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World J Nephrol. May 6, 2015; 4(2): 245-253
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.245
Treatment of hypogonadotropic male hypogonadism: Case-based scenarios
Lindsey E Crosnoe-Shipley, Osama O Elkelany, Cyrus D Rahnema, Edward D Kim
Lindsey E Crosnoe-Shipley, Osama O Elkelany, Cyrus D Rahnema, Edward D Kim, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, United States
Author contributions: Crosnoe-Shipley LE, Elkelany OO, Rahnema CD and Kim ED equally contributed to the manuscript.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edward D Kim, MD, Department of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine, 1928 Alcoa Highway, Suite 222, Knoxville, TN 37920, United States. ekim@utmck.edu
Telephone: +1-865-3059254 Fax: +1-865-3059716
Received: June 19, 2014
Peer-review started: June 21, 2014
First decision: August 14, 2014
Revised: December 27, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: May 6, 2015
Processing time: 322 Days and 18.3 Hours
Abstract

The aim of this study is to review four case-based scenarios regarding the treatment of symptomatic hypogonadism in men. The article is designed as a review of published literature. We conducted a PubMed literature search for the time period of 1989-2014, concentrating on 26 studies investigating the efficacy of various therapeutic options on semen analysis, pregnancy outcomes, time to recovery of spermatogenesis, as well as serum and intratesticular testosterone levels. Our results demonstrated that exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Cessation of exogenous testosterone should be recommended for men desiring to maintain their fertility. Therapies that protect the testis involve human chorionic gonadotropin (hCG) therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. Off-label use of SERMs, such as clomiphene citrate, are effective for maintaining testosterone production long-term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data. We concluded that exogenous testosterone supplementation decreases sperm production. It was determined that clomiphene citrate is a safe and effective therapy for men who desire to maintain fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment.

Keywords: Hypogonadism; Selective estrogen receptor modulator; Male fertility; Clomiphene; Human chorionic gonadotropin

Core tip: Symptomatic hypogonadism is both a common and growing health issue. Our four case-based scenarios assess different treatment options for hypogonadotropic male hypogonadism such as clomiphene citrate, human chorionic gonadotropin, and anastrozole. Furthermore, we provide clinical recommendations that can help physicians when confronted with situations such as the ones presented in this article.