Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters

Abstract

Objective: To analyze how frequently and why men presenting with infertility take testosterone (T) and if negative effects of T on semen parameters are reversed following cessation.

Design: Analysis of a prospectively collected database.

Setting: Male Infertility clinic.

Patient(s): Men presenting for fertility evaluation from 2008 to 2012.

Intervention(s): None.

Main outcome measure(s): The frequency and reason for T use in the infertile male population, and semen and hormonal parameters while on T and following discontinuation.

Result(s): A total of 59/4,400 men (1.3%) reported taking T. T was prescribed by a variety of physicians, including endocrinologists (24%), general practitioners (17%), urologists (15%), gynecologists (5%), and reproductive endocrinologists (3%). Only one of the men admitted that he had obtained T from an illicit source. More than 82% of men were prescribed T for the treatment of hypogonadism, but surprisingly, 12% (7/59) were prescribed T to treat their infertility. While on T, 88.4% of men were azoospermic, but by 6 months after T cessation, 65% of the men without other known causes for azoospermia recovered spermatogenesis.

Conclusion(s): In Canada, T was not commonly used by men presenting for fertility investigation (1.3%). Close to 2/3 of infertile men using T recovered spermatogenesis within 6 months of T discontinuation.

Keywords: Testosterone; hormones; male infertility; semen; testosterone replacement therapy.