We have had a rash of new infertility patients whose husbands had been put on testosterone by their primary care providers. The usual story is that the husband complains of fatigue, maybe during a routine visit. The doctor (or in one case the nurse practitioner) gets a testosterone level, which is just below the normal range. The man gets put on testosterone. No one bothers to ask if he is trying to father a child. The couple subsequently shows up in our office with infertility, and the semen analysis shows ... no sperm.
The other story we hear occasionally is that the husband isn't taking any prescription meds, but his friend at the gym is providing him with a "nutritional supplement", which turns out to be a testosterone-like substance. We have learned to ask about this whenever we see an abnormal semen analysis.
Testosterone isn't a great contraceptive - only about 80% of men will develop azoospermia. I wonder if there is some sort of recent drug company campaign that is leading to this recent increase in testosterone prescriptions.
My partner Dr. Malizia recently saw an even more bizarre infertility case. The wife was getting testosterone from one of those "natural hormone replacement" clinics you see advertised on TV.
Please don't take testosterone if you are trying to have a baby!
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6 comments:
Thank you for sharing that with us! I have heard of RE's putting men on testosterone in order to help increase the sperm, and it didn't even help at all. You should educate them.
Many years ago, a course of testosterone was recommended by some urologists to improve male fertility. The rationale was that the discontinuation of this "testosterone rebound therapy" would cause FSH and LH levels to rise, increasing sperm production. This strategy has long been abandoned, but I still see it used occasionally. When I do, I recommend the male patient see a more knowledgeable physician.
MPS
Wanted to let you know, your blog is excellent! Very informative. I stumbled across this blog by doing a search on oil-based HSG dye and found your commentary very insightful. I went on to read other articles and bookmarked many of them.
Have you found a source yet for an oil-based HSG... and would you accept an out of town patient?
Please keep writing!
Thanks for bringing up this subject again. It turns out that there is a product very similar to Ethiodol that is now available on the US market: "Lipiodol Ultra-Fluide". See here for more details - http://www.guerbet-us.com/?page=lipiodol. The package insert doesn't list the product for use with HSGs, but that's not necessarily a deal-breaker. I'm going to contact the company tomorrow to see what they say about this issue.
Yes, we do take out-of-town patients.
MPS
Hello,
I had an hsg test done that shows I have a bicornuate uterus. I was referred to Alabama Fertility but not for Dr. Steinkampf. Are all the doctors in this office familiar diagnosing a septum or bicornuate uterus? I would like to have a laparoscopy because of my recurring miscarriages. Thank you
Yes, my partner will be able to help you just fine.
mps
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