Hormonal therapy in male infertility
What hormonal therapy is used in male infertility?
Testosterone is a very important fertility and sex hormone in men. It must be in normal range for better fertility outcomes. The normal range of testosterone is still controversial and differs from lab-to-lab and equipment-to equipment.
Adequate levels of endogenous testosterone (produced by the body) help in sperm production whereas exogenous testosterone (in the form of testosterone tablets or injections) suppresses sperm production due to negative feedback inhibition. Hence testosterone tablets or injections should not be taken by couples planning to have kids. Instead, we need to indirectly increase the testosterone levels using other form of medications such as clomiphene, anastrozole, letrozole, HCG injections and HMG Injections if there is low testosterone.
Is clomiphene used by men with infertility?
Yes, clomiphene is used by men to improve testosterone levels (Wheeler KM. Sex Med Rev 2019). Clomiphene is an oral tablet which was first introduced in women with infertility issues. Subsequently it is being used by andrologists since last 30-40 years to treat men with low testosterone levels and infertility.
How is clomiphene taken by men?
It is a tablet taken by mouth daily or on alternate days or twice a week depending on the testosterone levels. Your andrologist will decide the appropriate regimen.
Can hormone therapy increase sperm counts?
Hormone therapy can be given when the testosterone levels are very low. In such a scenario, hormonal therapy may improve sperms counts thereby increasing fertility rates.
Are HCG and HMG injections painful in men?
HCG and HMG injections are usually given twice or thrice a week under the skin (subcutaneous) or into the muscle (intramuscular). These injections do not cause any additional pain compared to a TT injection which you would have taken after a fall or rusted metal injury. HCG and HMG injections are given to improve testosterone levels in men and best results are seen in a case of hypogonadotropic hypogonadism.
How long is the hormonal therapy in male infertility?
The duration of hormonal therapy is usually around 3-4 months in men but may vary depending on the cause and simultaneous assisted reproductive techniques.
Who is the best doctor for hormonal therapy in male infertility?
Dr Pramod Krishnappa is the best andrologist dealing with Men’s’ Sexual Health and Male Fertility. He has been trained extensively in high volume Andrology centres in Madrid (Spain), Belgrade, Budapest, Chicago, and New York.
Dr Pramod Krishnappa has done male infertility fellowship under Prof Dr Craig Niederberger at the University of Illinois at Chicago (UIC), who is one of the first centers in the USA to start hormonal therapy in male infertility.
Frequently Asked Questions
Yes. Although testosterone is important for normal male reproductive function, taking testosterone from outside the body can suppress the hormonal signals required for sperm production. Men trying to conceive should therefore discuss testosterone and male fertility with an andrologist before starting testosterone tablets or injections.
When low testosterone is caused by inadequate hormonal stimulation of the testes, medicines such as clomiphene or gonadotropin injections may be used to stimulate the body's own reproductive hormone pathway. In suitable patients, hormonal treatment for male infertility may improve testosterone levels and potentially sperm production.
Yes. Clomiphene may be used in selected men with low testosterone and infertility because it can stimulate the body's own hormone production rather than providing external testosterone. Clomiphene for male infertility should be considered only after appropriate evaluation by an andrologist.
For a man actively trying to conceive, external testosterone can suppress sperm production. Clomiphene may instead stimulate the body's hormonal pathway and increase endogenous testosterone in appropriate patients. The choice of clomiphene versus testosterone depends on the underlying hormonal problem and the patient's fertility goals.
HCG and HMG may be considered when hormonal deficiency is affecting sperm production, particularly in conditions such as hypogonadotropic hypogonadism. These medicines work differently from external testosterone, so HCG and HMG for male infertility should be prescribed according to the man's hormone profile and reproductive needs.
Sperm production takes time, so improvement is not usually expected immediately after starting treatment. Hormonal therapy may generally continue for around three to four months, although the duration varies according to the cause and whether assisted reproductive treatment is being used. Sperm count improvement with hormone therapy should therefore be assessed over an appropriate treatment period.
No. Hormonal treatment is most useful when a hormonal problem is contributing to impaired sperm production. A low sperm count caused by conditions such as a varicocele, obstruction, primary testicular dysfunction, or other factors may require a different approach. Low sperm count treatment should therefore begin with identifying the underlying cause.
Not necessarily. Treatment duration and management can vary depending on whether assisted reproductive techniques are being used at the same time. Depending on the couple's circumstances, male fertility treatment may be combined with IUI, IVF, or ICSI rather than used as the only treatment.
Yes. HCG and HMG treatment may be particularly useful when male infertility is associated with hypogonadotropic hypogonadism. In these patients, hypogonadotropic hypogonadism treatment may help restore the hormonal stimulation needed for sperm production.
Treatment should be individualized according to the underlying hormonal problem rather than started solely because of a low sperm count or testosterone result. An andrologist may review hormone levels, semen parameters, fertility history, and other relevant clinical findings before recommending male infertility hormone testing and treatment.
