- 作者：Edward D. Kim ; M.D.a ; ekim@utmck.edu ; Lindsey Crosnoe ; B.S.a ; Natan Bar-Chama ; M.D.b ; Mohit Khera ; M.D.c ; Larry I. Lipshultz ; M.D.c
- 关键词：Hypogonadism ; selective estrogen receptor modulator ; male fertility
- 刊名：Fertility and Sterility
- 出版年：2013
- 出版时间：1 March, 2013
- 年：2013
- 卷：99
- 期：3
- 页码：718-724
- 全文大小：201 K
Objective
To review the mechanisms of T replacement therapy's inhibition of spermatogenesis and current therapeutic approaches in reproductive aged men.Design
Review of published literature.
Setting
PubMed search from 1990-2012.
Patient(s)
PubMed search from 1990-2012.
Intervention(s)
A literature review was performed.
Main Outcome Measure(s)
Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular T?levels.
Result(s)
Exogenous T suppresses intratesticular T production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve hCG therapy or selective estrogen receptor (ER) modulators, but may also include low-dose hCG with exogenous T. Off-label use of selective ER modulators, such as clomiphene citrate (CC), are effective for maintaining T production long term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data.
Conclusion(s)
Exogenous T supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without T supplementation represents an alternative treatment.