As more men are waiting until later in life to father children, and more men are being diagnosed with low testosterone at a younger age, there is a fair amount of cross-over in these 2 groups of men. A longstanding challenge in reproductive medicine has been treating men with low testosterone in a fertility preserving manner. The majority of testosterone replacement therapies suppress sperm counts, often to zero, and for some men on testosterone therapy long term, they may not bounce back in sperm production. Natesto, an intranasal testosterone replacement gel appears to be the exception to the rule.
Traditionally, men with low testosterone desiring to maintain fertility potential have been treated with clomid, a medication used off-label to stimulate testicular cells to produce more testosterone in a manner that does not suppress sperm production. The challenge has been that although some men feel just as well, many men do not get the same level of symptomatic response to clomid as they do with testosterone replacement therapy. Therefore, the goal of reaching a normalized testosterone level, achieving optimal symptomatic responses, and not compromising fertility has been a difficult combination to be successfully achieved. The team at AFRM has published a study showing this is possible with Natesto. Dr. Parviz Kavoussi states, “Men in this study were converted from clomid to Natesto and had improved libido, normalization of testosterone levels, and lower levels of estrogen on Natesto than clomid while maintaining semen analysis parameters. This data is very encouraging for this to be an option for men in this situation; however, larger studies are still needed to confirm it and clinically, follow up semen analyses are still recommended to ensure that sperm production is not compromised when treating men with low testosterone desiring to maintain sperm production, with Natesto.”