madman
Super Moderator
Abstract
Introduction
The management of male infertility, particularly that induced by the use of anabolic androgenic steroids (AAS), presents a significant challenge in andrology and urology. Anabolic steroids are known to disrupt the hypothalamic–pituitary-gonadal (HPG) axis, leading to reduced sperm production and quality, which can result in infertility. The cessation of AAS use does not immediately restore fertility, as the recovery of the HPG axis can take months to years, depending on the duration and intensity of steroid use. Given the limited number of large-scale clinical trials that define protocols for drugs to recover spermatogenesis following testosterone and AAS use and misuse, new approaches are mandatory.
Objective
This review explores the potential role of FSH analogs in preserving and recovering fertility, with consideration of dosages and the timing of therapeutic interventions.
Methods
A review search was performed employing Medline, Embase, Scopus, Cochrane Library, and Web of Science from inception to May 2024. The following keywords were used: “testosterone replacement therapy” or “anabolic androgenic steroids” or “anabolic androgenic steroids abuse” or “anabolic androgenic steroids misuse” and “infertility” or “sperm parameters” or “sperm count” or “sperm quality” or “recombinant FSH” or “FSH analogues” or “purified FSH”. Then, the basic concepts and the clinical findings were discussed in order to unify traditional and recent evidence through a narrative review for practitioners and scientists in the area of andrology and urology.
Results
The early administration of an FSH analogue emerges as a promising approach to hasten the recovery of spermatogenesis following the cessation of testosterone and anabolic androgenic steroid use, leveraging its supportive role in male reproductive health, given its direct effect on FSH receptors. Recombinant FSH at 75-150 IU 1 to 3 times a week is an attempt to enhance spermatogenesis recovery intra-AAS use or after cessation. The choice between purified or recombinant FSH forms appears to be pivotal in expediting recovery and enhancing the chances of conception. Nonetheless, the high cost of these medications poses a significant barrier.
Conclusions
In conclusion, the administration of FSH analogues offers a viable strategy for accelerating the recovery of spermatogenesis in individuals affected by infertility due to the use of AAS. This therapeutic approach capitalizes on the critical role of FSH in male reproductive physiology, potentially reducing the recovery time of the HPG axis after AAS cessation. However, the establishment of a standardized treatment protocol is necessary to optimize outcomes. Factors such as the choice between purified or recombinant FSH, the patient’s partner’s reproductive health, and the economic considerations of treatment must be carefully weighed. Given the promising yet preliminary nature of current findings, further large-scale clinical trials are essential to refine treatment strategies, assess the efficacy of lower doses, and ultimately enhance fertility restoration in this patient population.
