Male factors significantly contribute to the issues faced by couples who are experiencing difficulties with conception. Management of the infertile male is complicated and based on a multitude of factors. Each couple is unique and has diverse issues, necessitating unique interventional approaches. Management can range from the optimization of lifestyle factors to treatment with surgery and medications. Several options exist in the medical optimization of the infertile, or subfertile male including treatment with gonadotropins (HCg, FSH), selective estrogen receptor modulators (i.e., clomiphene citrate), aromatase inhibitors (i.e., arimidex, letrozole), and prolactin altering agents (i.e., dostinex, bromocriptine). The use of the agents, both alone and in combination, is detailed in the current chapter.

The epilogue argues that the surprising resistance to “true sex” in both nineteenth-century literature and medicine prefigures the contemporary resistance to medical sex assignment surgery for patients born with intersex traits. In nineteenth-century France, the medical management of “hermaphrodism” did not systematically render it invisible by attempting to shape the body to align with cultural beliefs about binary gender. For starters, most of the technology did not yet exist. In the period before it became available – much of which was later necessary for those trans people who desired to modify their bodies in order to reflect their own gender identities – doctors responses to ambiguous sex and the sex determinations they made varied almost as much as the bodies of the people who came to see them; and, in some ways, technological limitations, a legal blind spot, and the lack of medical consensus on “hermaphrodism” afforded some individuals freedom to live their lives outside of medical control in a way that became virtually impossible in the twentieth century. The intersex rights movement finally brought about the rejection of John Money’s theories, and gave rise to new medical protocols for intersex patients.