Testosterone Therapy and Male Fertility

Testosterone deficiency affects large numbers of males and is often accompanied by numerous bothersome signs and symptoms. The formulations of exogenous testosterone therapy that are routinely used in clinical practice to treat men with testosterone deficiency also commonly result in suppressed endogenous testosterone production and impaired spermatogenesis. In 2018, the American Urological Association published guidelines regarding the evaluation and treatment of men with testosterone deficiency. A key feature of this document was the recommendation that “alternative therapies” be considered for use in men with testosterone deficiency who desire preservation of their future fertility. These alternative therapies, including aromatase inhibitors, human chorionic gonadotropin (hCG), and selective estrogen receptor modulators (SERMs), work via different mechanisms but share the common end result of improving endogenous testosterone production and thus supporting spermatogenesis. Familiarity and comfort in the use of these agents are important in treating testosterone-deficient males who desire concurrent fertility preservation.