PDF(Pubmed)
Abstract：
Use of testosterone replacement therapy (TRT) and anabolic-androgenic steroids (AAS) has increased over the last 20 years, coinciding with an increase in men presenting with infertility and hypogonadism. Both agents have a detrimental effect on spermatogenesis and pose a clinical challenge in the setting of hypogonadism and infertility. Adding to this challenge is the paucity of data describing recovery of spermatogenesis on stopping such agents. The unwanted systemic side effects of these agents have driven the development of novel agents such as selective androgen receptor modulators (SARMs). Data showing natural recovery of spermatogenesis following cessation of TRT are limited to observational studies. Largely, these have shown spontaneous recovery of spermatogenesis after cessation. Contemporary literature suggests the time frame for this recovery is highly variable and dependent on several factors including baseline testicular function, duration of drug use and age at cessation. In some men, drug cessation alone may not achieve spontaneous recovery, necessitating hormonal stimulation with selective oestrogen receptor modulators (SERMs)/gonadotropin therapy or even the need for assisted reproductive techniques. However, there are limited prospective randomized data on the role of hormonal stimulation in this clinical setting. The use of hormonal stimulation with agents such as gonadotropins, SERMs, aromatase inhibitors and assisted reproductive techniques should form part of the counselling process in this cohort of hypogonadal infertile men. Moreover, counselling men regarding the detrimental effects of TRT/AAS on fertility is very important, as is the need for robust randomized studies assessing the long-term effects of novel agents such as SARMs and the true efficacy of gonadotropins in promoting recovery of spermatogenesis.
摘要：
在过去的20年中，睾酮替代疗法（TRT）和合成代谢-雄激素类固醇（AAS）的使用有所增加，与出现不孕症和性腺功能减退的男性增加相吻合。两种药物对精子发生都有有害作用，并在性腺机能减退和不育症的情况下构成临床挑战。增加这一挑战的是缺乏描述停止此类药物后精子发生恢复的数据。这些药剂的不希望的全身性副作用已经推动了新型药剂如选择性雄激素受体调节剂(SARM)的开发。显示TRT停止后精子发生自然恢复的数据仅限于观察性研究。很大程度上,这些都显示了停止后精子发生的自发恢复。当代文献表明，这种恢复的时间框架是高度可变的，并且取决于几个因素，包括基线睾丸功能。药物使用持续时间和戒烟年龄。在一些男人中，单独停止药物可能无法实现自发恢复，需要用选择性雌激素受体调节剂（SERM）/促性腺激素疗法进行激素刺激，甚至需要辅助生殖技术。然而,关于激素刺激在这种临床环境中的作用的前瞻性随机数据有限.使用激素刺激与药物如促性腺激素，SERMs,芳香化酶抑制剂和辅助生殖技术应成为该性腺机能减退性不育男性队列中咨询过程的一部分.此外，就TRT/AAS对生育率的不利影响向男性提供咨询非常重要，对于评估SARM等新型药物的长期效果以及促性腺激素在促进精子发生恢复中的真正功效的稳健随机研究也是如此。
