Kolettis Peter N, Purcell Matthew L, Parker William, Poston Tyler, Nangia Ajay K
Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
Urology. 2015 May;85(5):1068-1073. doi: 10.1016/j.urology.2014.12.052. Epub 2015 Mar 25.
To determine (1) the frequency of testosterone (T) use in 2 academic male infertility practices, (2) the effect on semen parameters, and (3) the potential for reversibility.
We performed a retrospective review. Inclusion criteria were supplemental T usage at the time of initial visit, T cessation, and semen analyses before and after T cessation.
From January 2005 to March 2011, 110 of 1540 patients evaluated for infertility (7.1%) were on supplemental T. Thirty-nine patients met the inclusion criteria. Twenty-two of 39 patients (56%) were started on medical recovery by medical treatment. Median sperm concentration increased from 0 to 6.3 million/mL (P <.0001) after T cessation, with median follow-up of 4.5 months. Eight men (21%) remained azoospermic, and 3 men had sperm concentrations of ≤ 0.1 million/mL. Fifteen of 22 men given medical treatment and 16 of 17 men given no treatment had sperm return to the semen, respectively (P = .1061). Final sperm concentration did not differ between those who received medical treatment and those who did not.
Exogenous T treatment causes infertility and is common among reproductive-aged men. These effects are transient for some, but not all men had return of sperm to the semen during the study interval, suggesting a possible underlying primary testicular dysfunction or ongoing hypothalamic-pituitary-testicular axis suppression. Education about exogenous T's negative reproductive effects is necessary to avoid this preventable form of infertility. Men with low T levels should have sufficient evaluation to evaluate for underlying pathology before starting T.
确定（1）两家学术性男性不育诊疗机构中睾酮（T）的使用频率，（2）其对精液参数的影响，以及（3）可逆性的可能性。
我们进行了一项回顾性研究。纳入标准为初次就诊时使用补充睾酮、停用睾酮，以及停用睾酮前后的精液分析。
2005年1月至2011年3月，1540例接受不育评估的患者中有110例（7.1%）使用补充睾酮。39例患者符合纳入标准。39例患者中有22例（56%）开始接受药物恢复治疗。停用睾酮后，中位精子浓度从0增加至630万/mL（P<.0001），中位随访时间为4.5个月。8名男性（21%）仍无精子，3名男性的精子浓度≤10万/mL。接受治疗的22名男性中有15名、未接受治疗的17名男性中有16名精子分别回到精液中（P = 0.1061）。接受治疗者与未接受治疗者的最终精子浓度无差异。
外源性睾酮治疗会导致不育，在育龄男性中很常见。这些影响对一些人来说是短暂的，但并非所有男性在研究期间精子都回到了精液中，这表明可能存在潜在的原发性睾丸功能障碍或持续的下丘脑-垂体-睾丸轴抑制。有必要开展关于外源性睾酮对生殖的负面影响的教育，以避免这种可预防的不育形式。睾酮水平低的男性在开始使用睾酮前应进行充分评估，以评估潜在的病理情况。
