MP44-10 CONVERTING MEN FROM CLOMIPHENE CITRATE TO NATESTO® FOR HYPOGONADISM IMPROVES LIBIDO, MAINTAINS SEMEN PARAMETERS, AND REDUCES ESTRADIOL

Abstract

You have accessJournal of UrologyInfertility: Therapy I (MP44)1 Apr 2020MP44-10 CONVERTING MEN FROM CLOMIPHENE CITRATE TO NATESTO® FOR HYPOGONADISM IMPROVES LIBIDO, MAINTAINS SEMEN PARAMETERS, AND REDUCES ESTRADIOL Parviz Kavoussi*, G. Luke Machen, Melissa Gilkey, Caitlin Hunn, Shu-Hung Chen, Keikhosrow Kavoussi, Amy Esqueda, J. David Wininger, and Shahryar Kavoussi Parviz Kavoussi*Parviz Kavoussi* More articles by this author , G. Luke MachenG. Luke Machen More articles by this author , Melissa GilkeyMelissa Gilkey More articles by this author , Caitlin HunnCaitlin Hunn More articles by this author , Shu-Hung ChenShu-Hung Chen More articles by this author , Keikhosrow KavoussiKeikhosrow Kavoussi More articles by this author , Amy EsquedaAmy Esqueda More articles by this author , J. David WiningerJ. David Wininger More articles by this author , and Shahryar KavoussiShahryar Kavoussi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000899.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditional testosterone replacement therapy (TRT) such as gels and injections, suppress the gonadotropins follicle stimulating hormone (FSH) and luteinizing hormone (LH), thereby suppressing spermatogenesis downstream. Clomiphene citrate (CC) is an off-label treatment for hypogonadism in a spermatogenic preserving manner. Most men have normalization of testosterone (T) on CC, but estradiol (E2) levels commonly rise, and symptomatic response is worse on CC than on TRT, particularly libido. The intranasal TRT, Natesto®, at more frequent intervals allows FSH and LH to remain at normal levels. A phase IV clinical trial has shown men treated with Natesto® did not have a significant suppression of semen parameters from baseline. Our objective was to evaluate outcomes in men converted from CC to Natesto®. METHODS: Retrospective chart review of men on CC with low libido who changed to Natesto®. Semen analyses, T, and E2 levels were obtained on CC and again 3 months after discontinuing CC and initiating Natesto®. Results are reported as means with standard deviations. RESULTS: Forty-six men desiring to maintain fertility potential changed from CC to Natesto® and 15 of them had reached the 3 months post-Natesto® treatment to evaluate their responses. The mean age was 39 (7) years and they had improvements in T levels on both treatments, but significantly higher E2 levels on CC than baseline or on Natesto®. There was no significant change in any semen parameters comparing them while on CC to after converting to Natesto®. All patients reported improved libido after converting from CC to Natesto®. CONCLUSIONS: Although men reach eugonadal T levels on both CC and Natesto®, CC nearly doubled E2 levels from baseline, and converting men from CC to Natesto® returned E2 to baseline levels. There was not a detrimental effect on semen parameters, and there was subjective reporting of improved libido after converting from CC to Natesto®. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e659-e660 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Parviz Kavoussi* More articles by this author G. Luke Machen More articles by this author Melissa Gilkey More articles by this author Caitlin Hunn More articles by this author Shu-Hung Chen More articles by this author Keikhosrow Kavoussi More articles by this author Amy Esqueda More articles by this author J. David Wininger More articles by this author Shahryar Kavoussi More articles by this author Expand All Advertisement PDF downloadLoading ...