title: Medical testosterone: an iatrogenic cause of male infertility and a growing problem.
abstract: OBJECTIVE
  To determine (1) the frequency of testosterone (T) use in 2 academic male infertility practices, (2) the effect on semen parameters, and (3) the potential for reversibility.
  
  
  METHODS
  We performed a retrospective review. Inclusion criteria were supplemental T usage at the time of initial visit, T cessation, and semen analyses before and after T cessation.
  
  
  RESULTS
  From January 2005 to March 2011, 110 of 1540 patients evaluated for infertility (7.1%) were on supplemental T. Thirty-nine patients met the inclusion criteria. Twenty-two of 39 patients (56%) were started on medical recovery by medical treatment. Median sperm concentration increased from 0 to 6.3 million/mL (P <.0001) after T cessation, with median follow-up of 4.5 months. Eight men (21%) remained azoospermic, and 3 men had sperm concentrations of ≤ 0.1 million/mL. Fifteen of 22 men given medical treatment and 16 of 17 men given no treatment had sperm return to the semen, respectively (P = .1061). Final sperm concentration did not differ between those who received medical treatment and those who did not.
  
  
  CONCLUSIONS
  Exogenous T treatment causes infertility and is common among reproductive-aged men. These effects are transient for some, but not all men had return of sperm to the semen during the study interval, suggesting a possible underlying primary testicular dysfunction or ongoing hypothalamic-pituitary-testicular axis suppression. Education about exogenous T's negative reproductive effects is necessary to avoid this preventable form of infertility. Men with low T levels should have sufficient evaluation to evaluate for underlying pathology before starting T.
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, AL. Electronic address: pkolettis@uabmc.edu.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kolettis
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Purcell
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS.
authors.forename: William
authors.initials: W
authors.lastname: Parker
authors.affiliation: Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Tyler
authors.initials: T
authors.lastname: Poston
authors.affiliation: Department of Urology, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Nangia
mesh_terms: D000328:Adult; D000728:Androgens / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D007248:Infertility, Male / Q000139:chemically induced*; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies; D055101:Semen Analysis; D013739:Testosterone / Q000009:adverse effects*
chemical_list: D000728:Androgens; D013739:Testosterone