[Risk of Male Infertility Due to Testosterone Replacement Therapy for Late-Onset Hypogonadism (LOH)].
Level 4 - case-series / case-control
Case series of patients presenting with secondary infertility
PubMed 33271659 · doi:10.14989/ActaUrolJap_66_11_407
What was done
Review of 6 patients (identified among 4,375 men presenting for infertility evaluation) who had developed male infertility after receiving testosterone replacement therapy for late-onset hypogonadism for 3 to 12 months. Management involved immediate cessation of testosterone, followed by human chorionic gonadotropin (hCG) in 2 patients and clomiphene in 1 patient for those requiring prompt recovery.
What was found
Five of 6 patients had markedly suppressed blood gonadotropin levels; 1 patient had reference-range gonadotropins with elevated testosterone. Semen analysis findings ranged from severe oligospermia to azoospermia. Semen parameters significantly improved in all patients except 1 patient treated with hCG for only 1 month. No exact numerical semen parameters or hormone levels were provided in the abstract.
Why it matters
Exogenous testosterone suppresses the hypothalamic-pituitary-gonadal axis, frequently causing secondary spermatogenic failure. It highlights that testosterone replacement is contraindicated in men desiring fertility preservation, where alternatives like hCG or clomiphene should be considered instead.
Limits
Very small case series (n = 6) from a single center without a control group. Pre-treatment baseline semen parameters, quantitative recovery metrics, and precise recovery durations were not reported in the abstract.
Cited by
- supports Exogenous testosterone suppresses fertility in men.