University of Tennessee Graduate School of Medicine, Knoxville, Tennessee 37920, USA.
Fertil Steril. 2013 Mar 1;99(3):718-24. doi: 10.1016/j.fertnstert.2012.10.052. Epub 2012 Dec 7.
To review the mechanisms of T replacement therapy's inhibition of spermatogenesis and current therapeutic approaches in reproductive aged men.
Review of published literature.
PubMed search from 1990-2012.
PATIENT(S): PubMed search from 1990-2012.
INTERVENTION(S): A literature review was performed.
MAIN OUTCOME MEASURE(S): Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular T levels.
RESULT(S): Exogenous T suppresses intratesticular T production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve hCG therapy or selective estrogen receptor (ER) modulators, but may also include low-dose hCG with exogenous T. Off-label use of selective ER modulators, such as clomiphene citrate (CC), are effective for maintaining T production long term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data.
CONCLUSION(S): Exogenous T 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 T supplementation represents an alternative treatment.
综述 T 替代疗法抑制精子发生的机制及目前在生育期男性中的治疗方法。
文献复习。
1990-2012 年 PubMed 检索。
1990-2012 年 PubMed 检索。
文献复习。
精液分析和妊娠结局，精子发生恢复时间，血清和睾丸内 T 水平。
外源性 T 抑制睾丸内 T 产生，这是正常精子发生的绝对前提。保护睾丸的治疗方法包括 hCG 治疗或选择性雌激素受体（ER）调节剂，但也可能包括低剂量 hCG 与外源性 T。选择 ER 调节剂（如枸橼酸氯米酚（CC））的超适应证使用对于长期维持 T 产生是有效的，并提供了一种安全、口服治疗的便利。目前，由于缺乏长期数据，不推荐常规使用芳香化酶抑制剂。
外源性 T 补充会降低精子生成。激素避孕研究表明，大多数男性在停药后 1 年内精子生成恢复正常。枸橼酸氯米酚是希望保持未来潜在生育能力的男性的安全有效治疗方法。尽管在普通人群中使用较少，但 hCG 联合或不联合 T 补充的治疗方法是一种替代治疗方法。
