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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More information on HCG+TRT

L-Carnitine Increases Sperm Motility and Quality

L-carnitine is concentrated in the epididymis, where sperm mature and acquire their motility (86). Two uncontrolled trials of L-carnitine supplementation in more than 100 men diagnosed with decreased sperm motility found that oral L-carnitine supplementation (3 grams/day) for three to four months significantly improved sperm motility (87, 88). However, no information on subsequent fertility was reported. A cross-sectional study of 101 fertile and infertile men found that L-carnitine concentrations in semen were positively correlated with the number of sperm, the percentage of motile sperm, and the percentage of normal appearing sperm in the sample (89), suggesting that L-carnitine levels in semen may be useful in evaluating male infertility. More recently, a placebo-controlled,double-blind, cross-over trial in 86 patients with male infertility found that L-carnitine (2 grams/day) supplementation for two months led to significantly improvements in sperm quality, evidenced by increases in sperm concentration and motility (90). Similar improvements in sperm motility were observed in a subsequent placebo-controlled, double-blind, randomized study conducted by the same group, but the patients received combination therapy consisting of L-carnitine (2 grams/day) and acetyl-L-carnitine (1 gram/day) for six months (91). Interestingly, in both studies, the most dramatic carnitine-induced improvements were noted in patients with the lowest baseline sperm motility measures (i.e., most severe cases) (90, 91). Another group of researchers also reported improved sperm motility following combined carnitine therapy. In this placebo-controlled, double-blind, randomized study, 44 patients with idiopathic asthenozoospermia (reduced sperm motility) received placebo, L-carnitine (3 grams/day), acetyl-L-carnitine (3 grams/day), or a combination of L-carnitine (2 grams/day) and acetyl-L-carnitine (1 gram/day). The combination therapy as well as acetyl-L-carnitine, alone, resulted in significant increases in sperm motility (92). Together, these data suggest that carnitine therapy may be useful in disorders of sperm motility and male infertility; however, large-scale clinical trials are undoubtedly necessary.

Source: http://lpi.oregonstate.edu/infocenter/othernuts/carnitine/

Smoking is associated with altered semen quality and endocrine hormonal status

A study was conducted as part of an epidemiological survey of 126 nonsmokers and 178 smokers, showing primary infertility residing around Kolkata region of Eastern India. Their lifestyle history including smoking habits along with semen and blood were collected. The study examined the association of cigarette smoking with the risk of infertility, by determining the semen quality, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels, and androgen receptor (AR)-CAG repeat length in a group of smokers compared with a control group (non smokers). Based on conventional WHO criteria, lower sperm motility (P < 0.001) and increased sperm morphological defects (P < 0.0001) were associated with smoking habits. Binary logistic regression analysis for the effect of smoking status on sperm DNA integrity demonstrated significant positive correlation (p = 0.006). Serum FSH and LH levels were higher for smokers compared with non-smokers while the testosterone level decreased significantly with the increasing smoking habit. The mean length of CAG repeats in AR gene was significantly higher for smokers with low testosterone compared to non-smokers. The study suggested that smoking is associated with altered semen quality, endocrine hormonal status, and number of CAG repeats in the AR gene.


Read More: http://informahealthcare.com/doi/abs/10.3109/19396368.2012.684195