顧芳瑜1、陳偉傑1、吳建志1,2,3
1臺北醫學大學附設醫院泌尿科;
臺北醫學大學醫學系 2泌尿學科，3醫學教育暨人文學科
Treatment choice for azoospermic man caused by exogenous testosterone: A case report and literature review

Fang-Yu Ku1、Wei-Cheih Chen1、Chien-Chih Wu1,2,3 1Department of Urology, Taipei Medical University Hospital;
School of Medicine, Department of 2Urology, 3Education and Humanities in Medicine, Taipei Medical University

 

Purpose: To evaluate the treatment choice for an azoospermic man caused by long term exogenous testosterone replacement therapy.
Case Report: A 36-year-old infertile man was referred from Reproductive Center due to zero sperm count found by his semen analysis in December 2016. According to him, he received testosterone injection therapy in order to strengthen his erectile function about once per month since one year before. Physical examination revealed bilateral testes normal in volume and consistency, bilateral epididymides not swelling or palpable indurated nodule, bilateral vas deferens palpable.
Hormone assay showed E2 56.19 pg/mL, FSH 0.14 mIU/mL, LH <0.10 mIU/mL, Prolactin 15.55 ng/mL, and Testosterone 4.16 ng/mL. Spermatogenesis failure caused by exogenous testosterone was impressed. The gynecologist and embryologist in Reproductive Center suggested surgical sperm retrieval to do ICSI. The treatment choice became a decision making issue.
Literature Review: Both testosterone replacement and anabolic androgenic steroid use can lead to
suppression of the hypothalamic-pituitary-gonadal axis (HPG axis), resulting in a diminution of spermatogenesis. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. An increased production of endogenous testosterone may be accomplished using strategies such as injectable gonadotropins (hCG), selective estrogen receptor modulators, and aromatase inhibitors, although these are off-label use. There is no literature discussing about surgical sperm retrieval to do ICSI for exogenous testosterone caused spermatogenesis failure.

1