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Fertility Preservation in Hypogonadal Men

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The Complete Guide to Male Fertility Preservation

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Abstract

Increasing numbers of men in the United States are seeking treatment for symptomatic hypogonadism with testosterone supplementation therapy (TST). In addition, the use of anabolic-androgenic steroids (AAS) is also increasing. Our current knowledge of the male hypothalamic-pituitary-gonadal axis demonstrates that exogenous androgen use suppresses intratesticular testosterone (T) concentration and consequently shuts down spermatogenesis in the overwhelming majority of cases, leading to potential infertility. Men who are hypogonadal who have not completed their family have several medical options that will allow both the treatment of their symptoms and the preservation of spermatogenesis. Human chorionic gonadotropin, recombinant human FSH, selective estrogen receptor modulators, and aromatase inhibitors, among other agents, have been shown to increase low serum T in appropriate candidates with ondary hypogonadism. For those men who have previously been treated with TST/AAS, are currently on treatment or anticipate starting therapy, and who also desire restoration or maintenance of their fertility, these same agents have demonstrated efficacy in reversing or preventing the negative feedback of exogenous androgen on the hormonal axis. In this chapter, we propose treatment algorithms when a patient desires restoration or maintenance of his fertility in the setting of TST.

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Authors and Affiliations

  1. Department of Urology, University of Miami Health System, Miller School of Medicine, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA

    Robert J. Carrasquillo MD & Ranjith Ramasamy MD

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  1. Robert J. Carrasquillo MD
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  2. Ranjith Ramasamy MD
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Correspondence to Ranjith Ramasamy MD .

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Editors and Affiliations

  1. Department of Urology, Hamad Medical Corporation, Doha, Qatar

    Ahmad Majzoub

  2. Department of Urology, Andrology Center, Cleveland Clinic, Cleveland, Ohio, USA

    Ashok Agarwal

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Carrasquillo, R.J., Ramasamy, R. (2018). Fertility Preservation in Hypogonadal Men. In: Majzoub, A., Agarwal, A. (eds) The Complete Guide to Male Fertility Preservation. Springer, Cham. https://doi.org/10.1007/978-3-319-42396-8_9

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  • DOI: https://doi.org/10.1007/978-3-319-42396-8_9

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