Age and Duration of TRT Predict Time to Return of Sperm Count After hCG

[Michael Scally MD]

Kohn TP, Louis MR, Pickett SM, et al. Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy. Fertility and Sterility. http://www.fertstert.org/article/S0015-0282(16)62919-9/abstract

Objective - To determine factors that influence sperm recovery after T-associated infertility.

Design - Clinical retrospective study.

Setting - Academic male-infertility urology clinic.

Patient(s) - Sixty-six men who presented with infertility after T use.

Intervention(s) - T cessation and combination high-dose hCG and selective estrogen modulator (SERM) therapy.

Main Outcome Measure(s) - Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy.

Result(s) - A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of T use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of T use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery.

Conclusion(s) - Increasing age and duration of T use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term T therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months.

 

[Tyler81]

Thanks for the post Dr Scally.
When I asked my endo he said in theory I should be able to regain my sperm count and fertility but he also added, "But you've been on testosterone for quite a long time now"

So this study reminds me of why i am trying to transition off treatment.

After 6 years on replacement I think it is best to regain my fertility now or I may lose the ability to regain it in the future.

 

[Michael Scally MD]

[OA] Recovery of Spermatogenesis After Hormone Therapy: What to Expect and When to Expect It

Administration of exogenous sex steroids suppresses spermatogenesis through estrogen and androgen receptor-mediated feedback inhibition of hypothalamic and pituitary function. This results in an acquired variant of hypogonadotropic hypogonadism (HH) characterized by extremely low or undetectable serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), atrophic testes, and severe oligozoospermia or azoospermia.

This clinical picture has become common in clinical practice with the increasing prevalence of testosterone therapy, which is prescribed to tens of thousands of reproductive-aged men in the United States annually. Many of these men (and their doctors) are not aware of the well-established reproductive toxicity of testosterone therapy.

Azoospermia induced by the administration of exogenous sex steroids is also encountered in men who abuse anabolic steroids and in male-to-female transgendered patients on estrogen-based therapies who desire biological children or who wish to cryopreserve sperm before orchiectomy for gender reassignment.

Most of what we know about recovery of spermatogenesis after hormone therapy comes from large, well-designed clinical trials of relatively short-duration hormonal male contraception in healthy men with normal baseline fertility. These studies have clearly demonstrated the severe impact of exogenous androgen administration on sperm production and semen quality.

They also have reassuringly reported that the overwhelming majority of men recover fertility after cessation of hormone administration in a time-dependent manner. However, recovery without medical therapy to stimulate endogenous testicular function is slow.

...

Stahl PJ. Recovery of spermatogenesis after hormone therapy: what to expect and when to expect it. Fertil Steril 2017;107:338-9. http://www.fertstert.org/article/S0015-0282(16)63068-6/fulltext