Extract

It is 2024. Direct-to-consumer testosterone replacement therapy advertisements on social media are pervasive. Academic and private practice men’s health centers are abundant. At-home semen testing and reproductive health evaluations are commonplace. For many young men, discussing issues such as subfertility and sexual dysfunction has become less taboo. Couples are increasingly recognizing the importance of simultaneous fertility evaluations, and more men are seeing male fertility specialists than ever before. Therein lies a slippery slope of men aiming to optimize their testosterone while maintaining their fertility potential.

It is well known that exogenous testosterone disrupts normal spermatogenesis. By suppressing the hypothalamic-pituitary-gonadal axis that is critical for intratesticular testosterone production and spermatogenesis, exogenous testosterone can render men to be severely oligospermic or azoospermic. By the same token, testosterone deficiency is commonly seen in men presenting for infertility evaluation, including men with oligospermia or nonobstructive azoospermia. It is of concern, however, that approximately 25% of urologists who responded to a national survey of American Urological Association members stated that they would treat infertile men with exogenous testosterone while these men actively pursued pregnancy.1

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