MANday: Fertility after Exogenous Testosterone Treatment
There are many reasons why a person decides to start testosterone replacement therapy (TRT). Some of the reasons include improved physical performance, testosterone deficiency, delay of growth and puberty, congenital syndromes, pituitary deficiency, late onset hypogonadism, etc. Infertility is not one of the reasons for TRT and in many cases people on TRT do not realize or are not told the negative side effects of TRT in terms of fertility. On the contrary, other people do realize that TRT may have a negative side effect on fertility, but at the moment fertility is not their primary concern. When fertility does become a primary concern many of these folks come to The Y Factor for evaluation and treatment.
Here at The Y Factor we realize that everyone is an individual and that reasons for starting TRT may differ. We also realize that goals change overtime and we take this into consideration when evaluating for fertility issues. In terms of fertility, we know that TRT produces hypogonadotropic hypogonadism by suppressing hypothalamic and pituitary stimulation of the testes, resulting in oligo-or azoospermia and causing testicular hypotrophy or atrophy. We also know that, in most cases, recovery of spermatogenesis and hormonal production occurs spontaneously with the cessation of TRT and usually no additional treatment is required, however recovery may take months. In a few cases though, stopping TRT does not lead to recovery of spermatogenesis and hormonal production or improved fertility. This is where it becomes more complex and knowing what to look for and how to treat it is one of our specialties.
There are many sources of information that one can find online stating that by taking medications such as hCG or clomid will counter or reverse the negative effects of TRT on the hypothalamus-pituitary-gonadal axis. This is true in some cases but, on other occasions, it can further decrease spermatogenesis and fertility. It should be noted for example that early stimulation of the testes with hCG alone, after stopping TRT, continues to suppress pituitary production of gonadotropins, therefore delaying recovery of the hypothalamus-pituitary-gonadal axis. In addition, in some cases, starting hCG and clomid will not improve fertility regardless of prior use of TRT. In primary hypogonadism for example, the issue is not related to the hypothalamus or the pituitary organs, instead the issue is directly associated with the testicles themselves. Treatment in cases like this are completely different.
Here at The Y Factor we specialize in finding and correcting male fertility issues regardless of the initial reasons why someone started on TRT. We thoroughly evaluate to see what if any underlying factors lead to decreased fertility. Some contributing factors we look for include congenital or acquired urogenital abnormalities such as cryptorchidism, malignancy such as cancer therapy exposure or exposure to cytotoxic agents, urogenital tract infections such as prostatitis or epididymitis, increased scrotal temperature that may occur with varicoceles, endocrine disturbances such as primary or secondary hypogonadism, genetic abnormalities such as Klinefelter’s syndrome, and immunological factors such as sperm autoantibodies. We have the knowledge necessary to look for and treat many of these conditions to help improve your fertility or to help you decide your best options in terms of a successful conception. Our goal is to find and improve all factors that contribute to decreased fertility to improve your chances of conception whether conception is natural or via assisted reproductive technologies (ART) such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Come see us at The Y Factor to get started with your evaluation.
Kin, C. P. T., Goldstein, M., & Rosenwaks, Z. (2004). Reproductive medicine secrets. Hanley & Belfus.
Epocrates Online. (n.d.). https://online.epocrates.com/diseases/49711/Male-factor-infertility/Highlights-Basics.
Benancio Martinez Jr is a certified Family Nurse Practitioner and one of the newest integral parts of the Y Factor team. Benancio is the medical provider in charge of the Northpointe location and brings to the Y Factor 10 years of nursing experience obtained through the emergency departments of the VA and Kingwood medical centers, as well as clinical experience in family practice, hematology, and oncology.
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