Hypogonadisme en een kinderwens, hebben we opties om te behandelen?

Abstract

Male hypogonadism is a clinical and biochemical testosterone insufficiency syndrome, caused by low testosterone and corresponding symptoms. Hypogonadism affects various organ functions and quality of life. Patients and clinicians struggle to treat hypogonadal males with an active or future wish to conceive. The use of exogenous testosterone therapy has serious disadvantages. It has a negative impact on the endogenic testosterone production and spermatogenesis which results in sub- or infertility during therapy and 1–2 years onwards after discontinuation. In 10% spermatogenesis will not recover at all. Nowadays human chorionic gonadotropin (HCG) is the only registered medication for this indication. Besides lifestyle changes, off-label selective estrogen receptor modulators (SERMS) and aromatase inhibitors (AIs) are being used. Clomiphene citrate, a selective estrogen receptor modulator, seems to be the most promising. It increases the testosterone level, seems to have a positive effect on bone health and, most important, does not affect spermatogenesis.