Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy.
Level 4 - case-series / case-control
Retrospective single-arm case series without an active control group
PubMed 23260550 · doi:10.1016/j.juro.2012.09.043
What was done
A retrospective chart review was conducted on 26 hypogonadal men (mean age 35.9 years) treated with testosterone replacement therapy (daily topical gel, n=7; weekly intramuscular injection, n=19) alongside concomitant low-dose intramuscular human chorionic gonadotropin (hCG, 500 IU every other day). Serum total testosterone, free testosterone, estradiol, semen parameters (volume, density, motility, forward progression), and pregnancy rates were evaluated before and during treatment over a mean follow-up of 6.2 months.
What was found
Mean serum total testosterone increased from 207.2 to 1,055.5 ng/dl (p < 0.0001) and free testosterone increased from 8.1 to 20.4 pg/ml (p = 0.02), while estradiol changed from 2.2 to 3.7 pg/ml (p = 0.11). Pretreatment semen values were volume 2.9 ml, density 35.2 million/ml, motility 49.0%, and forward progression 2.3. No differences in semen parameters were observed during follow-up, with no impact observed by testosterone formulation. No patient developed azoospermia, and 9 of 26 men achieved pregnancy with their partner during follow-up.
Why it matters
Testosterone replacement therapy typically suppresses gonadotropins and induces azoospermia in many patients. These data suggest concurrent low-dose hCG may preserve spermatogenesis and fertility in men requiring testosterone therapy.
Limits
The study is limited by a small sample size (n=26), retrospective uncontrolled design, and lack of a testosterone-only comparison group. Specific numerical follow-up semen values were not reported in the abstract, and average follow-up was relatively short (6.2 months).
Cited by
- supports Co-administering human chorionic gonadotropin (hCG) alongside exogenous testosterone therapy can partially to completely prevent or offset the depletion of sperm count.