madman
Super Moderator
Abstract
INTRODUCTION AND OBJECTIVES:
Testosterone therapy (TTh) is known to suppress spermatogenesis, but combination TTh with human chorionic gonadotropin (hCG) has been shown to maintain spermatogenesis in a small 26-patient case series. That study did not account for prior fertility (or infertility). The objective of this study is to assess total motile count (TMC) in men on combination TTh and hCG versus men on monotherapy TTh, while accounting for prior fertility.METHODS:
We reviewed patient charts from a single academic institution from 2015 to present to identify men with 1) proven fertility, 2) actively taking injectable TTh, and 3) who provided a semen sample for analysis. Men were included if they were taking 200-300 mg of testosterone weekly, either as monotherapy TTh or TTh combined with 1500 IU of hCG injected once weekly. Proven fertility was defined by previously fathering a child or a normal semen analysis prior to starting TTh. Men were excluded if not actively on TTh (TTh discontinued prior to semen analysis) or if they were taking or had previously taken oral anabolic steroids. Standard parametric and non-parametric statistical tests, as well as linear multivariate regression, were performed using R.RESULTS:
We included 62 men on monotherapy TTh and 44 men on combination TTh + hCG. Median total motile count was significantly higher in men on combination therapy compared with men on TTh monotherapy (median TMC 13.7 vs 0 million motile sperm, p<0.0001). 100% of patients on TTh monotherapy had TMC ≤5 million, while only 32% on combination therapy had TMC ≤5 million. 3 of 44 men (7%) became azoospermic on combination therapy, compared with 81% of men on TTh monotherapy. Compared with men on TTh monotherapy, men on TTh+hCG combination therapy were younger but had been on testosterone for longer and had higher total testosterone levels (p<0.05 for all). On multivariate regression, only the use of hCG was associated with higher total motile counts (p<0.0001); age, duration of testosterone use, and hormone levels were non-significant.CONCLUSIONS:
This is the largest study assessing the fertility potential of combination TTh and hCG. A high proportion of previously fertile men maintained spermatogenesis with once weekly hCG injections while on TTh.
