Strategies for Reversing Exogenous Testosterone-Induced Infertility

Exogenous testosterone use in men of peak fertility age is a particular concern, as it can lead to disruption of the hypothalamic-pituitary-gonadal (HPG) axis, resulting in infertility. Unfortunately, this population is often unaware of the adverse events, specifically infertility, that can arise from exogenous testosterone use. Discontinuation of exogenous testosterone may result in recovery in the HPG axis with time; however, not all patients will rebound or tolerate symptoms of low testosterone in the interim. Additionally, some of these patients may have an immediate interest in conception. To date, there is a paucity of literature dealing with this growing population. This article aims to review infertility and HPG axis disruption resulting from exogenous testosterone use, examine pharmacological management, guide clinicians on how to approach these patients, and provide recommendations on when to refer to urology/andrology or endocrinology.