Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. However, there’s no reliable evidence that hCG works for this purpose. Although this low calorie diet can help reduce weight, there’s no evidence that using hCG products helps. The FDA has also advised consumers that there’s no substantial evidence that hCG works for weight loss.
Where possible, clinicians should use LCMS to measure total testosterone levels to maximize accuracy and limit CV between tests in men undergoing testing, particularly in men with very low total testosterone levels. Given the growing concern and need for proper testosterone therapy, the AUA identified a need to produce an evidence-based document that informs clinicians on the proper evaluation and management of testosterone deficient patients. Testosterone levels should be measured every 6-12 months while on testosterone therapy.
In our series, a single patient had Sertoli-cell only on testis biopsy, whereas the remaining patients had either maturation arrest or hypospermatogenesis. Although our results are higher than that reported in the literature, it should be noted that our population comprises patients with a good prognosis for sperm retrieval. Collectively, we were able to harvest sperm from 50% of patients, considering both TESA and ejaculated specimens. NOA patients with hypergonadotropic hypogonadism have an increased number of interstitial testicular lesions (containing no Leydig cells) and fibrosis compared with obstructive azoospermia patients (32).
In patients who have two PSA levels at baseline that raise suspicion for the presence of prostate cancer, a more formal evaluation, potentially including reflex testing (e.g., 4K or phi), and prostate biopsy with/without MRI, should be considered before initiating testosterone therapy. It is the opinion of this Panel that serum PSA levels should be measured prior to the commencement of testosterone therapy in patients over 40 years of age in order to minimize the risk of prescribing testosterone therapy to men with occult prostate cancer. The cut-off of 300 ng/dL was chosen based on the mean total testosterone levels cited in the best available literature with a view to maximizing the potential benefit from prescribing testosterone while minimizing the risks of such treatment. The care of testosterone deficient patients should focus on accurate assessment of testosterone levels, symptoms and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated. We presented these patients in terms of their baseline characteristics, and compared pre-treatment and post-treatment Testosterone levels, evaluating the relationship of treatment period testosterone changes with both hCG dosage and duration of therapy. Unfortunately, this means that the scope of treatment with TRT can be limited, precluding treatment of patients with subclinical hypogonadism (SH), who may present with the clinical syndrome, although baseline testosterone levels remain above 300 ng/dL (9). Since the FDA warning in 2015, other studies have failed to demonstrate a risk of cardiovascular events in patients on testosterone therapy.
Cleveland Clinic is a non-profit academic medical center. Our findings suggest that hormonal stimulation with recombinant gonadotropins could be considered for selected infertile men with NOA as an alternative to sperm donation. It resulted in the retrieval of viable spermatozoa for ICSI in four cases, resulting in three live births and one ongoing pregnancy.
Likewise, there might be value in defining the trough level (measured prior to injection on day one) to ensure patients remains therapeutic throughout the entire cycle. While mid-cycle testing is convenient for patients, there may be value in assessing peak level (18-36 hours after injection) as the adverse events (e.g., polycythemia, hyperestrogenism) are likely at least partially related to the peak level. In a study directly comparing the pharmacokinetics of 2 doses of SQ testosterone enanthate injected weekly (50 or 100 mg) and 1 concentration of IM testosterone enanthate injected once (200 mg), the IM testosterone achieved the highest peak testosterone (mean 2,261 ng/dL) followed by SQ 100 mg (1,345 ng/dL) and SQ 50 mg (622 ng/dL).437 The time-to-peak level was slightly faster with IM testosterone (33 hours) compared to SQ 100 mg (36 hours) and SQ 50 mg (45 hours).

Gender: Female

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