The Treatment of Hypogonadism in Men of Reproductive Age.

summary

Aromatase inhibitors are often used to treat hypogonadism related to obesity and male infertility as they blocks the conversion of androgens to estrogens, raise plasma T/E2 ratio, and increases serum levels of LH, FSH, and testosterone.

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.

LINK - http://www.ncbi.nlm.nih.gov/pubmed/23219010