title: The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use.
abstract: OBJECTIVE
  About 3 million men take testosterone in the United States with many reproductive-age men unaware of the negative impact of testosterone supplementation on fertility. Addressing this population, we provide an early report on the use of human chorionic gonadotropin (HCG)-based combination therapy in the treatment of a series of men with likely testosterone-related azoospermia or severe oligospermia.
  
  
  METHODS
  We retrospectively reviewed charts from two tertiary care infertility clinics to identify men presenting with azoospermia or severe oligospermia (<1 million sperm/mL) while taking exogenous testosterone. All were noted to have been placed on combination therapy, which included 3,000 units HCG subcutaneously every other day supplemented with clomiphene citrate, tamoxifen, anastrozole, or recombinant follicle-stimulating hormone (or combination) according to physician preference.
  
  
  METHODS
  Clinical outcomes, including hormone values, semen analyses, and clinical pregnancies, were tracked.
  
  
  RESULTS
  Forty-nine men were included in this case series. Return of spermatogenesis for azoospermic men or improved counts for men with severe oligospermia was documented in 47 men (95.9%), with one additional man (2.1%) having a documented pregnancy without follow-up semen analysis. The average time to return of spermatogenesis was 4.6 months with a mean first density of 22.6 million/mL. There was no significant difference in recovery by type of testosterone administered or supplemental therapy. No men stopped HCG or supplemental medications because of adverse events.
  
  
  CONCLUSIONS
  We here provide an early report of the feasibility of using combination therapy with HCG and supplemental medications in treating men with testosterone-related infertility. Future discussion and studies are needed to further characterize this therapeutic approach and document the presumed improved tolerability and speed of recovery compared with unaided withdrawal of exogenous testosterone.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Wenker
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Dupree
authors.affiliation: Department of Urology, Dalhousie University, Saint John, NB, Canada.
authors.forename: Gavin M
authors.initials: GM
authors.lastname: Langille
authors.affiliation: Urology of Indiana, Male Reproductive Endocrinology and Surgery, Carmel, IN, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Kovac
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.|Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Ramasamy
authors.affiliation: Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Dolores
authors.initials: D
authors.lastname: Lamb
authors.affiliation: The Urology Center of Colorado, Denver, CO, USA.
authors.forename: Jesse N
authors.initials: JN
authors.lastname: Mills
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.|Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage* / Q000494:pharmacology; D003131:Combined Modality Therapy; D005640:Follicle Stimulating Hormone; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007248:Infertility, Male / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012189:Retrospective Studies; D013091:Spermatogenesis / Q000187:drug effects*; D013739:Testosterone / Q000008:administration & dosage*
chemical_list: D006063:Chorionic Gonadotropin; D011994:Recombinant Proteins; D013739:Testosterone; D005640:Follicle Stimulating Hormone
keywords: Azoospermia; Human Chorionic Gonadotropin; Infertility; Testosterone