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Clinical Use of Anabolics and Hormones
Clinical Use of Anabolics and Hormones
Recovery of sperm production following testosterone replacement or anabolic steroids
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<blockquote data-quote="Nelson Vergel" data-source="post: 143921" data-attributes="member: 3"><p>[ATTACH=full]7169[/ATTACH]</p><p></p><p></p><p>Algorithm for the treatment of steroid induced infertility. TTh: testosterone therapy, AAS: androgenic-anabolic steroids, SA: semen analysis, T: testosterone, LH: luteinizing hormone, FSH: follicle stimulating hormone, HCG: human chorionic gonadotropin, SQ: subcutaneous, QOD: quaqua altera die (every other day), QD: quaque die (once a daily), Q7 days: quaque 7 days, rhFSH: recombinant human follicle stimulating hormone, TESE: testicular sperm extraction, m-TESE: microdissection testicular sperm extraction.</p><p></p><p>[ATTACH=full]7170[/ATTACH]</p><p></p><p></p><p>Preserving testicular function and reproductive ability remains an ongoing challenge to practitioners prescribing TTh. Exogenous testosterone is known to decrease intratesticular testosterone and thus impair spermatogenesis. Indeed, in 1996 the World Health Organization investigated weekly injections of 200 mg testosterone enanthate (TE) as a form of contraception. The task force demonstrated that TE caused azoospermia in approximately 75% of men after only 6 months of use [71]. Both the American Urological Association and the Endocrine Society published guidelines in 2018 which recommend against TTh in men wishing to preserve fertility [2, 72]. Current evidence suggests, however, that adjuvant medications can be prescribed in an effort to maintain testicular health and fertility while receiving TTh.</p><p></p><p>Coadministration of HCG with TTh has been shown to help preserve spermatogenesis in men by maintaining physiologic intratesticular testosterone levels throughout treatment. In 2005, Coviello et al [58] demonstrated that TTh caused intratesticular testosterone levels to drop by 94% in otherwise healthy, reproductive-aged men. However, adding subcutaneous 250 IU HCG every other day to their TTh regimen prevented this precipitous fall with intratesticular testosterone levels only dropping 7% from baseline. Furthermore, men who received TTh and 500 IU of HCG every other day actually experienced an increase in their intratesticular testosterone by 26% [58]. This study showed that intratesticular testosterone could be reliably maintained while on TTh. Future studies would prove that spermatogenesis itself, and thus the male's fertility, could likewise be persevered throughout therapy.</p><p></p><p>A retrospective study published by Hsieh et al [73] in 2013 found that out of 26 men treated with TRT and intramuscular 500 IU HCG every other day, no patient became azoospermic. Nineteen of the 26 patients received injectable testosterone while seven were treated with transdermal testosterone gels. Mean serum hormone levels before vs during treatment were: testosterone 207.2 vs. 1,055.5 ng/dL (p<0.0001), free testosterone 8.1 vs. 20.4 pg/mL (p=0.02). No differences in SA parameters were observed during greater than 1 year of follow-up. During the study's follow-up, nine men established a pregnancy with his partner [73]. This study continues to serve as the foundation of ‘fertility-preserving’ TTh regimens currently utilized today.</p><p></p><p>Sensibly, all men wishing to preserve fertility while on TTh should obtain a baseline SA. During the initial consultation, it is also important to identify the patient's goals with regard to the timing of pregnancy (Table 1). If the patient desires pregnancy within the next 6 months and has not yet started, they should abstain from initiating TTh until pregnancy has been achieved. If they desire pregnancy within 6 months and are already receiving TTh, it is recommended that they stop all TTh and follow a recovery regimen identical to what was detailed in the previous section.</p><p></p><p>Source: <a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002" target="_blank">Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery</a></p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 143921, member: 3"] [ATTACH=full]7169[/ATTACH] Algorithm for the treatment of steroid induced infertility. TTh: testosterone therapy, AAS: androgenic-anabolic steroids, SA: semen analysis, T: testosterone, LH: luteinizing hormone, FSH: follicle stimulating hormone, HCG: human chorionic gonadotropin, SQ: subcutaneous, QOD: quaqua altera die (every other day), QD: quaque die (once a daily), Q7 days: quaque 7 days, rhFSH: recombinant human follicle stimulating hormone, TESE: testicular sperm extraction, m-TESE: microdissection testicular sperm extraction. [ATTACH=full]7170[/ATTACH] Preserving testicular function and reproductive ability remains an ongoing challenge to practitioners prescribing TTh. Exogenous testosterone is known to decrease intratesticular testosterone and thus impair spermatogenesis. Indeed, in 1996 the World Health Organization investigated weekly injections of 200 mg testosterone enanthate (TE) as a form of contraception. The task force demonstrated that TE caused azoospermia in approximately 75% of men after only 6 months of use [71]. Both the American Urological Association and the Endocrine Society published guidelines in 2018 which recommend against TTh in men wishing to preserve fertility [2, 72]. Current evidence suggests, however, that adjuvant medications can be prescribed in an effort to maintain testicular health and fertility while receiving TTh. Coadministration of HCG with TTh has been shown to help preserve spermatogenesis in men by maintaining physiologic intratesticular testosterone levels throughout treatment. In 2005, Coviello et al [58] demonstrated that TTh caused intratesticular testosterone levels to drop by 94% in otherwise healthy, reproductive-aged men. However, adding subcutaneous 250 IU HCG every other day to their TTh regimen prevented this precipitous fall with intratesticular testosterone levels only dropping 7% from baseline. Furthermore, men who received TTh and 500 IU of HCG every other day actually experienced an increase in their intratesticular testosterone by 26% [58]. This study showed that intratesticular testosterone could be reliably maintained while on TTh. Future studies would prove that spermatogenesis itself, and thus the male's fertility, could likewise be persevered throughout therapy. A retrospective study published by Hsieh et al [73] in 2013 found that out of 26 men treated with TRT and intramuscular 500 IU HCG every other day, no patient became azoospermic. Nineteen of the 26 patients received injectable testosterone while seven were treated with transdermal testosterone gels. Mean serum hormone levels before vs during treatment were: testosterone 207.2 vs. 1,055.5 ng/dL (p<0.0001), free testosterone 8.1 vs. 20.4 pg/mL (p=0.02). No differences in SA parameters were observed during greater than 1 year of follow-up. During the study's follow-up, nine men established a pregnancy with his partner [73]. This study continues to serve as the foundation of ‘fertility-preserving’ TTh regimens currently utilized today. Sensibly, all men wishing to preserve fertility while on TTh should obtain a baseline SA. During the initial consultation, it is also important to identify the patient's goals with regard to the timing of pregnancy (Table 1). If the patient desires pregnancy within the next 6 months and has not yet started, they should abstain from initiating TTh until pregnancy has been achieved. If they desire pregnancy within 6 months and are already receiving TTh, it is recommended that they stop all TTh and follow a recovery regimen identical to what was detailed in the previous section. Source: [URL="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002"]Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery[/URL] [/QUOTE]
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Clinical Use of Anabolics and Hormones
Clinical Use of Anabolics and Hormones
Recovery of sperm production following testosterone replacement or anabolic steroids
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