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Re: Oligospermia and IDIOTS From: Mark Jutras (mjutras@gate.net) Sun Feb 24 09:36:21 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Dean Huffman .: "Vaccinating Boys for Girls' Sake?" Previous message: PURUSHOTTAM SAH: "Oligospermia" This is a very dangerous article when the goal is achieving pregnancy. Exogenous testosterone suppresses sperm production. It has been a necessary part of treatment in most male "birth control pill" studies to achieve azoospermia. Those of us who treat fertility full time have seen dozens of men who were put on testosterone by their urologist and now are azoospermic rather that just oligospermic. As we know, it is always possible to get unusual findings is a study which is exactly what his article on low dose testosterone and estrogen is. The finding of any study needs to be considered in the context of reasonableness. Are the findings reasonable? In this case they certainly are not. The hormonal concept is much easier for a gynecologist to understand than a urologist. We know about the feedback loop. If estrogen is low the brain puts out more FSH to raise the level and if the level is high we suppress FSH and LH production. The loop is no different in men. If you give external testosterone or estrogen you will suppress LH and FSH release causing a drop in sperm production. In addition, intratesticular testosterone is several times higher than peripheral levels, about 40 times higher. It appears that these levels are necessary for normal maturation of the sperm including appropriate packaging of DNA to prevent damage to the sperm DNA. Men with lower testosterone levels do not undergo this packaging correctly and their sperm are found to have higher percentage of sperm with DNA fragmentation which leads to much higher pregnancy loss rates. The idea of treatments such as clomiphene citrate, hCG, gonadotropins, and aromatase inhibitors is to increase the stimulation to the testicle to increase both intratesticular hormone production and sperm production. The primary problem with treatment is that it has tended to be used in a shotgun approach. All may be able to increase sperm production to some degree in the right patient. The problem is determining which is right for which man. The other problem is that except for the hypothalamic patient, you are rarely going to achieve normal levels. However, you can change the relative degree in many. You may shift a guy from IVF only to a reasonable try at IUI. You may be able to shift the situation from needing a testicular biopsy to do IVF to one were you can use ejaculate. And with aromatase inhibitor, it has been shown that you can increase the probability of successful testicular biopsy in the group of men with an abnormal testosterone/estradiol ratio. So to summarize and repeat: NEVER GIVE EXOGENOUS TESTOSTERONE OR ESTROGEN TO A MAN WHO'S WIFE WANTS TO CONCEIVE!!!!! -- Mark Jutras, MD, HCLD Next message: Dean Huffman .: "Vaccinating Boys for Girls' Sake?" Previous message: PURUSHOTTAM SAH: "Oligospermia"

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