Low testosterone, also known as hypogonadism, is a common diagnosis made in over 13 million men in the United States annually. The challenge in men wanting to maintain fertility potential who are hypogonadal has been that all the traditional forms of testosterone replacement therapy (TRT) such as gels and injections suppress sperm production to zero or nearly zero. The most common treatment for hypogonadism for men desiring to maintain sperm production has been the off-label use of clomiphene citrate (CC) that is effective in most men at brining testosterone levels to normal levels. The challenge has been that the majority of men do not get as significant of a symptomatic response, especially in libido, on CC as they do on TRT. Natesto®, a nasal gel form of TRT has been shown to not significantly decrease sperm production in a recent clinical trial. Since this data was presented, AFRM began offering the opportunity for patients with a poor symptomatic response on CC to change treatment to Natesto®. The findings of the outcomes in these men were accepted to be presented at the American Urological Association meeting in Washington, DC, but unfortunately due to the COVID 19 pandemic the meeting was canceled. The AUA is proceeding with the meeting in a virtual format and the team at AFRM has the opportunity to present their outcomes which revealed that men who converted from CC to Natesto® had improvement in libido, maintained semen parameters and fertility potential, and resulted in lower estrogen levels than CC.
Dr. Parviz Kavoussi states, “This drug has been a true breakthrough in the ability to treat men with low testosterone in a manner that gives an optimal symptom response, improves testosterone levels, and maintains sperm production, a response that was not to be thought possible prior to this medication.”