It seems like more and more attention is being given to testosterone therapy and testosterone replacement. It has been commonly acknowledged that men’s testosterone levels drop as they age and many men will need help. Commercials for testosterone products such as testosterone gels abound on TV. However some use of testosterone replacement may cross the line of true medical necessity.
Recent headlines have reported on Sports figures that attended “rejuvenation clinics” to obtain testosterone or who obtained and then used anabolic steroids from other sources, giving them , potentially, an unfair edge. Some Olympic figures have used testosterone. The New Jersey Star Ledger reported on testosterone use in law enforcement. In fact, some people believe that non medical use of androgens has become a public health concern with the prevalence of male gym attendees using estimated to be as high as 15 to 30%.
For many patients who take testosterone, the therapy has been tremendously successful in terms of addressing their needs of a restoration to their energy level, their libido, and their strength. Patients who are on testosterone can maximize its safety by following up with their physician for monitoring and ensuring that their levels are maintained within a reasonable range. However, unmonitored Testosterone and or anabolic steroid use can have a variety of negative health effects including gynecomastia (male breast tissue), polycythemia (blood count increased to an unhealthy range), decreased libido, elevated liver enzymes , fluid retention and changes in cholesterol metabolism to name a few.
Regardless of how therapy is accomplished, whether under a doctor’s care or acquiring and using through less legitimate means, Testosterone therapy, by itself, lowers sperm production over time and fertility problems in men who take testosterone and or other anabolic steroids is common. The current practice among body builders and others of “stacking” different anabolic agents can make the problem more profound and therapy to attempt to undo the damage may require more time and different medications.
Normal testosterone production in the body depends on the hypothalamic-Pituitary-Gonadal (HPG) axis. The testes make testosterone and when their production drops, the hypothalamus triggers the pituitary gland to release a chemical called Luteinizing hormone (LH). LH then signals the testes to resume testosterone production. Taking exogenous (from outside the body) testosterone disrupts this axis and suppresses LH release. LH release is also tied to release of Follicle stimulating hormone (FSH) a chemical released by the pituitary to stimulate sperm production. When LH release is suppressed, so is FSH release.
For patients that use anabolic steroids and or testosterone and who have fertility issues, treatment and resolution of fertility problems is usually feasible with appropriate treatment, best accomplished under the guidance of a properly educated and trained physician. Physicians who have particular expertise in these issues are more commonly endocrinologists and urologists, particularly urologists with an interest in or special training in male fertility.
In my practice, I’ve seen a number of patients on testosterone therapy or on androgen supplementation for a variety of reasons. Depending on the duration of medication, number of agents used and the dosage, impairment to sperm production can range from lower sperm count to an absolute cessation in sperm production and a total absence of sperm in the ejaculate (also known as azoospermia). Depending on the body’s response to cessation of androgen supplements, a variety of therapies are available to help restore sperm production. Typically several months are necessary for maximal response. A key to success in treatment is a willingness on the part of the patient to work with his doctor and comply with therapy.