Testosterone has a variety of functions and is commonly used in older men to treat symptoms of hypogonadism, such as decreased libido, decreased mood and erectile dysfunction. Despite its positive effects on sexual function, it has a negative effect on fertility. Exogenous testosterone therapy can negatively affect the hypothalamic-pituitary gonadal axis and inhibit the production of follicle stimulating hormone and luteinizing hormone. The purpose of this review is to discuss the contraceptive properties of testosterone therapy and to discuss strategies to increase testosterone in men with the desire to preserve fertility.

Objective To compare postoperative pain control among men who received different quantities of narcotic prescriptions following scrotal surgery. We hypothesized that men receiving eight vs four pills of acetaminophen 300 mg/codeine 30 mg there would be no significant difference in mean pain following scrotal and inguinal surgery. Patients and methods In this prospective, open‐label study, men who underwent scrotal surgery received eight or four acetaminophen 300 mg/codeine 30 mg pills. Men were encouraged to take scheduled non‐steroidal anti‐inflammatory drugs (NSAIDs), apply ice on the incision, and take acetaminophen 300 mg/codeine 30 mg as needed for breakthrough pain. Men were evaluated within 1‐2 weeks after surgery. Statistical analysis was performed using Microsoft Excel and Stata/IC 15.1. Results A total of eighty‐seven men met inclusion criteria, fifty‐four men received eight acetaminophen/codeine pills, and thirty‐three men received four pills. There was no significant difference in mean pain score (0‐10) of men receiving eight pills vs four pills in the week after surgery (3.6 ± 1.9 vs 3.3 ± 1.8, P = .5004). Of men who used NSAIDs and ice, 93.5% and 92.3% found them to be moderately or very helpful. Conclusion Reducing the total prescription of combined narcotic/non‐narcotic medication is not associated with increased postoperative pain in patients undergoing scrotal/inguinal surgery. There was no difference in postoperative pain in men taking eight or four acetaminophen 300 mg/codeine 30 mg pills. A limited prescription of eight or four pills was adequate for pain control in the majority of men who underwent scrotal surgery. NSAIDs and ice were found to be useful adjuncts for pain relief by those who used them.

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Objective: To study the factors that influence men's disposition toward postmortem disposition of their cryopreserved gametes. Design: Retrospective chart review. Setting: Large academic health center. Patient(s): All patients R18 years of age who underwent sperm cryopreservation from June 2016 to January 2020 were included. Samples intended for donation or records with an unspecified reason for preservation were excluded. Interventions(s): Not applicable. Main Outcome Measure(s): Patients' reasons for undergoing sperm cryopreservation, method of retrieval, and whether they chose to have the sample preserved or discarded postmortem. Result(s): A total of 217 participants were included, with a mean age of 35.8 AE 10.8 years. Of these, 176 (81.1%) decided to preserve their sperm for a spouse and 41 (18.9%) elected to have the sample discarded when choosing the fate of their cryopreserved sample after their death. There was no significant difference in disposition toward sample fate based on age or method of collection. However, there was a significant difference based on the ''reason for cryopreservation.'' We found that compared with patients who underwent sperm cryopreservation because of cancer-related treatments, the patients who underwent sperm banking before vasectomy were more inclined to discard the sample. Men whose sperm was collected as in vitro fertilization backup were less willing to discard the sample. Conclusion(s):It appears that men's dispositions toward postmortem disposition of their cryopreserved sperm are influenced by reason for cryopreservation, rather than age or method used for collection. As cryopreservation has become more common and affordable, understanding the factors that affect men's disposition toward the postmortem disposition of the cryopreserved gametes is imperative, because this knowledge has the potential to influence institutional policies and legislation, and may help in resolving future legal conflicts and ethical dilemmas. (Fertil Steril Rep Ò 2020;1:21-4. Ó2020 by American Society for Reproductive Medicine.

Physician assistants (PA) and nurse practitioners have been moving toward specialty practices, like urology. With increased training and education, they manage more complex conditions independently. Whether they are the primary provider or the follow up to a specialist, physician extenders can play a vital role in managing patients undergoing testosterone therapy. Physician extenders should be able to understand the indications, risks and associated adverse effects of administering testosterone in order to proficiently take care of patients with low testosterone. The goal of this review is to recognize the role and the limits to which physician extenders should manage hypogonadism, and when physician collaboration or referral is necessary.