Low dose human chorionic gonadotropin prevents azoospermia and maintains fertility in hypogonadal men on testosterone replacement therapy

Abstract

OBJECTIVE: Exogenous testosterone administration decreases serum gonadotropins, impairs normal spermatogenesis and suppresses intratesticular testosterone levels. Azoospermia occurs in 65% of patients on testosterone replacement therapy(TRT). Recent studies have demonstrated that intratesticular testosterone levels can be maintained during exogenous TRT with co-administration of low dose human chorionic gonadotropin(HCG). It is hypothesized that HCG is protective and supports continued spermatogenesis in patients on TRT. DESIGN: This is a retrospective review of patients on TRT that were given low-dose HCG to preserve their fertility from 2008-2009. MATERIALS AND METHODS: TRT was administered as a daily topical gel or a weekly injection. Men desiring to preserve fertility were also prescribed HCG 500 units every other day. Serum testosterone, semen analysis and pregnancy outcomes were obtained before and after initiation of therapy. Statistical analysis was performed using SPSS. RESULTS: A total of 17 men were treated, with mean follow-up of 8.6 months. 71% of patients were on injectable testosterone and 29% were on topical gel. Mean serum testosterone was 290 prior to treatment and 960 during treatment. Mean sperm density was 34 M/ml prior to TRT and 26 M/ml during treatment(p=0.5). Mean sperm motility was 47% prior to therapy and 51% during therapy(p=0.8). Compared to baseline, 6/17 of patients had a lower sperm density and 2/17 had a decrease in motility during TRT. However, no patient became azoospermic. Pregnancy was achieved in 9/12 of patients attempting to conceive during treatment. CONCLUSION: Low dose HCG may be beneficial for men in their reproductive years that require TRT. HCG is protective and supportive of continued spermatogenesis when given in conjunction with injectable or topical TRT. Concurrent HCG use can preserve fertility in hypogonadal males desiring pregnancy while on TRT. Longer follow-up is needed to determine whether this benefit is sustained.