SERMS during TRT for Fertility

[dmore]

Has anyone ever recommended or tried Clomid for men on TRT in order to maintain fertility?
Anyone have experiences?

Fertil Steril. 2003 Oct;80(4):914-20.
Effectiveness of combined tamoxifen citrate and testosterone undecanoate treatment in men with idiopathic oligozoospermia.
Adamopoulos DA, Pappa A, Billa E, Nicopoulou S, Koukkou E, Michopoulos J.
Source

Department of Endocrinology, Elena Venizelou Hospital, Athens, Greece. hel-soc-andro@ath.fortnet.gr
Abstract
OBJECTIVE:

To assess the effect of treatment with a combination of the antiestrogen tamoxifen citrate and the androgen testosterone undecanoate on sperm variables and pregnancy incidence in men with idiopathic oligozoospermia and couple subfertility.
DESIGN:

Prospective, randomized, placebo-controlled trial.
SETTING:

Clinical research in a tertiary care academic hospital.
PATIENT(S):

Two hundred twelve men with idiopathic oligozoospermia and 82 normozoospermic men with female factor subfertility.
INTERVENTION(S):

Oligozoospermic patients were randomly assigned to two treatment groups with tamoxifen citrate, 20 mg/d, and testosterone undecanoate, 120 mg/d (n = 106) or placebo treatment (n = 106) for 6 months. Normozoospermic men were followed for the same period. Couple counseling was part of the intervention in all groups.
MAIN OUTCOME MEASURE(S):

Pregnancy incidence and sperm characteristics after 3 and 6 months on medication and 3 months after the end of the trial.
RESULT(S):

In the active treatment group, total sperm count (median [25th, 75th percentile], 27.1 x 10(6) cells/mL [9.4, 54.0 x 10(6) cells/mL] at baseline and 61.5 x 10(6) cells/mL [28.2, 119.6 x 10(6) cells/mL] at 6 months), progressive motility (mean [+/-SD], 29.7% +/- 12.0% at baseline and 41.6% +/- 13.1% at 6 months), and normal morphology (mean, 41.2% +/- 14.0% at baseline and 56.6% +/- 11.5% at 6 months) were noted. No marked changes were observed in placebo recipients or normozoospermic men. The incidence of spontaneous pregnancy was 33.9% in the active treatment group and 10.3% in the placebo group (36 vs. 11 pregnancies), with a relative risk of 3.195 (95% CI, 2.615 to 3.765).
CONCLUSION(S):

Treatment with tamoxifen citrate and testosterone undecanoate improved sperm variables and led to a higher incidence of pregnancy in couples with subfertility related to idiopathic oligozoospermia.

Fertil Steril. 1997 Apr;67(4):756-62.
The combination of testosterone undecanoate with tamoxifen citrate enhances the effects of each agent given independently on seminal parameters in men with idiopathic oligozoospermia.
Adamopoulos DA, Nicopoulou S, Kapolla N, Karamertzanis M, Andreou E.
Source

Endocrine Department, Elena Venizelou Hospital, Athens, Greece.
Abstract
OBJECTIVE:

To evaluate the effects of combined tamoxifen citrate and T undecanoate treatment on seminal parameters in men with idiopathic oligozoospermia.
DESIGN:

Prospective randomized clinical study.
SETTING:

A state hospital tertiary clinic.
PATIENT(S):

Eighty oligozoospermic men were included in the protocol.
INTERVENTION(S):

Patients were randomized to receive placebo, T undecanoate (40 mg three times per day), tamoxifen citrate (10 mg two times per day), or T undecanoate plus tamoxifen citrate.
RESULT(S):

Tamoxifen citrate plus T undecanoate treatment produced a satisfactory improvement of total sperm number, motility, and functional sperm fraction after 3 and 6 months. Comparisons with other active treatment groups showed significantly higher increment values for motility and functional fraction, whereas aniline, acrosine, and free L-carnitine also were markedly better in the combination treatment group.
CONCLUSION(S):

These results indicate that the combination of tamoxifen citrate with T undecanoate not only improves significantly important seminal parameters but also compares favorably with the single treatments used. Therefore, this combination deserves a place as a first line of treatment in idiopathic oligozoospermia.

 

[Michael Scally MD]

The lab values are needed for any possible explanation. I sense sloppy work.

From the same group:

Koukkou E, Billa E, Kapolla N, Pappa A, Venaki E, et al. An empiric treatment for idiopathic oligozoospermia revisited: a 20-year investigative saga. Andrologia. 2012;44(5):337-42. http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0272.2012.01286.x/abstract

A series of studies aiming at introducing an effective treatment for idiopathic oligozoospermia was conducted in a step-wise fashion spanning over a 20-year period.

The concept was that co-administration of an accessory gland-stimulating androgen, testosterone undecanoate (40 mg t.i.d.) and the FSH raising anti-oestrogen tamoxifen citrate (10 mg b.i.d.) may improve sperm parameters.

A prerequisite for such an effect was the demonstration that testosterone undecanoate had no suppressing action on pituitary-testicular axis.

In this context, initial studies demonstrated no change in basal or stimulated gonadotrophin and testosterone secretion in short- or long-term protocols.

Two subsequent trials with this combination showed a marked improvement of sperm parameters and pregnancy incidence, with a seasonal variation noted in response to treatment, this being higher during the cold seasons of autumn and winter.

Regarding the mechanism of testosterone undecanoate's action, a recent study from our unit showed that its administration resulted in a marked rise of serum DHT levels. Because this steroid is an epididymal function promoter, it appears that its contribution in the combination is mediated mainly through its DHT raising effect.

By and large, this empiric approach for the treatment of idiopathic oligozoospermia was satisfactorily documented after a 20-year investigative saga.

 

[dmore]

Thanks for your input Dr Scally.
If I may quote:
"testosterone undecanoate had no suppressing action on pituitary-testicular axis."

So basically they are saying Nebido, in particular, has no suppressing action, thus it won't affect HTPA axis being it the reason why SERMS still boost fertility?
So the same won't happen with other esters?

 

[Brez]

Is it the testosterone in conjunction with tomoxafin that significantly raises dht or the testosterone by itself?

 

[dmore]

Is it the testosterone in conjunction with tomoxafin that significantly raises dht or the testosterone by itself?

Looks like test itself, in the case of this study in particular, undecanoate ester.

 

[killler]

Thanks for your input Dr Scally.
If I may quote:
"testosterone undecanoate had no suppressing action on pituitary-testicular axis."

So basically they are saying Nebido, in particular, has no suppressing action, thus it won't affect HTPA axis being it the reason why SERMS still boost fertility?
So the same won't happen with other esters?

Not Nebido....it is Andriol,the oral test which mainly converts to DHT and anecdotally it does not supress you much.

 

[Dr JIM]

Thanks for your input Dr Scally.
If I may quote:
"testosterone undecanoate had no suppressing action on pituitary-testicular axis."

So basically they are saying Nebido, in particular, has no suppressing action, thus it won't affect HTPA axis being it the reason why SERMS still boost fertility?
So the same won't happen with other esters?

The lab values are needed for any possible explanation.

I sense sloppy work

Agreed !

 

[Dr JIM]

And I’d start by comparing
LH/FSH levels to the dosage and dosing intervals.