In men who would like to preserve fertility, exogenous testosterone should be avoided as it has detrimental side effects on sperm production. This occurs because testosterone negatively feeds back on the HPG axis, suppressed secretion of FHS and LH leading to decreased intra-testicular testosterone levels. In these patients, the better choice is to increase endogenous testosterone production through other types of pharmacotherapy (e.g. hcg injections or clomid) or weight loss (e.g. for overweight and obese patients wishing to have children).
To review the current literature for the effect of hormones used in rejuvenation clinics on the maintenance of spermatogenesis.
Review of published literature.
Men who have undergone exogenous testosterone (T) and/or anabolic androgenic steroid (AAS) therapies.
MAIN OUTCOME MEASURE(S):
Semen analysis, pregnancy outcomes, and time to recovery of spermatogenesis.
Exogenous testosterone and anabolic androgenic steroids suppress intratesticular testosterone production, which may lead to azoospermia or severe oligozoospermia. Therapies that protect spermatogenesis involve human chorionic gonadotropin (hCG) therapy and selective estrogen receptor modulators (SERMs). The studies examining the effect of human growth hormone (HGH) on infertile men are uncontrolled and unconvincing, but they do not appear to negatively impact spermatogenesis. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data.
The use of hormones for rejuvenation is increasing with the aging of the Baby Boomer population. Men desiring children at a later age may be unaware of the side-effect profile of hormones used at rejuvenation centers. Testosterone and anabolic androgenic steroids have well-established detrimental effects on spermatogenesis, but recovery may be possible with cessation. Clomiphene citrate, human growth hormone (HGH)/insulin-like growth factor-1 (IGF-1), human chorionic gonadotropin (hCG), and aromatase inhibitors do not appear to have significant negative effects on sperm production, but quality data are lacking.
Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.