The efficacy of anastrozole in subfertile men with and without abnormal testosterone to estradiol ratios

Abstract

BackgroundAromatase inhibitors (AIs), such as anastrozole, have shown effectiveness in treating oligoasthenozoospermia due to abnormal testosterone to estradiol (T/E2) ratio (T/E2 <10). However, its efficacy in subfertile men without abnormal T/E2 ratio (T/E2 >10) remained unevaluated. This retrospective study aimed to investigate whether patients with T/E2 ratio >10 could also benefit from anastrozole treatment.MethodsOne hundred and five subfertile patients treated with 1 mg anastrozole daily were included, in which 62 patients had a T/E2 ratio of <10, and 43 patients had this ratio >10. Semen parameters and sex hormone levels (including FSH, LH, PRL, E2 and total T) were measured before and after a three-month treatment. T/E2 ratio and total progressive motility sperm count were calculated from these results.ResultsPatients in both groups (T/E2 ratio <10 and >10) showed significant increase in sex hormone levels (FSH, LH and total T), T/E2 ratio and semen parameters (semen volume, sperm concentration, total sperm count, progressive motility and total progressive motility count). The changes of these parameters between two groups were comparable. A subgroup analysis comparing the effect of anastrozole on overweight and normal patients also showed no significant difference. Improvements in semen parameters were seen in some azoospermic and cryptozoospermic patients.ConclusionsThe majority of subfertile men with and without abnormal T/E2 ratios responded to anastrozole treatment with significantly improved semen parameters and sex hormone levels. Anastrozole showed potential effectiveness in male subfertile patients with T/E2 >10, to be confirmed by future prospective, randomized, controlled studies.