility.
  • To guide clinicians in approaching and managing these patients, including referral recommendations.

Main Methods:

  • Literature review focusing on exogenous testosterone use, HPG axis function, and male infertility.
  • Analysis of current pharmacological treatments for HPG axis recovery.
  • Synthesis of clinical guidance for patient management and specialist referral.

Main Results:

  • Exogenous testosterone disrupts the HPG axis, causing hypogonadism and infertility.
  • While discontinuation may allow HPG axis recovery, rebound is not guaranteed, and interim low testosterone symptoms can be problematic.
  • Some individuals may desire rapid fertility restoration, necessitating specific management.

Conclusions:

  • Clinicians must be aware of the potential for infertility associated with exogenous testosterone use in men of reproductive age.
  • Management requires a nuanced approach, considering pharmacological options and timely referral to specialists (urology/andrology or endocrinology).
  • Further research is needed to optimize fertility recovery strategies in this growing population.