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Diagnosis and treatment of hypogonadism in men seeking to preserve fertility – what are the options?

International Journal of Impotence Research (2024)Cite this article

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Abstract

Male hypogonadism is a clinical syndrome that results in low testosterone levels and frequently leads to infertility. The syndrome occurs due to disruption at one or more levels of the hypothalamic-pituitary-gonadal axis. Testosterone replacement therapy (TRT) is the most common treatment utilised for male hypogonadism. However, long-acting forms of TRT leads to infertility and so is inappropriate for patients wishing to conceive. For patients who wish to remain fertile, nasal TRT, clomiphene citrate, exogenous gonadotropins, gonadotropin releasing hormone and aromatase inhibitors have been used as alternative treatment options with different degrees of success. A review of the literature was performed to identify the safety and efficacy of alternative treatment options. Gonadotropin releasing hormone can successfully induce spermatogenesis but is impractical to administer. Likewise, aromatase inhibitors have limited use due to inducing osteopenia. Nasal TRT may be a good treatment option for these patients, but its efficacy has so far only been demonstrated in small sample sizes. However, clomiphene citrate and exogenous gonadotropins are safe, offer good symptom control and can successfully induce fertility in hypogonadism patients.

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Authors and Affiliations

  1. Kingston Hospital, Kingston upon Thames, UK

    Alexander William Cloberry Lockie

  2. Northampton General Hospital, Northampton, UK

    Peter Grice

  3. Manchester Royal Infirmary, Manchester, UK

    Raj Mathur, Ian Pearce & Vaibhav Modgil

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Contributions

AWCL wrote the first draft of the paper. After this AWCL amended the paper based on the contributions from the other authors. PG assisted AWCL in writing the first draft. PG reviewed the paper multiple times and recommended amendments at each stage. RM reviewed the paper and provided us with his specialist input as a fertility expert. IP reviewed the paper and gave his input. VM had the original idea for the paper and recruited the other authors. VM provided guidance throughout on how best to address the topic. He further reviewed the paper at every stage and gave his input.

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Correspondence to Alexander William Cloberry Lockie.

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Lockie, A.W.C., Grice, P., Mathur, R. et al. Diagnosis and treatment of hypogonadism in men seeking to preserve fertility – what are the options?. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00897-4

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