(093) The Continued Use of Testosterone Does Not Interfere with Human Chorionic Gonadotropin-Mediated Return of Spermatogenesis
Authors: Kassab J , Garcia Keeme-sayre A , Lindsey J , Torres-Anguiano J , Garcia T , Lipshultz L 
Published: February 2024

Abstract

Introduction
Depression of spermatogenesis is a significant problem in the hypogonadal patient on testosterone therapy (TTh). We commonly prescribe human chorionic gonadotropin (hCG) concomitantly in these men to prevent testicular atrophy and to maintain some degree of spermatogenesis. When a pregnancy is desired, we increase the hCG to 3000 units subcutaneously three times weekly. Traditionally, testosterone therapy is discontinued during this high-dose hCG treatment. However, the question remains as to whether these men can continue TTh with the use of hCG, thus bypassing the need to stimulate pituitary hormones.

Objective
To investigate whether patients with low testosterone, in an effort to avoid hypogonadal symptoms, can continue their testosterone therapy when using hCG in an effort to reestablish normal spermatogenesis.

Methods
We studied 260 patients who had been prescribed hCG at a university hospital within the observation range of 01/01/2021–12/31/2022. Two cohorts were evaluated: hCG + TTh and hCG without TTh. Dosage information, other medications, comorbidities, demographic information (including age and race), as well as laboratory results of hormones and semen analyses were captured into a patient database. Baseline laboratory values for each patient were documented prior to being prescribed hCG, followed by subsequent values for each of these variables in the months following this prescription. One-way ANOVAs were employed using SPSS to analyze the longitudinal impacts of hCG on testosterone, total sperm count, and total motile count. For the analysis of testosterone values, we separated patients based on whether they were concomitantly prescribed and taking testosterone therapies (TTh).

Results
When assessing the baseline testosterone in patients on TTh compared to the following four follow-up visits (n=154) since taking hCG, the f-ratio of the one-way ANOVA was 9.13256 (p-value &lt; 0.00001). In the same assessment for patients not on TTh (n=37), the f-ratio value is 4.93955 (p-value = 0.0011). Lastly, when analyzing total sperm count across all patients with documented semen analyses (SA) across four follow-up visits (n=64) since taking hCG, the f-ratio value is 2.66654 (p-value = 0.034). Both cohorts experienced improvements across these two metrics. Our data did not show any statistically significant differences in the two groups in total motile count across the follow-up visits.

Conclusions
Our findings confirm strong improvements in testosterone and total sperm count, regardless of whether or not adjunctive TTh was used. These results highlight the efficacy of hCG longitudinally in promoting hormonal and reproductive recovery in hypogonadal men, warranting further investigation into its long-term effects and clinical applications. These data provide valuable insights that can assist healthcare professionals in providing informed guidance to patients regarding the anticipated therapeutic outcomes of hCG treatment, including expected timeline and magnitude.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant).