In our series, a single patient had Sertoli-cell only on testis biopsy, whereas the remaining patients had either maturation arrest or hypospermatogenesis. Although our results are higher than that reported in the literature, it should be noted that our population comprises patients with a good prognosis for sperm retrieval. Collectively, we were able to harvest sperm from 50% of patients, considering both TESA and ejaculated specimens. NOA patients with hypergonadotropic hypogonadism have an increased number of interstitial testicular lesions (containing no Leydig cells) and fibrosis compared with obstructive azoospermia patients (32).
Testosterone deficiency is defined as testosterone blood levels less than 300 nanograms per deciliter (ng/dL) along with symptoms of low testosterone. Although the study was not powered to detect cardiovascular events as a primary endpoint, the authors did not detect increased risk in the testosterone group. Individual pellets consist of 75 mg of testosterone and may be combined to deliver variable doses of testosterone therapy.
Vicari et al. looked at long term hCG treatment in 17 men with isolated hypogonadotropic hypogonadism, observing a significant increase in testicular volume, in a time-dependent manner, and testosterone, at 15 and 24 months of treatment (13). This corresponded with reports of symptom improvement in 50% of patients, with no reports of side effects or complications. In our study, we retrospectively evaluated 20 men who were treated for symptoms of hypogonadism with human chorionic gonadotropin (hCG) monotherapy. The major parameters of concern for analysis were T improvement from initial to follow-up as well as the degree of T changes as they correlated to dosage and other baseline characteristics such as LH, FSH and therapy duration. Dates of each patient’s treatment initiation and the latest follow-up visits were recorded to evaluate the average duration of treatment, and patient reports of side effects, complications and symptom improvement were recorded. The study also evaluated baseline characteristics such as age, treatment indications, hCG dosage, past medical history and physical exam findings. We sought to evaluate the response of serum testosterone to hCG monotherapy as evidence of its efficacy at various doses and therapeutic durations, as well as its safety.
Furthermore, the identification of other pituitary tumors or processes may have important clinical implications for the patient beyond testosterone deficiency.178 Hypergonadotropic hypogonadism, which is not a contraindication to begin testosterone therapy, can result from a number of conditions, including congenital abnormalities (KS being the most common), iatrogenic causes (e.g., bilateral orchiectomy, testicular radiation, chemotherapy), testicular trauma, infection, or autoimmune damage. Their role in diagnosing testosterone deficiency is unclear, and they should not be used at the expense of a full patient evaluation, including laboratory testosterone measurement. Screening questionnaires are not an appropriate tool to identify candidates for testosterone therapy. Testosterone deficiency is prevalent in men presenting for an infertility evaluation.159  The testes contain germ cells that produce spermatozoa and Leydig cells that produce testosterone; any pathology of the testes can result in infertility and testosterone deficiency, conditions that frequently co-exist. As such, all patients who have a history of unexplained anemia should have their testosterone tested.
However, per the recent American Urological Association (AUA) guidelines, it should be reserved for patients with testosterone deficiency, as defined as less than 300 ng/dL (8). We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam findings and serum testosterone and gonadotropins before and after therapy. In males, it may play important role as an alternative to testosterone for boosting testosterone levels and maintaining fertility.
Three of these men were brachytherapy patients alone, did not cease testosterone therapy, and their PSA values eventually decreased. Overall, seven studies reported no benefits on QoL in men using testosterone therapy compared to placebo,199, 205, 212, 225, 226, 230, 303, 318 while five studies demonstrated improvements.203, 317, 319, 328, 329 The impact of testosterone therapy on QoL in men with testosterone deficiency is challenging to quantify due to variable study methodology and inherent limitations with standardized questionnaires. However, when patients were requested to assess their global impression of change regarding energy level, men receiving testosterone were significantly more likely to rate changes as a little or much better compared to placebo (approximately 15% more in testosterone cohort). Patients with anemia, both unexplained and explained, can increase their Hb and/or Hct levels while on testosterone therapy.
There is also a dearth of data evaluating the safety of testosterone therapy in men treated with radiation therapy (RT). Product labels for all testosterone formulations explicitly state that their use is contraindicated in men with a history of prostate cancer, which results from Huggins' precept that testosterone therapy feeds prostate cancer cell proliferation. Studies were ineligible if they used supra-physiologic levels of testosterone or if participants were using androgens other than testosterone. The controversy surrounding prostate cancer and testosterone stems from the work of Dr. Charles Huggins who discovered that treating metastatic prostate cancer patients with ADT resulted in cancer remission,341 suggesting that the presence of testosterone would lead to an increased likelihood of prostate cancer development.
Given the increasing incidence of both testosterone deficiency and prostate cancer with advancing age, it is common for the two conditions to co-exist in older men. The other men in the study already had metastatic disease at the time of testosterone initiation. Increasing patient age and increasing duration of prior exogenous testosterone use both significantly reduced the likelihood of reaching the 5 million TMSC benchmark. In this population, exogenous testosterone was stopped and combination high-dose hCG and SERM therapy was initiated.

Gender: Female

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