[OA] Rambhatla A, Mills JN, Rajfer J. The Role of Estrogen Modulators in Male Hypogonadism and Infertility. Rev Urol 2016;18(2):66-72. The Role of Estrogen Modulators in Male Hypogonadism and Infertility
Main Points
· Estradiol has been targeted by male reproductive and sexual medicine specialists to help treat conditions such as infertility and hypogonadism. In some infertile men, particularly those with hypogonadism, or those who have a low serum testosterone to estradiol ratio, there is some evidence suggesting that selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) can reverse the low serum testosterone levels or the testosterone to estradiol imbalance and occasionally improve any associated infertile or subfertile state.
· SERMs exhibit tissue-specific estrogen receptor agonist or antagonist activity. Clomiphene citrate (clomiphene) and tamoxifen are two SERMs that are commonly used in men’s health. They work as estrogen antagonists at the level of the pituitary gland and thus stimulate the release of luteinizing hormone and follicle-stimulating hormone, which in turn drive both the steroidogenic and spermatogenic functions of the testes.
· Although the studies on tamoxifen use in men have largely focused on those men who have infertility, its mechanism of action suggests it can also be used to raise testosterone levels in men with low testosterone who possibly may have relatively elevated serum estradiol levels.
· AIs lower estrogen levels by blocking the aromatase enzyme, which converts testosterone to estradiol. Their use has broadened to include conditions in which the desire is to either lower serum estradiol and/or increase serum testosterone levels.
Estradiol, normally considered a female hormone, appears to play a significant role in men in a variety of physiologic functions, such as bone metabolism, cardiovascular health, and testicular function. As such, estradiol has been targeted by male reproductive and sexual medicine specialists to help treat conditions such as infertility and hypogonadism.
The compounds that modulate estradiol levels in these clinical conditions are referred to as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). In a certain subset of infertile men, particularly those with hypogonadism, or those who have a low serum testosterone to estradiol ratio, there is some evidence suggesting that SERMs and AIs can reverse the low serum testosterone levels or the testosterone to estradiol imbalance and occasionally improve any associated infertile or subfertile state.
This review focuses on the role these SERMs and AIs play in the aforementioned reproductive conditions.
Main Points
· Estradiol has been targeted by male reproductive and sexual medicine specialists to help treat conditions such as infertility and hypogonadism. In some infertile men, particularly those with hypogonadism, or those who have a low serum testosterone to estradiol ratio, there is some evidence suggesting that selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) can reverse the low serum testosterone levels or the testosterone to estradiol imbalance and occasionally improve any associated infertile or subfertile state.
· SERMs exhibit tissue-specific estrogen receptor agonist or antagonist activity. Clomiphene citrate (clomiphene) and tamoxifen are two SERMs that are commonly used in men’s health. They work as estrogen antagonists at the level of the pituitary gland and thus stimulate the release of luteinizing hormone and follicle-stimulating hormone, which in turn drive both the steroidogenic and spermatogenic functions of the testes.
· Although the studies on tamoxifen use in men have largely focused on those men who have infertility, its mechanism of action suggests it can also be used to raise testosterone levels in men with low testosterone who possibly may have relatively elevated serum estradiol levels.
· AIs lower estrogen levels by blocking the aromatase enzyme, which converts testosterone to estradiol. Their use has broadened to include conditions in which the desire is to either lower serum estradiol and/or increase serum testosterone levels.
Estradiol, normally considered a female hormone, appears to play a significant role in men in a variety of physiologic functions, such as bone metabolism, cardiovascular health, and testicular function. As such, estradiol has been targeted by male reproductive and sexual medicine specialists to help treat conditions such as infertility and hypogonadism.
The compounds that modulate estradiol levels in these clinical conditions are referred to as selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). In a certain subset of infertile men, particularly those with hypogonadism, or those who have a low serum testosterone to estradiol ratio, there is some evidence suggesting that SERMs and AIs can reverse the low serum testosterone levels or the testosterone to estradiol imbalance and occasionally improve any associated infertile or subfertile state.
This review focuses on the role these SERMs and AIs play in the aforementioned reproductive conditions.
