Testosterone+ HCG Preserves Healthy Sperm in Men on Testosterone Replacement Therapy (Injections and gels)

Tung-Chin  Hsieh, Alexander  W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of

Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island

Purpose: Testosterone replacement therapy results in decreased serum gonadotropins (hormones produced by the pituitary gland- LH and FSH- that jump start testicular function) and  intratesticular testosterone (inside the testicles), and  impairs spermatogenesis (sperm production), leading to azoospermia (no viable sperm) in  40%  of patients. However, intratesticular  testosterone can  be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which  may  support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the  records of hypogonadal men  treated with testosterone replacement therapy and  concomitant low dose  human chorionic gonadotropin (HCG). Testosterone replacement consisted of daily  topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every  other day.  Serum and  free testosterone, estradiol, semen parameters and  pregnancy rates were  evaluated before  and  during therapy.

Results: A total of 26 men  with a mean age  of 35.9  years were  included in  the study. Mean followup  was 6.2 months. Of the men  19 were  treated with injectable testosterone and   7  were  treated with transdermal gel.  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) and  estradiol 2.2 vs 3.7 pg/ml  (p = 0.11).  Pretreatment semen parameters were  volume 2.9 ml,  density 35.2 million per ml, motility 49.0% and  forward progression 2.3. No differences in semen parameters  were  observed during greater than 1  year of followup. No impact on semen parameters was  observed as  a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and  human chorionic gonadotropin therapy. Nine  of 26 men  contributed to pregnancy with the  partner during followup.

Conclusions: Low dose  human chorionic gonadotropin appears to maintain semen  parameters in hypogonadal men  on testosterone replacement therapy. Concurrent testosterone replacement and  human  chorionic gonadotropin use  may preserve fertility in hypogonadal males who desire fertility preservation while  on testosterone replacement therapy.


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 Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression

This study shows that HCG can keep intratesticular (inside the testes) testosterone - ITT normal even when they are exposed to testosterone injections. An HCG dose of 500 IU every other day increased ITT to levels higher than baseline. All other doses failed to achieve normalization of baseline ITT. ITT is crucial for Leydig cells to work properly so that they do not atrophy (lose volume due to inactivity)

http://www.ncbi.nlm.nih.gov/m/pubmed/15713727/


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