Concomitant Intramuscular Human Chorionic Gonadotropin

Preserves Spermatogenesis in Men Undergoing Testosterone

Replacement Therapy

Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of

Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island

Purpose:

Testosterone replacement therapy results in decreased serum gonado-

tropins and intratesticular testosterone, and impairs spermatogenesis, leading to

azoospermia in 40% of patients. However, intratesticular testosterone can be

maintained during testosterone replacement therapy with co-administration of

low dose human chorionic gonadotropin, which may support continued spermato-

genesis in patients on testosterone replacement therapy.

Materials and Methods:

We retrospectively reviewed the records of hypogonadal

men treated with testosterone replacement therapy and concomitant low dose hu-

man chorionic gonadotropin. Testosterone replacement consisted of daily topical gel

or weekly intramuscular injection with intramuscular human chorionic gonadotro-

pin (500 IU) every other day. Serum and free testosterone, estradiol, semen param-

eters and pregnancy rates were evaluated before and during therapy.

Results:

A total of 26 men with a mean age of 35.9 years were included in the

study. Mean followup was 6.2 months. Of the men 19 were treated with injectable

testosterone and 7 were treated with transdermal gel. Mean serum hormone

levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl

(p

±

0.0001), free testosterone 8.1 vs 20.4 pg/ml (p

²

0.02) and estradiol 2.2 vs 3.7

pg/ml (p

²

0.11). Pretreatment semen parameters were volume 2.9 ml, density

35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in

semen parameters were observed during greater than 1 year of followup. No

impact on semen parameters was observed as a function of testosterone formu-

lation. No patient became azoospermic during concomitant testosterone replace-

ment and human chorionic gonadotropin therapy. Nine of 26 men contributed to

pregnancy with the partner during followup.

Conclusions:

Low dose human chorionic gonadotropin appears to maintain se-

men parameters in hypogonadal men on testosterone replacement therapy. Con-

current testosterone replacement and human chorionic gonadotropin use may

preserve fertility in hypogonadal males who desire fertility preservation while on

testosterone replacement therapy.

Key Words:

testis; infertility, male; testosterone; chorionic

gonadotropin; spermatogenesis

Abbreviations

and Acronyms

E

²

estradiol

FP

²

forward progression

FT

²

free T

HCG

²

human chorionic

gonadotropin

T

²

testosterone

TMS

²

total motile sperm

TRT

²

T replacement therapy

Accepted for publication August 28, 2012.

Study received institutional review board ap-

proval.

* Correspondence and requests for reprints:

Scott Department of Urology, Baylor College of

Medicine, 6624 Fannin St., Suite 1700, Houston,

Texas 77030 (telephone: 713-798-6163; FAX: 713-

798-6007; e-mail:

larryl@bcm.edu

).

† Financial interest and/or other relationship

with Eli Lilly, Endo, Auxilium, Allergan and Amer-

ican Medical Systems.

M

ALE

hypogonadism is characterized

by low serum T and characteristic

symptoms, including fatigue, decreased

libido, erectile dysfunction, difficulty

concentrating, sleep disturbances and

loss of lean body mass or weight gain.

The prevalence of male hypogonadism

is reported to be 37% in the United

States and a higher prevalence is ob-

served with increasing age.

The im-

0022-5347/13/1892-0647/0

THE JOURNAL OF UROLOGY

Vol. 189, 647-650, February 2013

© 2013 by A

MERICAN

U

ROLOGICAL

A

SSOCIATION

E

DUCATION AND

R

ESEARCH

,I

NC

.

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