Crosnoe Lindsey E, Grober Ethan, Ohl Dana, Kim Edward D
1 University of Tennessee Graduate School of Medicine, Knoxville, TN, USA ; 2 University of Toronto, Toronto, CA, Canada ; 3 University of Michigan, Ann Arbor, MI, USA.
Transl Androl Urol. 2013 Jun;2(2):106-13. doi: 10.3978/j.issn.2223-4683.2013.06.01.
Testosterone replacement therapy inhibits spermatogenesis, representing a problem for hypogonadal men of reproductive age.
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.
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.
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.
睾酮替代疗法会抑制精子发生，这对有生育能力的性腺功能减退男性来说是个问题。
对1990年至2013年期间PubMed上的文献进行综述。检查精液分析和妊娠结局、精子发生恢复时间、血清和睾丸内睾酮水平。
外源性睾酮会抑制睾丸内睾酮的产生，而这是正常精子发生的绝对前提条件。保护睾丸的疗法包括人绒毛膜促性腺激素（hCG）疗法或选择性雌激素受体调节剂（SERM），但也可能包括低剂量hCG与外源性睾酮联合使用。SERM，如枸橼酸氯米芬，对维持睾酮产生有效，是一种耐受性良好的口服疗法。基于缺乏长期数据，不建议常规使用芳香化酶抑制剂。
外源性补充睾酮会减少精子生成。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。枸橼酸氯米芬对希望维持未来生育潜力的男性来说是一种安全有效的疗法。虽然在普通人群中使用频率较低，但补充或不补充睾酮的hCG疗法是一种替代治疗方法。
