Oral testosterone pills have traditionally been a big “no-no”, as the previous formulation, methyltestosterone, used in the 1970s, was ultimately found to damage the liver. As a result, there has not been a pill form of oral testosterone replacement for decades, until fairly recently. A pharmacokinetic mechanism has been developed for testosterone pills to be used in a liver-safe manner, and there are currently 3 FDA-approved brand names on the market.
Another “no-no” has been prescribing testosterone replacement therapy to men with low testosterone who wish to maintain sperm production. Traditional long-acting testosterone therapies suppress sperm production, often to zero. Oral testosterone pills may be exceptions as they are short-acting, twice-a-day pills that have demonstrated they can maintain the hormonal patterns consistent with maintaining sperm production in some, but not all men. However, there is very limited data assessing semen analyses in men taking these oral pills, with very small numbers of participants revealing mixed results. Larger studies are being conducted to evaluate the impact of oral testosterone therapy further.
Dr. Parviz Kavoussi recently co-authored a study guiding the use of oral testosterone therapy and lectured on this topic at the UC Irvine Men’s Health Course. He states, “Although we are optimistic and ongoing studies are underway, the ability of oral testosterone to maintain sperm production and in whom, has not yet been established. Until larger studies are completed, oral testosterone should be approached as potentially suppressing sperm production.”
