Owen Ryan C, Elkelany Osama O, Kim Edward D
University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.
Curr Opin Obstet Gynecol. 2015 Aug;27(4):258-64. doi: 10.1097/GCO.0000000000000192.
Prescribing habits for the treatment of symptomatic hypogonadism have recently stirred controversy surrounding testosterone replacement therapy. As a result, the gynecologist will need to recognize this iatrogenic form of decreased sperm production in couples seeking fertility advice. We have compiled a review of the current literature on testosterone supplementation pertaining to the gynecologic practice.
Over the last decade, testosterone use has seen a recent increase including in men desiring to become fathers. Many physicians and hypogonadal men do not recognize that testosterone replacement therapy can have a detrimental effect on spermatogenesis. Fortunately, the cessation of treatment will yield predictable recovery of sperm production for most men. A growing body of evidence supports the use of selective estrogen receptor modulators, such as clomiphene citrate, or human chorionic gonadotropin for the treatment of hypogonadism in men who wish to maintain fertility potential. Recently, the Food and Drug Administration has recommended a labeling update on testosterone products to warn of possible increased risk of venous thromboembolism, cardiovascular events and stroke.
Clinicians should be familiar with current practices involving testosterone replacement therapy and the implications on male factor fertility.
近期，症状性性腺功能减退的处方习惯引发了围绕睾酮替代疗法的争议。因此，妇科医生需要在寻求生育建议的夫妇中识别这种医源性精子生成减少的情况。我们对当前与妇科实践相关的睾酮补充文献进行了综述。
在过去十年中，睾酮的使用量有所增加，包括那些希望成为父亲的男性。许多医生和性腺功能减退的男性并未认识到睾酮替代疗法会对精子发生产生不利影响。幸运的是，对于大多数男性而言，停止治疗后精子生成将可预测地恢复。越来越多的证据支持使用选择性雌激素受体调节剂（如枸橼酸氯米芬）或人绒毛膜促性腺激素来治疗希望保持生育潜力的男性性腺功能减退。最近，美国食品药品监督管理局建议更新睾酮产品标签，以警告静脉血栓栓塞、心血管事件和中风风险可能增加。
临床医生应熟悉当前涉及睾酮替代疗法的实践及其对男性生育因素的影响。
