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Urology. 2015 May;85(5):1068-1073. doi: 10.1016/j.urology.2014.12.052. Epub 2015 Mar 25.

Medical testosterone: an iatrogenic cause of male infertility and a growing problem.

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Department of Urology, University of Alabama at Birmingham, Birmingham, AL. Electronic address:
Department of Urology, University of Alabama at Birmingham, Birmingham, AL.
Department of Urology, University of Kansas Medical Center, Kansas City, KS.



To determine (1) the frequency of testosterone (T) use in 2 academic male infertility practices, (2) the effect on semen parameters, and (3) the potential for reversibility.


We performed a retrospective review. Inclusion criteria were supplemental T usage at the time of initial visit, T cessation, and semen analyses before and after T cessation.


From January 2005 to March 2011, 110 of 1540 patients evaluated for infertility (7.1%) were on supplemental T. Thirty-nine patients met the inclusion criteria. Twenty-two of 39 patients (56%) were started on medical recovery by medical treatment. Median sperm concentration increased from 0 to 6.3 million/mL (P <.0001) after T cessation, with median follow-up of 4.5 months. Eight men (21%) remained azoospermic, and 3 men had sperm concentrations of ≤ 0.1 million/mL. Fifteen of 22 men given medical treatment and 16 of 17 men given no treatment had sperm return to the semen, respectively (P = .1061). Final sperm concentration did not differ between those who received medical treatment and those who did not.


Exogenous T treatment causes infertility and is common among reproductive-aged men. These effects are transient for some, but not all men had return of sperm to the semen during the study interval, suggesting a possible underlying primary testicular dysfunction or ongoing hypothalamic-pituitary-testicular axis suppression. Education about exogenous T's negative reproductive effects is necessary to avoid this preventable form of infertility. Men with low T levels should have sufficient evaluation to evaluate for underlying pathology before starting T.

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