Anabolic steroid-induced hypogonadism: diagnosis and treatment.

OBJECTIVE: To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management. DESIGN: Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria. SETTING: Not applicable. PATIENT(S): Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS. INTERVENTION(S): History and physical examination followed by medical intervention if necessary. MAIN OUTCOME MEASURES(S): Serum testosterone and gonadotropin levels, symptoms, and fertility restoration. RESULT(S): Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators. CONCLUSION(S): Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management.

Angled vas cutter for vasovasostomy: technique and results.

OBJECTIVE: To describe the technique and results of bilateral vasovasostomy using a 3-mm vas cutting forceps angled at 15° (catalog no. NHF-3.15; ASSI) for vasal transection. DESIGN: Retrospective chart review. Institutional review board approval was granted by Western Institutional Review Board. SETTING: Single vasectomy reversal center. PATIENT(S): Men who underwent a bilateral vasovasostomy at a single institution by a single surgeon between 2001 and 2012 and had a minimum of one semen analysis postoperatively or a reported natural conception. INTERVENTION(S): Before September 14, 2010, a straight-edge vas cutter was used on all vasovasostomy connections; 375 men received a bilateral vasovasostomy and met follow-up criteria. Beginning on September 14, 2010, an angled cutter was used on all vasovasostomy patients, with 194 men meeting the exclusion criteria. MAIN OUTCOME MEASURE(S): A minimum of 1 × 10(6) sperm reported on a postoperative semen analysis, or a reported natural conception was used to establish patency. RESULT(S): The overall vasovasostomy patency rate using the angled vas cutter was 99.5% and was 95.7% using the straight vas cutter. CONCLUSION(S): The development of an angled vas cutter provides an increased surface area for vasal wound healing to allow for larger tissue diameter for better healing, resulting in high patency rates after vasovasostomy.

Effect of rejuvenation hormones on spermatogenesis.

OBJECTIVE: To review the current literature for the effect of hormones used in rejuvenation clinics on the maintenance of spermatogenesis. DESIGN: Review of published literature. SETTING: Not applicable. PATIENT(S): Men who have undergone exogenous testosterone (T) and/or anabolic androgenic steroid (AAS) therapies. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen analysis, pregnancy outcomes, and time to recovery of spermatogenesis. RESULT(S): Exogenous testosterone and anabolic androgenic steroids suppress intratesticular testosterone production, which may lead to azoospermia or severe oligozoospermia. Therapies that protect spermatogenesis involve human chorionic gonadotropin (hCG) therapy and selective estrogen receptor modulators (SERMs). The studies examining the effect of human growth hormone (HGH) on infertile men are uncontrolled and unconvincing, but they do not appear to negatively impact spermatogenesis. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data. CONCLUSION(S): The use of hormones for rejuvenation is increasing with the aging of the Baby Boomer population. Men desiring children at a later age may be unaware of the side-effect profile of hormones used at rejuvenation centers. Testosterone and anabolic androgenic steroids have well-established detrimental effects on spermatogenesis, but recovery may be possible with cessation. Clomiphene citrate, human growth hormone (HGH)/insulin-like growth factor-1 (IGF-1), human chorionic gonadotropin (hCG), and aromatase inhibitors do not appear to have significant negative effects on sperm production, but quality data are lacking.

Impact of age on male fertility.

PURPOSE OF REVIEW: An increasing number of older men are seeking help for fathering a child, but male fertility gradually declines with age. This review highlights changes in male reproductive biology and practical clinical concerns for aging men. RECENT FINDINGS: Aging may have an impact on sperm DNA damage such as single nucleotide polymorphisms. A recent landmark study identified that the number of single gene de-novo mutations in the offspring increased by two mutations per year based on paternal age. Additionally, advanced paternal age has been linked with neurocognitive disorders such as autism and schizophrenia. For the management of hypogonadism, strategies using selective estrogen modulators have been increasingly utilized to maintain fertility potential. SUMMARY: Aging has an impact on male fertility potential, as well as potential genetic effects for the offspring.

Exogenous testosterone: a preventable cause of male infertility.

MAIN PROBLEM: Testosterone replacement therapy inhibits spermatogenesis, representing a problem for hypogonadal men of reproductive age. METHODS: A literature review of PubMed from 1990-2013. Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular testosterone levels were examined. RESULTS: Exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve human chorionic gonadotropin (hCG) therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. SERMs, such as clomiphene citrate, are effective for maintaining testosterone production and represent a well-tolerated, oral therapy. Routine use of aromatase inhibitors is not recommended based on a lack of long-term data. CONCLUSIONS: Exogenous testosterone supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment.