Exogenous Testosterone and Male Infertility
Exogenous Testosterone and Male Infertility
Symptomatic hypogonadism is not uncommon. It is estimated that more than 6.5 million men in the U.S. will have symptomatic androgen deficiency by 2025. Between the ages of 20 and 30 years, men experience a decline in testosterone and free testosterone levels by 0.4% and 1.3% per year, respectively. Indeed, Mulligan et al. observed that roughly 39% of men over the age of 45 had low serum testosterone levels, defined as less than 300 ng/dL.
Testosterone therapies have been increasingly utilized in aging men, as well as in men of reproductive age. Compared to the 1970s men are fathering children at an older age. Combined with the maturation of the Baby Boomer population, it is anticipated that there may be a significant increase in hypogonadal, aging men desiring to father children. The treatment of hypogonadism requires symptoms, as well as low serum testosterone levels. With the recent introduction of several newer commercial testosterone preparations and an increased public awareness of androgen deficiency syndromes, use of hormone replacement therapies (HRT) has been increasing. Over the past five years there has been an increase in testosterone prescriptions by 170%. However, men desiring to maintain their reproductive potential may not be fully aware of the risks of exogenous testosterone therapy.
Testosterone users and health care professionals are often unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal axis and may result in infertility. Physicians need to educate their patients about the potentially deleterious effects exogenous testosterone can have on spermatogenesis and on fertility. Indeed, use of intramuscular testosterone has been investigated as a male contraceptive agent.
The Extent of the Problem
Symptomatic hypogonadism is not uncommon. It is estimated that more than 6.5 million men in the U.S. will have symptomatic androgen deficiency by 2025. Between the ages of 20 and 30 years, men experience a decline in testosterone and free testosterone levels by 0.4% and 1.3% per year, respectively. Indeed, Mulligan et al. observed that roughly 39% of men over the age of 45 had low serum testosterone levels, defined as less than 300 ng/dL.
Testosterone therapies have been increasingly utilized in aging men, as well as in men of reproductive age. Compared to the 1970s men are fathering children at an older age. Combined with the maturation of the Baby Boomer population, it is anticipated that there may be a significant increase in hypogonadal, aging men desiring to father children. The treatment of hypogonadism requires symptoms, as well as low serum testosterone levels. With the recent introduction of several newer commercial testosterone preparations and an increased public awareness of androgen deficiency syndromes, use of hormone replacement therapies (HRT) has been increasing. Over the past five years there has been an increase in testosterone prescriptions by 170%. However, men desiring to maintain their reproductive potential may not be fully aware of the risks of exogenous testosterone therapy.
Testosterone users and health care professionals are often unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal axis and may result in infertility. Physicians need to educate their patients about the potentially deleterious effects exogenous testosterone can have on spermatogenesis and on fertility. Indeed, use of intramuscular testosterone has been investigated as a male contraceptive agent.