Preoperative medical testicular salvage therapy with CC
with or without hCG may improve the accuracy of the
decision for the best method of reconstruction, VV or EV,
therefore increasing the success of VR in patients with a his-
tory of TST. If managed appropriately, VR in men after TST
can have outcomes comparable with the general population.
Baillargeon J, Urban RJ, Ottenbacher KJ, et al. Trends in androgen
prescribing in the United States, 2001 to 2011.
JAMA Intern Med
Mulligan T, Frick MF, Zuraw QC, et al. Prevalence of hypo-
gonadism in males aged at least 45 years: the HIM study.
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Bassil N, Alkaade S, Morley JE. The bene
ts and risks of testosterone
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performed annually in the United States: data from the National
Survey of Family Growth.
Schwarzer JU. Vasectomy reversal using a microsurgical three-layer
technique: one surgeon
s experience over 18 years with 1300 pa-
Int J Androl
Mui P, Perkins A, Burrows PJ, et al. The need for epi-
didymovasostomy at vasectomy reversal plateaus in older vasec-
tomies: a study of 1229 cases.
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and extent of spermatogenic suppression during hormonal male
contraception: an integrated analysis.
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Roth MY, Ilani N, Wang C, et al. Characteristics associated with
suppression of spermatogenesis in a male hormonal contraceptive trial
using testosteroneand Nestorone(
Manetti GJ, Honig SC. Update on male hormonal contraception: is
the vasectomy in jeopardy?
Int J Impot Res
Liu PY, Swerdloff RS, Christenson PD, et al; Hormonal Male
Contraception Summit Group. Rate, extent, and modi
spermatogenic recovery after hormonal male contraception: an in-
Jarow JP, Lipshultz LI. Anabolic steroid-induced hypogonadotropic
Am J Sports Med
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citrate treatment in young hypogonadal men.
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men with human chorionic gonadotropin alone.
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microsurgical vasectomy reversals by the Vasovasostomy Study
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heads and tails within the vasal
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chorionic gonadotropin maintains intratesticular testosterone in
normal men with testosterone-induced gonadotropin suppression.
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J Sex Med
Increased awareness about potential links between hypogonadism
and metabolic syndrome, sexual dysfunction, mood disorders, and
tness in men leads to dramatic increase in utilization of
testosterone replacement therapy (TRT).
Some of the men
treated with TRT either never had children or remarry and decide
to have children with their new spouses.
TRT by lowering serum
luteinizing hormone (LH) and follicle-stimulating hormone
(FSH) can lead to suppression of spermatogenesis. When human
chorionic gonadotropin (hCG) was given with TRT, no sup-
pression of spermatogenesis was observed providing convincing
evidence that it is not TRT per se causing spermatogenic sup-
pression but decrease in serum LH and FSH levels as a result of
TRT. As no reliable method exists at this point to predict which
men will suppress their sperm production while on TRT, it is wise
to stop TRT to allow for LH and FSH recovery before vasectomy
reversal for at least 3-6 months. However, if such an approach is
necessary in men who have normal LH and FSH levels despite
TRT is an area of debate. From a purely physiological perspective,
if LH and FSH are within normal range then it would be unlikely
that suppression of spermatogenesis would occur with normal LH
and FSH levels despite of TRT.
The choice of anastomosis during vasectomy reversal depends
on the presence of sperms in the testicular end of vas, thus it is
paramount that spermatogenesis is optimized before an attempt
at reconstruction. The authors present their experience with 6
men who wished vasectomy reversal after TRT. Based on few
published observational studies using clomiphene citrate and/or
hCG to restore normal pituitary function in men with sup-
pression of LH and FSH after TRT, authors used 25 mg with or
without hCG 3 times a week to restore spermatogenesis. It is
reassuring to notice that within minimum of 3 months of
therapy with clomiphene citrate and/or hCG, sperms were
ed in all 6 subjects. In addition, results of vasectomy
reversal seem to re
ect the type of anastomosis, with bilateral
vasoepididymostomy resulting in azoospermia on follow-up
semen analysis despite the presence of nonmotile sperms in
uid rather than the medical treatment used.
This article brings an important issue of inherited risks of
spermatogenic suppression in some if not all men on TRT. Lack
of a control arm makes it unclear if any form of therapy other
than stopping TRT and following FSH and LH is indeed
necessary; hence, additional studies with larger numbers of
subjects are needed.
Clomiphene citrate and hCG treatments add additional cost
and the need for injections in addition to not being Food and
approved treatments for male infertility.
UROLOGY 84 (6), 2014