Ineffective use of testosterone in male infertility

Since testosterone has been used so effectively in the treatment of endocrine insufficiency of the testes, its use has also been attempted in the treatment of idiopathic male infertility. Testosterone rebound was one of the earliest modalities in this regard. The published success rate in terms of pregnancies varied considerably from centre to centre, but remained low overall (Charny and Gordon 1978; Getzoff 1955; Lamensdorf etal. 1975; Rowley and Heller 1972). All studies were uncontrolled trials without placebo and double-blinding and therefore inconclusive. Testosterone rebound therapy cannot be recommended for treatment of infertility and is no longer practiced.

More recently, testosterone undecanoate has been tested for the treatment of idiopathic male infertility. However, a significant increase in pregnancy rates could not be demonstrated (Comhaire etal. 1995; Kloer etal. 1980; Pusch 1989). When testosterone undecanoate was given combined with tamoxifen and/or hMG, an improvement of semen parameters was observed (Adamopoulos etal. 1995; 1997). However, in these studies no pregnancy rates were reported. The therapeutic goal of every infertility treatment should be an increase in pregnancy rates, therefore, studies in which only improved semen parameters are reported, without examining the pregnancy rates, must be considered as inconclusive in terms of infertility treatment. Similarly, after many years of clinical use no significant effect of mesterolone on pregnancy rates could be demonstrated in an extensive WHO-sponsored mul-ticentre trial (WHO 1989).

Thus, to date testosterone and other androgens have no place in evidence-based treatment of idiopathic male infertility (Kamischke and Nieschlag 1999).

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