Strategies to Increase Testosterone in Men Seeking Fertility.

IF 1 Q4 UROLOGY & NEPHROLOGY
Kevin Y Chu, Justin K Achua, Ranjith Ramasamy
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引用次数: 4

Abstract

Prevalence of testosterone deficiency is increasing in the adolescent and young adult male population. As the average paternal age rises, there is a significant population of men with hypogonadism seeking testosterone therapy wishing to achieve or maintain fertility potential. Identification of potential lifestyle modifications that may improve the testosterone deficiency is one of the initial interventions of the holistic strategy in treatment. This is followed by drug therapy; however, traditional testosterone therapy acts as a contraceptive by suppressing the hypothalamus-pituitary-gonadal (HPG) axis and therefore cannot be used as a treatment strategy. A solution has been the off-label use of selective estrogen receptor modulators, human chorionic gonadotropin (hCG), and anastrozole inhibitors to treat hypogonadal symptoms while increasing intratesticular testosterone, a necessity for spermatogenesis. Recently, a novel therapy, Natesto intranasal testosterone gel, has been shown to increase serum testosterone levels while maintaining semen parameters. This is hypothesized to be because of its short-acting properties having lesser effect on the HPG axis, in contrast to the long-acting properties of traditional testosterone therapy. It is important to differentiate hypogonadal men between those seeking to achieve or maintain fertility status because the drug therapy of choice differs. This can be accomplished by determining the levels of 17-hydroxyprogesterone (17-OHP), because it is a biomarker for intratesticular testosterone. Those with low 17-OHP may wish to initiate treatment with alternative therapies, whereas those with high 17-OHP may trial short-acting testosterone therapies. As the urologist's armamentarium continues to increase, better strategies to increase testosterone levels in men seeking fertility can be achieved.

寻求生育能力的男性增加睾丸激素的策略。
青少年和年轻成年男性人群中睾酮缺乏的患病率正在增加。随着平均父亲年龄的增加,有相当一部分患有性腺功能减退症的男性寻求睾酮治疗,希望实现或保持生育潜力。识别可能改善睾酮缺乏症的潜在生活方式改变是整体治疗策略的初步干预措施之一。然后是药物治疗;然而,传统的睾酮治疗通过抑制下丘脑-垂体-性腺(HPG)轴来起避孕作用,因此不能用作治疗策略。一种解决方案是在标签外使用选择性雌激素受体调节剂、人绒毛膜促性腺激素(hCG)和阿那曲唑抑制剂来治疗性腺功能减退症状,同时增加睾丸内睾酮,这是精子发生的必要条件。最近,一种新的治疗方法,Natesto鼻内睾酮凝胶,已被证明可以在保持精液参数的同时提高血清睾酮水平。据推测,这是因为与传统睾酮治疗的长效特性相比,其短效特性对HPG轴的影响较小。区分性腺功能减退的男性和寻求达到或保持生育状态的男性很重要,因为选择的药物治疗不同。这可以通过测定17-羟基孕酮(17-OHP)的水平来实现,因为它是睾丸内睾酮的生物标志物。17-OHP低的患者可能希望开始采用替代疗法进行治疗,而17-OHP高的患者可能会尝试短效睾酮疗法。随着泌尿科医生的医疗设备不断增加,可以采取更好的策略来提高寻求生育能力的男性的睾酮水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Turkish journal of urology
Turkish journal of urology Medicine-Urology
CiteScore
2.10
自引率
0.00%
发文量
53
期刊介绍: The aim of the Turkish Journal of Urology is to contribute to the literature by publishing scientifically high-quality research articles as well as reviews, editorials, letters to the editor and case reports. The journal’s target audience includes, urology specialists, medical specialty fellows and other specialists and practitioners who are interested in the field of urology.
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