Reply: To PMID 25307733.

Abstract

Lost in the aftermath of the exponential growth of testosterone supplementation therapy (TST) are numerous downstream effects dealt with by the male fertility specialist. One previously unappreciated effect of TST is how the suppression of spermatogenesis creates a dilemma for the vasectomy reversal surgeon, potentially affecting the method of reconstruction, and thus, the outcomes. In the present article, preoperative testicular salvage therapy was used to optimize spermatogenesis before reversal. The proposed protocol for salvage therapy after discontinuation of TST routinely recommended included a combination of clomiphene citrate (25 mg daily) with human chorionic gonadotropin (3000 units subcutaneously every other day) for a period of 3 months before reassessment. In this study, because some patients elected to only use clomiphene, the population ultimately studied included men who received clomiphene with or without human chorionic gonadotropin. Editorial CommentUrologyVol. 84Issue 6PreviewIncreased awareness about potential links between hypogonadism and metabolic syndrome, sexual dysfunction, mood disorders, and physical fitness in men leads to dramatic increase in utilization of testosterone replacement therapy (TRT).1 Some of the men treated with TRT either never had children or remarry and decide to have children with their new spouses.2 TRT by lowering serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can lead to suppression of spermatogenesis. When human chorionic gonadotropin (hCG) was given with TRT, no suppression of spermatogenesis was observed providing convincing evidence that it is not TRT per se causing spermatogenic suppression but decrease in serum LH and FSH levels as a result of TRT. Full-Text PDF