Advertisement

Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters

      Objective

      To analyze how frequently and why men presenting with infertility take testosterone (T) and if negative effects of T on semen parameters are reversed following cessation.

      Design

      Analysis of a prospectively collected database.

      Setting

      Male Infertility clinic.

      Patient(s)

      Men presenting for fertility evaluation from 2008 to 2012.

      Intervention(s)

      None.

      Main Outcome Measure(s)

      The frequency and reason for T use in the infertile male population, and semen and hormonal parameters while on T and following discontinuation.

      Result(s)

      A total of 59/4,400 men (1.3%) reported taking T. T was prescribed by a variety of physicians, including endocrinologists (24%), general practitioners (17%), urologists (15%), gynecologists (5%), and reproductive endocrinologists (3%). Only one of the men admitted that he had obtained T from an illicit source. More than 82% of men were prescribed T for the treatment of hypogonadism, but surprisingly, 12% (7/59) were prescribed T to treat their infertility. While on T, 88.4% of men were azoospermic, but by 6 months after T cessation, 65% of the men without other known causes for azoospermia recovered spermatogenesis.

      Conclusion(s)

      In Canada, T was not commonly used by men presenting for fertility investigation (1.3%). Close to 2/3 of infertile men using T recovered spermatogenesis within 6 months of T discontinuation.

      Key Words

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Fertility and Sterility
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bhasin S.
        • Cunningham G.R.
        • Hayes F.J.
        • Matsumoto A.M.
        • Snyder P.J.
        • Swerdloff R.S.
        • et al.
        Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2010; 95: 2536-2559
        • Isidori A.M.
        • Giannetta E.
        • Greco E.A.
        • Gianfrilli D.
        • Bonifacio V.
        • Isidori A.
        • et al.
        Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis.
        Clin Endocrinol. 2005; 63: 280-293
        • Wang C.
        • Swerdloff R.S.
        • Iranmanesh A.
        • Dobs A.
        • Snyder P.J.
        • Cunningham G.
        • et al.
        Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men.
        J Clin Endocrinol Metab. 2000; 85: 2839-2853
        • Pugh P.J.
        • Jones R.D.
        • West J.N.
        • Jones T.H.
        • Channer K.S.
        Testosterone treatment for men with chronic heart failure.
        Heart. 2004; 90: 446-447
        • Liu P.Y.
        • Swerdloff R.S.
        • Christenson P.D.
        • Handelsman D.J.
        • Wang C.
        • Hormonal Male Contraception Summit Group
        Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis.
        Lancet. 2006; 367: 1412-1420
        • Palonek E.
        • Gottlieb C.
        • Garle M.
        • Bjorkhem I.
        • Carlstrom K.
        Serum and urinary markers of exogenous testosterone administration.
        J Steroid Biochem Mol Biol. 1995; 55: 121-127
        • Nieschlag E.
        Clinical trials in male hormonal contraception.
        Contraception. 2010; 82: 457-470
        • Mahmoud A.
        • t'Sjoen G.
        Male hormonal contraception: where do we stand?.
        Eur J Contracept Reprod. 2012; 17: 179-186
        • Dohle G.R.
        • Smit M.
        • Weber R.F.
        Androgens and male fertility.
        World J Urol. 2003; 21: 341-345
        • Andersson A.M.
        • Jorgensen N.
        • Frydelund-Larsen L.
        Rajpert–de Meyts E, Skakkebaek NE. Impaired Leydig cell function in infertile men: a study of 357 idiopathic infertile men and 318 proven fertile controls.
        J Clin Endocrinol Metab. 2004; 89: 3161-3167
        • Knuth U.A.
        • Maniera H.
        • Nieschlag E.
        Anabolic steroids and semen parameters in bodybuilders.
        Fertil Steril. 1989; 52: 1041-1047
        • Turek P.J.
        • Williams R.H.
        • Gilbaugh third, J.H.
        • Lipshultz L.I.
        The reversibility of anabolic steroid-induced azoospermia.
        J Urol. 1995; 153: 1628-1630
        • Lloyd F.H.
        • Powell P.
        • Murdoch A.P.
        Anabolic steroid abuse by body builders and male subfertility.
        BMJ. 1996; 313: 100-101
        • Reyes-Fuentes A.
        • Veldhuis J.D.
        Neuroendocrine physiology of the normal male gonadal axis.
        Endocrinol Metab Clin North Am. 1993; 22: 93-124
        • Kanayama G.
        • Brower K.J.
        • Wood R.I.
        • Hudson J.I.
        • Pope Jr., H.G.
        Anabolic-androgenic steroid dependence: an emerging disorder.
        Addiction. 2009; 104: 1966-1978
        • Tennant F.
        • Black D.L.
        • Voy R.O.
        Anabolic steroid dependence with opioid-type features.
        N Engl J Med. 1988; 319: 578
        • Fronczak C.M.
        • Kim E.D.
        • Barqawi A.B.
        The insults of illicit drug use on male fertility.
        J Androl. 2012; 33: 515-528
        • Cohen J.
        • Collins R.
        • Darkes J.
        • Gwartney D.
        A league of their own: demographics, motivations and patterns of use of 1,955 male adult nonmedical anabolic steroid users in the United States.
        J Int Soc Sports Nutr. 2007; 4: 12
        • Ko E.Y.
        • Siddiqi K.
        • Brannigan R.E.
        • Sabanegh Jr., E.S.
        Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association.
        J Urol. 2012; 187: 973-978
        • Hackett G.
        • Kirby M.
        • Jackson G.
        • Wylie K.
        British Society for Sexual Medicine. Evidence based medicine inevitably increases testosterone prescribing.
        BMJ. 2012; 345: e6167
      1. Purcell ML, Parker W, Poston T, Nangia AK, Kolettis PN. Medical testosterone causes iatrogenic male infertility—a growing problem. In: AUA2013 Annual Meeting: Abstracts, 2013.

        • Hsieh T.C.
        • Pastuszak A.W.
        • Hwang K.
        • Lipshultz L.I.
        Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy.
        J Urol. 2013; 189: 647-650