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INVITED COMMENTARY
Year : 2016  |  Volume : 18  |  Issue : 3  |  Page : 381

The importance of understanding baseline reproductive function prior to the administration of exogenous testosterone


1 Men's Health Center, 8240 Naab Road, Suite 220, Indianapolis, Indiana 46260, USA
2 Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA

Date of Web Publication05-Apr-2016

Correspondence Address:
Dr. Jason R Kovac
Men's Health Center, 8240 Naab Road, Suite 220, Indianapolis, Indiana 46260
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1008-682X.179142

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How to cite this article:
Kovac JR, Lipshultz LI. The importance of understanding baseline reproductive function prior to the administration of exogenous testosterone. Asian J Androl 2016;18:381

How to cite this URL:
Kovac JR, Lipshultz LI. The importance of understanding baseline reproductive function prior to the administration of exogenous testosterone. Asian J Androl [serial online] 2016 [cited 2019 Sep 18];18:381. Available from: http://www.ajandrology.com/text.asp?2016/18/3/381/179142 - DOI: 10.4103/1008-682X.179142

Recent increases in the awareness of hypogonadism as a clinical condition have led to more men being managed with testosterone supplementation therapy (TST). While highly effective at raising serum testosterone levels and controlling the symptoms of hypogonadism such as fatigue and low energy, [1] the resultant suppression of the hypothalamic-pituitary-gonadal axis can lead to an inhibition of gonadotropins, including follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and subsequent azoospermia.

In the article of McBride and Coward, [2] they review the physiology behind this phenomenon and describe numerous clinical approaches on how to restore spermatogenesis following TST. Given that 12.4% of all testosterone prescriptions occur in men under 40 years of age, [3] an awareness of this potential negative side effect cannot be overemphasized. Indeed, physicians need to be made aware that other options exist to treat hypogonadism in men who concurrently desire fertility. These options include oral medications such as clomiphene citrate and Arimidex as well as injectable options such as human chorionic gonadotropin. Combinations of these medications can also be used and titrated to attain optimized serum hormone levels. If physicians are uncomfortable using these medications, then referral could be considered to an andrologist well versed in the administration of each.

If a clinical decision has been made to commence exogenous TST in a male of reproductive age, then current and future fertility should be discussed prior to dispensation. At present, no standards exist on how to best manage this type of a situation clinically.

It is advised that prior to initiation of TST, baseline reproductive function should be assessed. All men should be given the option of obtaining a semen analysis and serum FSH level before starting exogenous testosterone. Coupled with a focused genital examination and documentation of testicular size, this approach has numerous potential benefits. First, it acts as a reference point for reproductive potential and may uncover unsuspected occult azoospermia or compromised reproductive capacity before the potential side effects of testosterone are manifested. Physical examination can also identify other potential causes for hypogonadism including varicocele and resultant testicular atrophy. [4] While controversial, varicocele repair could then be offered as a "natural" way to improve native testosterone levels and prevent further testicular damage. Pretreatment semen analysis values can also serve as target levels for the resolution of post-TST spermatogenic dysfunction.

This approach offers a combination of vigilance, physical examination, and laboratory monitoring that virtually eliminates the uncertainty of determining whether a man's compromised testicular function was innate, or due to exogenous testosterone supplementation.

 
  References Top

1.
Kovac JR, Rajanahally S, Smith RP, Coward RM, Lamb DJ, et al. Patient satisfaction with testosterone replacement therapies: the reasons behind the choices. J Sex Med 2014; 11: 553-62.  Back to cited text no. 1
    
2.
McBride JA, Coward RM. Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian J Androl 2016; 18: 373-80. [Doi: 10.4103/1008-682X.173938]. [Epub ahead of print].  Back to cited text no. 2
    
3.
Layton JB, Li D, Meier CR, Sharpless JL, Sturmer T, et al. Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. J Clin Endocrinol Metab 2014; 99: 835-42.  Back to cited text no. 3
    
4.
Dabaja A, Wosnitzer M, Goldstein M. Varicocele and hypogonadism. Curr Urol Rep 2013; 14: 309-14.  Back to cited text no. 4
    




 

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