Author(s): Kim ED, Crosnoe L, BarChama N, Khera M, Lipshultz LI
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Abstract OBJECTIVE: To review the mechanisms of T replacement therapy's inhibition of spermatogenesis and current therapeutic approaches in reproductive aged men. DESIGN: Review of published literature. SETTING: PubMed search from 1990-2012. PATIENT(S): PubMed search from 1990-2012. INTERVENTION(S): A literature review was performed. MAIN OUTCOME MEASURE(S): Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular T levels. RESULT(S): Exogenous T suppresses intratesticular T production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve hCG therapy or selective estrogen receptor (ER) modulators, but may also include low-dose hCG with exogenous T. Off-label use of selective ER modulators, such as clomiphene citrate (CC), are effective for maintaining T production long term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data. CONCLUSION(S): Exogenous T supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without T supplementation represents an alternative treatment. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
This article was published in Fertil Steril
and referenced in Journal of Steroids & Hormonal Science
- S.P. Goyal
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