Concomitant Intramuscular Human Chorionic Gonadotropin
Preserves Spermatogenesis in Men Undergoing Testosterone
Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†
From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of
Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island
Testosterone replacement therapy results in decreased serum gonado-
tropins and intratesticular testosterone, and impairs spermatogenesis, leading to
azoospermia in 40% of patients. However, intratesticular testosterone can be
maintained during testosterone replacement therapy with co-administration of
low dose human chorionic gonadotropin, which may support continued spermato-
genesis in patients on testosterone replacement therapy.
Materials and Methods:
We retrospectively reviewed the records of hypogonadal
men treated with testosterone replacement therapy and concomitant low dose hu-
man chorionic gonadotropin. Testosterone replacement consisted of daily topical gel
or weekly intramuscular injection with intramuscular human chorionic gonadotro-
pin (500 IU) every other day. Serum and free testosterone, estradiol, semen param-
eters and pregnancy rates were evaluated before and during therapy.
A total of 26 men with a mean age of 35.9 years were included in the
study. Mean followup was 6.2 months. Of the men 19 were treated with injectable
testosterone and 7 were treated with transdermal gel. Mean serum hormone
levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl
0.0001), free testosterone 8.1 vs 20.4 pg/ml (p
0.02) and estradiol 2.2 vs 3.7
0.11). Pretreatment semen parameters were volume 2.9 ml, density
35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in
semen parameters were observed during greater than 1 year of followup. No
impact on semen parameters was observed as a function of testosterone formu-
lation. No patient became azoospermic during concomitant testosterone replace-
ment and human chorionic gonadotropin therapy. Nine of 26 men contributed to
pregnancy with the partner during followup.
Low dose human chorionic gonadotropin appears to maintain se-
men parameters in hypogonadal men on testosterone replacement therapy. Con-
current testosterone replacement and human chorionic gonadotropin use may
preserve fertility in hypogonadal males who desire fertility preservation while on
testosterone replacement therapy.
testis; infertility, male; testosterone; chorionic
total motile sperm
T replacement therapy
Accepted for publication August 28, 2012.
Study received institutional review board ap-
* Correspondence and requests for reprints:
Scott Department of Urology, Baylor College of
Medicine, 6624 Fannin St., Suite 1700, Houston,
Texas 77030 (telephone: 713-798-6163; FAX: 713-
† Financial interest and/or other relationship
with Eli Lilly, Endo, Auxilium, Allergan and Amer-
ican Medical Systems.
hypogonadism is characterized
by low serum T and characteristic
symptoms, including fatigue, decreased
libido, erectile dysfunction, difﬁculty
concentrating, sleep disturbances and
loss of lean body mass or weight gain.
The prevalence of male hypogonadism
is reported to be 37% in the United
States and a higher prevalence is ob-
served with increasing age.
THE JOURNAL OF UROLOGY
Vol. 189, 647-650, February 2013
© 2013 by A
Printed in U.S.A.