Men who have low testosterone and want to conceive or maintain fertility potential should not be treated with testosterone replacement. As more men are being diagnosed with low testosterone across the US, this group of men needs to be treated very carefully. The problem is that giving men testosterone replacement, as is the traditional treatment for low testosterone, with options like gels, injections, or subcutaneous pellets, is harmful for a man’s fertility. When we give the body testosterone replacement, it fools the body into thinking it made that testosterone, and the signaling hormones telling the testicles to work (FSH and LH) think the testicles are doing a good job so the body stops sending these signals and the testicles shut down. Along with that, men on testosterone replacement typically have a sperm count of zero or nearly zero. In some men, testosterone replacement can even have a long term adverse effect on fertility. Dr. Kavoussi states, “Fortunately there are drugs we can use to treat men with low testosterone in a way that is fertility preserving and not harmful for sperm production, by actually increasing the signals to make the testicles work harder to produce testosterone. The most common one I prescribe is Clomid Citrate because it is oral, affordable, and will work in most men with a minimal side effect profile. It also has a fair amount of scientific data and studies to support its use, and has been used for years and years, even though this is an off-label use of the drug and it is not the indication for which it was FDA approved”.
One of the main side effects that we worry about with direct testosterone replacement is the potential of increasing red blood cell production in the blood vessels (hemoglobin/hematocrit), with possible harmful effects. Dr. Kavoussi recently collaborated with the Urology Department at the University of Virginia to perform a study to prove that there is an extremely low risk of this occurring on Clomid Citrate when compared to testosterone, suggesting it is safer from that standpoint. This gives further support to the use of Clomid Citrate to treat men with low testosterone until that man is completely done having children. This research was recently presented at the 2016 American Urological Association annual meeting in San Diego.