The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use

Wenker, Evan P.; Dupree, James M.; Langille, Gavin; Kovac, Jason R.; Ramasamy, Ranjith; Lamb, Dolores J.; Mills, Jesse N.; Lipshultz, Larry I.

doi:10.1111/jsm.12890

Cited by 66 publications

(54 citation statements)

References 8 publications

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“…In a preliminary study, we demonstrated that hCG therapy promotes sperm recovery after presumed testosterone-associated infertility (12). In the present study, important new findings are observed.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated that cessation of TTh in men seeking fertility treatment can lead to a return to baseline sperm concentrations (6, 10–12). However, the time for return of sperm to the ejaculate in quantities sufficient for fertility remains unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Another study examining more than 14,000 semen samples from World Health Organization (WHO) studies in which androgens were evaluated as a potential male contraceptive found that sperm production after therapy was only approximately 85% of pre-treatment concentrations (11). The literature also suggests that men who have been on high-dose TTh for longer periods will require longer to recover normal sperm production (12, 13). …”

Section: Introductionmentioning

confidence: 99%

“…Human chorionic gonadotropin (hCG) and selective estrogen receptor modulators (SERMs) are effective at restoring spermatogenesis alone and in combination (12, 14–17). The efficacy of hCG is attributed to its structural similarity to LH.…”

Section: Introductionmentioning

confidence: 99%

“…hCG doses described in the literature range from 3,000 – 10,000 IU, administered 2–3 times per week (8, 13, 15, 18, 19). In a retrospective chart review of azoospermic or severely oligospermic men, Wenkler et al observed return of spermatogenesis in a mean of 4.6 months with a mean density of 22 million sperm / mL in 95.9% of subjects receiving hCG 3000 IU every other day, along with either FSH, clomiphene citrate, tamoxifen, or anastrozole (12). In another retrospective review by Coward et al , men previously on TTh and seeking vasectomy reversal were treated with high-dose hCG (3000 IU every other day) and clomiphene citrate, with 83% having normalization of LH, FSH and testosterone levels (15).…”

Section: Introductionmentioning

confidence: 99%

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Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy

Kohn

Louis

Pickett

et al. 2017

Fertility and Sterility

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Objective To determine factors that influence sperm recovery after testosterone-associated infertility. Design Clinical retrospective study. Setting Academic male-infertility urology clinic. Patient(s) Sixty-six men who presented with infertility after testosterone use. Intervention(s) Testosterone (T) cessation and combination high-dose human chorionic gonadotropin (hCG) and selective estrogen modulator (SERM) therapy. Main Outcome Measure(s) Whether patients successfully achieved or failed to achieve a total motile count (TMC) of greater than 5 million sperm within 12 months of T cessation and initiation of therapy. Result(s) A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of testosterone use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of testosterone use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery. Conclusion(s) Increasing age and duration of testosterone use significantly reduce the likelihood of recovery of sperm in the ejaculate, based on a criterion of a TMC of 5 million sperm, at 6 and 12 months. Physicians should be cautious in pursuing long-term testosterone therapy, particularly in men who still desire fertility. Using these findings, physicians can counsel men regarding the likelihood of recovery of sperm at 6 and 12 months.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy

Kohn

Louis

Pickett

et al. 2017

Fertility and Sterility

Self Cite

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Influence of multiple human chorionic gonadotropin administrations on serum and urinary steroid Athlete Biological Passport profiles in males

Goodrum,

Moore,

Crouch

et al. 2023

Drug Testing and Analysis

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The Athlete Biological Passport (ABP) is a longitudinal tool used in anti‐doping to monitor biological parameters known to change with performance‐enhancing drug use. The ABP consists of multiple modules, including two aimed at detecting the use of endogenous anabolic androgenic steroids: the urinary and serum steroid modules. Human chorionic gonadotropin (hCG) is a protein hormone potentially abused by male athletes to increase the production of endogenous testosterone. To date, no studies have investigated the impact of extended hCG administration on the urinary and serum steroid modules of the ABP. The goal of this study was to identify the impact of multiple hCG administrations on the parameters tracked as part of the urinary and serum steroid modules of the ABP. Ten recreationally active, healthy male individuals self‐administered seven 250 μg hCG injections over 3 weeks. Serum and urine samples were collected before, during, and 2 weeks following the final injection. All ABP parameters were quantified in the respective matrix, and steroid profiles were created with Anti‐Doping Administration and Management System adaptive model upper and lower limits for both matrices. In both serum and urine profiles, testosterone increased; however, the testosterone/epitestosterone ratio in urine and the testosterone/androstenedione ratio in serum showed minimal changes. Additionally, serum luteinizing hormone (LH) was quantified using an immunoassay, and a serum testosterone/LH ratio was generated. Serum LH values decreased during administration causing large increases in the serum T/LH ratio, indicating this ratio may be a more sensitive parameter for detecting hCG abuse than urinary testosterone/epitestosterone or serum testosterone/androstenedione.

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Androgenic‐anabolic steroid abuse trend and management: A prospective, cross‐sectional, questionnaire‐based survey

Hashimi

Farahat²,

Kandil

et al. 2023

Health Science Reports

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Background and Aims Androgenic‐anabolic steroid (AAS) abuse is a global health concern, studies revealing an increasing trend of abuse and deleterious effects on reproductive health. Unfortunately, there is no consensus about management pathways due to the lack of specific guidelines. Methods A prospective study, multicentre, online survey, composed of 30 questions, was conducted to investigate the current trend of AAS abuse and the management followed by practitioners from different specialities dealing with this condition. Results A total of 151 respondents were included. The majority were general urologists (68.21%), andrologists (22.51%), and endocrinologists (9.28%). An increasing trend of AAS abuse was noticed by 90.73% of participants mostly in young age populations. Most of AAS abusers were presented with infertility (64.24%) and erectile dysfunction (59.60%), and their investigations showed abnormal semen analysis (77.48%), abnormal hormones (follicle‐stimulating hormone, luteinizing hormone, testosterone, and estradiol) (94.70%), and reduction in testicular size (50.33%). Most of respondents expected: the need of long duration for spontaneous recovery (6–12 months), relapse of AAS abuse in one‐third of patients, less knowledge about the adverse effects (39.74%), and risk of drug dependence (54.30%). Immediate treatment was the most offered plan of management (44.37%) followed by a waiting spontaneous recovery (32.45%), while the remaining would refer the patients to an either endocrinologist or andrologist. The treating physicians did not follow specific guidelines and most of participants (44.44%) reverted to their personal experience in the management. Conclusions Our study revealed an increasing trend of AAS abuse, deleterious effects of AAS use on reproductive health, and lack of consensuses among the treating physicians regarding the management of related adverse effects. Our study could be considered a call to the scientific bodies to have more studies, establish guidelines for management, and to have better awareness of this serious public health concern.

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The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use

Cited by 66 publications

References 8 publications

Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy

Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy

Influence of multiple human chorionic gonadotropin administrations on serum and urinary steroid Athlete Biological Passport profiles in males

Androgenic‐anabolic steroid abuse trend and management: A prospective, cross‐sectional, questionnaire‐based survey

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