A longstanding dilemma in male reproductive medicine has been the treatment of low testosterone in men desiring to maintain fertility. As the majority of testosterone replacement options such as gels and injections diminish sperm production, the primary option has traditionally been the off-label use of clomiphene citrate (CC) to increase serum testosterone levels in a manner that is not adverse for sperm production. The challenge has been that many men do not get as robust of a symptomatic response on CC as they do on direct testosterone replacement.
The team at AFRM published a study revealing that men who converted from CC to the intranasal form of testosterone replacement (Natesto) had a more robust symptomatic response without diminishing their semen parameters. Dr. Parviz Kavoussi recently published a follow up study reporting a single patient who did drop his sperm count after converting from CC to Natesto; however, he had such a better symptomatic response he did not want to discontinue the Natesto. His dose was decreased, his symptoms continued to respond well, his testosterone level remained normal, and his sperm production resumed. Simple dose adjustment allowed for return of fertility potential in this individual. The study also updated the data indicating that the overwhelming majority of men making this medication change maintained sperm production similar to when on CC. Dr. Kavoussi states, “The ability to use Natesto as a form of testosterone replacement in a manner that maintains sperm production in most men is a great breakthrough; however, it is important to recognize that this not one-hundred percent. Therefore, men making this change in medication should be followed closely with serum and sperm testing to confirm spermatogenesis is being maintained.” To read the most recent study click here.