Male Infertility: A Patient's Journey with Hypogonadotropic Hypogonadism

Male infertility

I am a patient with hypogonadotropic hypogonadism.
After being discharged from the military, I was referred to Chang Gung Memorial Hospital, where I underwent an MRI and chromosomal examination, both of which showed no issues.
I have been using HCG, starting from 4500 IU to 8000 IU weekly, for two years.
I have made significant progress; my voice has changed, and body hair has grown.
Afterward, I went abroad for studies but continued to receive medication from Taiwan.
Upon arriving here, I felt reluctant to trouble my family, so I sought medical care locally.
However, the doctor switched my medication to Testoderm 5 mg/day transdermal patches, citing that it is more economical and convenient, claiming that the effects would be similar to HCG.
The doctor mentioned that when I want to get married and have children, I could use it in conjunction with FSH, and the chances of success would still be high.
Currently, I am only using male hormones to maintain secondary sexual characteristics, which is sufficient for now.
One downside is that the testes will not continue to grow.
Since I am not a doctor, I did not argue for the necessity of HCG.
I have been on the new medication for six months, but there has been no significant progress.
The clinic only has one new endocrinologist, and I have not been able to switch back to my original medication (HCG).
In January of this year, I applied to a university and saw a new doctor, but he continued the previous approach.
While in Taiwan, I read the medication instructions, which stated that HCG is the most natural way to obtain male hormones, and I believe in this approach.

Should I insist on using HCG this time? I have learned online that some people use male hormones to gain muscle, but the side effect is testicular shrinkage.
I have undergone semen analysis three times between 1996 and 1998, and the sperm count was zero each time.
The doctor said that because I am not using FSH, I am not producing sperm.
I am concerned that my testicular volume is already small, and if I continue using male hormones, will it shrink further? I previously discussed this with the school doctor, who disagreed with my perspective, so he referred me to a second doctor.
The new endocrinologist here seems to have patients who are mostly elderly with diabetes.
Should I consult a urologist specializing in male infertility? I have only had a pituitary MRI and blood chromosomal examination; I have not undergone scrotal ultrasound or vasography, so I have not ruled out any organ defects.
I do not expect things to improve, but I do not want them to worsen.
If I can maintain optimal fertility, at least there is hope.
I fear that when I undergo artificial insemination in the future, I may not find sperm because the testosterone has already damaged my testes, and at that point, my life would be bleak.
Are there doctors in Taiwan who can help me? If so, I plan to return during the winter break.
Thank you for your response.
Sincerely yours,
Yi-Kang Huang

Kevin Huang, 20~29 year old female. Ask Date: 2000/11/29

Dr. Liu Jianting reply Urology

After puberty, the development of the organs has largely stabilized.
Supplementing with HCG is certainly a hope to maintain a glimmer of expectation.
Supplementing with testosterone will gradually lead to testicular dysfunction, but if the testicular function was already compromised, using testosterone may still serve a purpose.
I wonder if you have tested your FSH levels or even undergone a testicular biopsy to confirm the current function of the testes before deciding on the next steps.
Although reproductive technology has allowed many individuals with fertility issues to have "children," there are still many who cannot fulfill this desire.
Life inherently has its ups and downs, sunshine and rain, shadows and rainbows, but it can never be "completely dark." Please consult a urologist or a specialist in infertility upon your return to thoroughly explore your options.

Reply Date: 2000/11/29

More Info

Dear Yi-Kang Huang,
Thank you for sharing your journey with hypogonadotropic hypogonadism and your concerns regarding male infertility. Your situation is complex, and it’s understandable that you have many questions about the best course of action moving forward.

Hypogonadotropic hypogonadism is a condition where the body does not produce sufficient levels of gonadotropins (LH and FSH) due to a malfunction in the hypothalamus or pituitary gland. This can lead to low testosterone levels and impaired sperm production. Your experience with HCG (human chorionic gonadotropin) therapy, which stimulates the testes to produce testosterone and can also promote spermatogenesis, is a common treatment approach. The fact that you saw some positive changes, such as voice deepening and increased body hair, indicates that HCG was having some effect on your testosterone levels.

Switching to Testoderm (a testosterone transdermal patch) may have been suggested for its convenience and cost-effectiveness. However, it is important to note that while testosterone replacement therapy can help maintain secondary sexual characteristics, it does not stimulate the testes to produce sperm. This is a critical distinction, especially since you are concerned about your fertility potential. The concern about testicular atrophy (shrinkage) is valid; prolonged use of exogenous testosterone can lead to decreased testicular size and function, particularly if FSH is not administered concurrently to stimulate spermatogenesis.

You mentioned that you have not had any sperm production despite previous treatments, which raises the question of whether your testes are still capable of producing sperm. It is crucial to evaluate your current testicular function through tests such as a semen analysis, FSH, and LH levels, and possibly a testicular biopsy if indicated. This will provide a clearer picture of your fertility potential.

Given your concerns about the long-term effects of testosterone therapy on your testicular size and function, it may be beneficial to consult with a urologist or an endocrinologist who specializes in male infertility. They can provide a comprehensive evaluation and discuss potential treatment options tailored to your specific needs. It’s also important to consider that fertility preservation options, such as sperm banking, may be available to you, especially if you are considering future family planning.

Regarding your emotional well-being, it’s completely normal to feel a sense of loss or frustration when faced with infertility. Seeking support from a mental health professional, particularly one experienced in dealing with chronic health issues or infertility, can be very beneficial. They can help you process your feelings and develop coping strategies.

In summary, I recommend the following steps:
1. Consult a Specialist: Seek out a urologist or reproductive endocrinologist who specializes in male infertility for a thorough evaluation of your condition.

2. Semen Analysis: Get a semen analysis to assess your sperm production and quality.

3. Hormonal Evaluation: Have your FSH and LH levels checked to understand your hormonal status better.

4. Consider Sperm Banking: If you are concerned about future fertility, discuss sperm banking options with your healthcare provider.

5. Emotional Support: Consider speaking with a mental health professional to address the emotional challenges you are facing.

Your journey may feel daunting, but with the right support and information, you can navigate this challenging time. There are healthcare professionals in Taiwan who can assist you, and I encourage you to reach out to them upon your return.

Wishing you the best on your journey,
Sincerely,
Doctor Q&A Teams

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