What causes azoospermia and can it be treated?

Question

Hi doctor,

I am a 37-year-old male diagnosed with azoospermia and primary hypogonadism. I have been unable to produce sperm and underwent a Micro-TESE procedure 12 months ago, which was unsuccessful.

My endocrinologist has prescribed testosterone replacement therapy (TRT) in the form of a gel, with a dosage of 4 pumps daily (1 %). My current testosterone levels are 12 nmol/L. I am experiencing low libido, testicular atrophy, and elevated levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

I would like to understand the potential risks associated with starting TRT, particularly regarding cardiovascular health. I am concerned about whether TRT could increase my risk of heart-related conditions and would like to ensure that I am not adding to any existing risks.

Additional details about me:

Weight: 218.2 pounds.
Height: 183 centimeters.
Recent weight loss: 88.1 pounds.
Non-smoker.
Rarely consume alcohol.
Exercise: six to eight hours per week, primarily triathlon training.
Total cholesterol: 5.1 mmol/L.
High-density lipoprotein (HDL): 1.2 mmol/L.
Low-density lipoprotein (LDL): 3.3 mmol/L.
Triglycerides: 1.3 mmol/L.
Blood pressure: Normal, but tends to be higher in a doctor’s office.
Coronary artery calcium (CAC) score: 6.

Could you explain whether TRT might increase or decrease cardiovascular risks, including its effects on blood pressure and lipid profiles?

Based on my medical history and current situation, would you recommend proceeding with TRT?

Longevity is a key factor in my decision-making process, and I want to ensure this therapy aligns with my long-term health goals.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Patients with hypogonadotropic hypogonadism who have elevated levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are traditionally considered infertile. However, men with Klinefelter syndrome may benefit from consulting a reproductive urologist and undergoing testicular sperm extraction (TESE), followed by in vitro fertilization (IVF). This technique has enabled some men with Klinefelter syndrome to father children. Additionally, for those with Klinefelter syndrome who have reached puberty, cryopreservation of semen samples containing very low numbers of sperm is possible. It should be offered before initiating testosterone supplementation, as supplementation may suppress spermatogenesis.

In men, complications of untreated hypogonadism include a loss of libido, failure to achieve physical strength, and the social challenges associated with not going through puberty alongside peers (if hypogonadism occurs before puberty). It can also lead to osteoporosis. If hypogonadism occurs before the closure of the epiphyseal plates, the result is often a tall stature with a eunuchoid body habitus. Men with hypogonadotropic hypogonadism are typically infertile; however, procedures such as TESE have shown promise, particularly in cases of Klinefelter syndrome.

Testosterone replacement therapy (TRT) has potential side effects, such as an increased risk of prostate carcinoma, though this is more relevant in men over 50 years of age. TRT can also thicken the blood, increasing the risk of thrombosis and may exacerbate breathing issues, particularly in those with sleep apnea. There is a potential risk of heart problems associated with TRT, but this risk is unlikely to be significant at your age.

Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can mitigate these risks. Additionally, specific blood tests need to be conducted before starting TRT and monitored periodically during treatment to ensure safety and efficacy.

The benefits of TRT in your case outweigh the risks, given your current symptoms and medical condition.

I hope this explanation provides clarity.

Let me know if you need any further information.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

You may need to check your baseline blood sugar and lipid profile. While these may currently be within normal limits, monitoring them at least annually and addressing any abnormalities if they arise is advisable. If your hematocrit level is below 47 %, it is considered acceptable. If it rises above 50 %, the TRT dosage is typically reduced. Should it increase further, TRT may need to be discontinued. You can stop TRT at any time if necessary.

Donating blood can help reduce hematocrit levels, which may minimize potential risks associated with TRT.

I hope this explanation provides clarity.

Let me know if you need any further information.

Thank you.