title: The treatment of hypogonadism in men of reproductive age.
abstract: OBJECTIVE
  To review the mechanisms of T replacement therapy's inhibition of spermatogenesis and current therapeutic approaches in reproductive aged men.
  
  
  METHODS
  Review of published literature.
  
  
  METHODS
  PubMed search from 1990-2012.
  
  
  METHODS
  PubMed search from 1990-2012.
  
  
  METHODS
  A literature review was performed.
  
  
  METHODS
  Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular T levels.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Tennessee Graduate School of Medicine, Knoxville, Tennessee 37920, USA. ekim@utmck.edu
authors.forename: Edward D
authors.initials: ED
authors.lastname: Kim
authors.forename: Lindsey
authors.initials: L
authors.lastname: Crosnoe
authors.forename: Natan
authors.initials: N
authors.lastname: Bar-Chama
authors.forename: Mohit
authors.initials: M
authors.lastname: Khera
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007006:Hypogonadism / Q000503:physiopathology / Q000628:therapy*; D007248:Infertility, Male / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D013091:Spermatogenesis