Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T17:01:22.008Z Has data issue: false hasContentIssue false

Chapter 34 - Male Fertility and Testosterone Therapy

from Section 5 - Medical and Surgical Management of Issues of Male Health

Published online by Cambridge University Press:  06 December 2023

By
Juan Andino  and
James M. Dupree
Edited by
Douglas T. Carrell ,
Alexander W. Pastuszak  and
James M. Hotaling
Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
Get access

Summary

Exogenous testosterone functions as a male contraceptive. As a result, men treated with testosterone who desire fertility will need help when trying to restore or preserve fertility. In this chapter, we provide a framework for counseling and managing hypogonadal men who desire fertility. We explore strategies ranging from cessation of exogenous testosterone to using human chorionic gonadotropin, selective estrogen receptor modulators, aromatase inhibitors, or recombinant follicle-stimulating hormone with or without testosterone to preserve Sertoli and Leydig cell function. Furthermore, we provide strategies to maintain fertility while starting testosterone and clinical pathways for a hypogonadal man to recover fertility based on his desired timeline for a pregnancy.

Keywords

reproductionmale infertilitytestosterone therapyhypogonadism
Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
 , pp. 269 - 278
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mulhall, JP, Trost, LW, Brannigan, RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432. doi:10.1016/j.juro.2018.03.115Google Scholar
Harman, SM, Metter, EJ, Tobin, JD, Pearson, J, Blackman, MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86(2):724–731. doi:10.1210/jcem.86.2.7219Google Scholar
Howden, LM, Meyer, JA. 2010 Census Brief: Age and Sex Composition. 2011. www.census.gov/population. Accessed March 16, 2020.Google Scholar
US Census. Population QuickFacts. 2019. www.census.gov/quickfacts/fact/table/US/LFE046218. Published 2020. Accessed July 19, 2020.Google Scholar
Cohen, J, Nassau, DE, Patel, P, Ramasamy, R. Low testosterone in adolescents & young adults. Front Endocrinol (Lausanne). 2020;10. doi:10.3389/fendo.2019.00916Google Scholar
Martin, JA, Brady, MPH, Hamilton, E, Osterman, MJK, Driscoll, AK, Mathews, TJ. Births final data for 2015. Natl Vital Stat Rep. 2017;66(1):1. www.cdc.gov/nchs/data_access/Vitalstatsonline.htm. Accessed March 16, 2020.Google Scholar
Basaria, S. Male hypogonadism. Lancet. 2014;383(9924):1250–1263. doi:10.1016/S0140-6736(13)61126-5Google Scholar
Roth, MY, Page, ST, Lin, K, et al. Dose-dependent increase in intratesticular testosterone by very low-dose human chorionic gonadotropin in normal men with experimental gonadotropin deficiency. J Clin Endocrinol Metab. 2010;95(8):3806–3813. doi:10.1210/jc.2010-0360Google Scholar
Walker, WH. Non-classical actions of testosterone and spermatogenesis. Philos Trans R Soc Lond B Biol Sci. 2010;365(1546):1557–1569. doi:10.1098/rstb.2009.0258Google Scholar
Patel, AS, Leong, JY, Ramos, L, Ramasamy, R. Testosterone is a contraceptive and should not be used in men who desire fertility. World J Mens Health. 2019;37(1):45–54. doi:10.5534/wjmh.180036Google Scholar
World Health Organisation Task Force on Methods for the Regulation of Male Fertility. Contraceptive efficacy of testosterone-induced azoospermia in normal men. Lancet. 1990;336(8721):955–959. doi:10.1016/0140-6736(90)92416-FGoogle Scholar
Baillargeon, J, Kuo, Y-F, Westra, JR, Urban, RJ, Goodwin, JS. Testosterone prescribing in the United States, 2002–2016. JAMA. 2018;320(2):200–202. doi:10.1001/jama.2018.7999Google Scholar
Baillargeon, J, Urban, RJ, Ottenbacher, KJ, Pierson, KS, Goodwin, JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173(15):1465–1466. doi:10.1001/jamainternmed.2013.6895Google Scholar
Kansal, JK, Dietrich, PN, Doolittle, J, et al. MP45–17: online marketing practices and characteristics of stand-alone men’s health clinics. J Urol. 2020;203(4):e671. doi:10.1097/JU.0000000000000900.017Google Scholar
Dotson, JL, Brown, RT. The history of the development of anabolic-androgenic steroids. Pediatr Clin North Am. 2007;54(4):761–769. doi:10.1016/j.pcl.2007.04.003Google Scholar
Tatem, AJ, Beilan, J, Kovac, JR, Lipshultz, LI. Management of anabolic steroid-induced infertility: novel strategies for fertility maintenance and recovery. World J Mens Health. 2020;38(2):141–150. doi:10.5534/wjmh.190002Google Scholar
Silver, MD. Use of ergogenic aids by athletes. J Am Acad Orthop Surg. 2001;9(1):61–70. doi:10.5435/00124635-200101000-00007Google Scholar
Kanayama, G, Pope, HG. History and epidemiology of anabolic androgens in athletes and non-athletes. Mol Cell Endocrinol. 2018;464:4–13. doi:10.1016/j.mce.2017.02.039Google Scholar
Coward, RM, Rajanahally, S, Kovac, JR, Smith, RP, Pastuszak, AW, Lipshultz, LI. Anabolic steroid induced hypogonadism in young men. J Urol. 2013;190(6):2200–2205. doi:10.1016/j.juro.2013.06.010Google Scholar
Ly, LP, Liu, PY, Handelsman, DJ. Rates of suppression and recovery of human sperm output in testosterone-based hormonal contraceptive regimens. Hum Reprod. 2005;20(6):1733–1740. doi:10.1093/humrep/deh834Google Scholar
Kohn, TP, Louis, MR, Pickett, SM, et al. Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy. Fertil Steril. 2017;107(2):351–357.e1. doi:10.1016/j.fertnstert.2016.10.004Google Scholar
Rahnema, CD, Lipshultz, LI, Crosnoe, LE, Kovac, JR, Kim, ED. Anabolic steroid-induced hypogonadism: diagnosis and treatment. Fertil Steril. 2014;101:1271–1279. doi:10.1016/j.fertnstert.2014.02.002Google Scholar
Wenker, EP, Dupree, JM, Langille, GM, et al. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12(6):1334–1337. doi:10.1111/jsm.12890Google Scholar
Chambers, T, Anderson, R. The impact of obesity on male fertility. Hormones. 2015;14(4):563–568. doi:10.14310/horm.2002.1621Google Scholar
Grossmann, M. Hypogonadism and male obesity: focus on unresolved questions. Clin Endocrinol (Oxf). 2018;89(1):11–21. doi:10.1111/cen.13723Google Scholar
Ng Tang Fui, M, Prendergast, LA, Dupuis, P, et al. Effects of testosterone treatment on body fat and lean mass in obese men on a hypocaloric diet: a randomised controlled trial. BMC Med. 2016;14(1):153. doi:10.1186/s12916-016-0700-9Google Scholar
Rigon, FA, Ronsoni, MF, Hohl, A, van de Sande-Lee, S. Effects of bariatric surgery in male obesity-associated hypogonadism. Obes Surg. 2019;29(7):2115–2125. doi:10.1007/s11695-019-03829-0Google Scholar
Krzastek, SC, Smith, RP. Non-testosterone management of male hypogonadism: an examination of the existing literature. Transl Androl Urol. 2020;9(S2):S160–S170. doi:10.21037/tau.2019.11.16Google Scholar
Wheeler, KM, Sharma, D, Kavoussi, PK, Smith, RP, Costabile, R. Clomiphene citrate for the treatment of hypogonadism. Sex Med Rev. 2019;7(2):272–276. doi:10.1016/j.sxmr.2018.10.001Google Scholar
Whitten, SJ, Nangia, AK, Kolettis, PN. Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. Fertil Steril. 2006;86(6):1664–1668. doi:10.1016/j.fertnstert.2006.05.042Google Scholar
Pasqualotto, FF, Fonseca, GP, Pasqualotto, EB. Azoospermia after treatment with clomiphene citrate in patients with oligospermia. Fertil Steril. 2008;90(5):2014.e11–2014.e12. doi:10.1016/j.fertnstert.2008.03.036Google Scholar
Pavlovich, CP, King, P, Goldstein, M, Schlegel, PN. Evidence of a treatable endocrinopathy in infertile men. J Urol. 2001;165(3):837–841. www.ncbi.nlm.nih.gov/pubmed/11176482.Google Scholar
Raman, JD, Schlegel, PN. Aromatase inhibitors for male infertility. J Urol. 2002;98(6):624–629. doi:10.1097/00005392-200202000-00038Google Scholar
Coviello, AD, Matsumoto, AM, Bremner, WJ, et al. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab. 2005;90(5):2595–2602. doi:10.1210/jc.2004-0802Google Scholar
Turek, PJ, Williams, RH, Gilbaugh, JHI, Lipshultz, LI. The reversibility of anabolic steroid-induced azoospermia. J Urol. 1995;153(5):1628–1630. doi:10.1016/S0022-5347(01)67482-2Google Scholar
McBride, JA, Coward, R. Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian J Androl. 2016;18(3):373–380. doi:10.4103/1008-682X.173938Google Scholar
Buchter, D, Behre, H, Kliesch, S, Nieschlag, E. Pulsatile GnRH or human chorionic gonadotropin/human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases. Eur J Endocrinol. 1998;139(3):298–303. doi:10.1530/eje.0.1390298Google Scholar
Burgues, S, Calderon, MD. Subcutaneous self-administration of highly purified follicle stimulating hormone and human chorionic gonadotrophin for the treatment of male hypogonadotrophic hypogonadism. Spanish Collaborative Group on Male Hypogonadotropic Hypogonadism. Hum Reprod. 1997;12(5):980–986. doi:10.1093/humrep/12.5.980Google Scholar
Bhasin, S, Brito, JP, Cunningham, GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. doi:10.1210/jc.2018-00229Google Scholar
Hsieh, T-C, Pastuszak, AW, Hwang, K, Lipshultz, LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013;189:647–650. doi:10.1016/j.juro.2012.09.043Google Scholar
Lee, JA, Ramasamy, R. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Transl Androl Urol. 2018;7(Suppl. 3):S348–S352. doi:10.21037/tau.2018.04.11Google Scholar
Ramasamy, R, Armstrong, J, Lipshultz, L. Preserving fertility in the hypogonadal patient: an update. Asian J Androl. 2015;17(2):197–200. doi:10.4103/1008-682X.142772Google Scholar
Liu, PY, Turner, L, Rushford, D, et al. Efficacy and safety of recombinant human follicle stimulating hormone (Gonal-F) with urinary human chorionic gonadotrophin for induction of spermatogenesis and fertility in gonadotrophin-deficient men. Hum Reprod. 1999;14(6):1540–1545. doi:10.1093/humrep/14.6.1540.Google Scholar
Ishikawa, T, Ooba, T, Kondo, Y, Yamaguchi, K, Fujisawa, M. Assessment of gonadotropin therapy in male hypogonadotropic hypogonadism. Fertil Steril. 2007;88(6):1697–1699. doi:10.1016/j.fertnstert.2006.11.022Google Scholar
Patel, A, Patel, P, Bitran, J, Ramasamy, R. Can serum 17-hydroxyprogesterone and insulin-like factor 3 be used as a marker for evaluation of intratesticular testosterone? Transl Androl Urol. 2019;8(S1):S58–S63. doi:10.21037/tau.2019.01.16Google Scholar
Amory, JK, Coviello, AD, Page, ST, Anawalt, BD, Matsumoto, AM, Bremner, WJ. Serum 17-hydroxyprogesterone strongly correlates with intratesticular testosterone in gonadotropin-suppressed normal men receiving various dosages of human chorionic gonadotropin. Fertil Steril. 2008;89(2):380–386. doi:10.1016/j.fertnstert.2007.02.059Google Scholar
Ramasamy, R, Masterson, TA, Best, JC, et al. Effect of Natesto on reproductive hormones, semen parameters and hypogonadal symptoms: a single center, open label, single arm trial. J Urol. 2020;204(3):557–563. doi:10.1097/JU.0000000000001078Google Scholar
Arora, H, Zuttion, MSSR, Nahar, B, Lamb, D, Hare, JM, Ramasamy, R. Subcutaneous Leydig stem cell autograft: a promising strategy to increase serum testosterone. Stem Cells Transl Med. 2019;8(1):58–65. doi:10.1002/sctm.18-0069Google Scholar
Fayomi, AP, Peters, K, Sukhwani, M, et al. Autologous grafting of cryopreserved prepubertal rhesus testis produces sperm and offspring. Science. 2019;363(6433):1314–1319. doi:10.1126/science.aav2914Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×