My husband was just started on a series of testosterone injections for a low testosterone level (198). His semen analyses were very variable — 17.1, 5.1, 50.5 and 21.5 million with good motility and morphology, but with low volume ( 1.5-3mL per specimen). Do you think these injections will help?

Low testosterone may result from two different types of abnormality. The first, a failing testicle, is identified by the blood FSH level (too high a level means the testicle is failing) or small, very firm testicles, which may indicate previous infection or damage. The second condition occurs when the testicle is not receiving appropriate hormonal stimulation from the pituitary gland, which releases the hormones LH and FSH. LH stimulates the testicle to produce testosterone, while FSH stimulates sperm production. In this case, examination of the testicle may demonstrate normal to small testicular size with a softer-than-normal consistency. Testosterone supplementation would not usually be the first treatment considered for infertility associated with low testosterone. In my experience, the use of testosterone injections may actually depress sperm production further. After a thorough medical history and examination and a blood test to confirm normal liver function, I would consider the use of clomiphene, 1/2 tablet every other day. After three months a beneficial effect may be seen on semen analysis. In your husband’s case, it would appear that all but one of the specimens for semen analysis ( 5.1 million sperm/mL) were normal. I would suggest consideration of clomiphene therapy followed by a repeat semen analysis after three months. If infertility persists, ovulation induction combined with intrauterine insemination would be the treatment of choice.

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