As more men are being diagnosed with hypogonadism (testosterone deficiency) at younger ages, a challenge has been treating them with medications to increase testosterone levels in a way that is not detrimental for their sperm production and fertility potential.  Traditionally medications such as clomiphene citrate and hCG have been used to stimulate testicular cell testosterone production in a way that is not detrimental for sperm production.  However, there is variable symptomatic response in men on these treatments.  Recent data has indicated that a short acting frequently administered intranasal testosterone gel may allow for administration of direct testosterone replacement without significantly suppressing sperm production.  A new oral form of testosterone replacement has hit the market which is another short acting twice a day treatment.  Dr. Parviz Kavoussi presented data on this drug at the 2020 virtual Sexual Medicine Society of North America annual meeting.  He presented data indicating that similar to the intranasal gel, the short-acting testosterone pill does not completely suppress the signaling hormones (FSH and LH) to zero, whose jobs are to command the testicular cells to make sperm and testosterone, as most forms of testosterone replacement like gels and injections do completely suppress these command signals.  Dr. Kavoussi states, “This certainly does not prove that men can maintain sperm production on this medication, but is just the first piece of information to formulate such a potential hypothesis to design further research studies to see if this may be true.”