Challenges in diagnosis and treatment of testosterone deficiency in reproductive-aged men

Currently, an increasing number of young and middle-aged men are seeking treatment for symptoms related to low testosterone levels, which include depression, chronic fatigue, low libido, erectile dysfunction and/or infertility. In situations where conceiving a child is not a short- or medium-term goal, the preservation of reproductive function needs to be considered in the context of the treatment offered. Testosterone deficiency is often of unknown origin especially in men of reproductive age, and the choice of treatment method becomes even more difficult, in the context where the scientific evidence and degree of recommendation of various treatments is weak. Literature review was performed using major databases including PubMed, Hinari, SpringerLink and Scopus (Elsevier). One third of infertile men under the age of 50 were found to be hypogonadal. Correlation of spermogram result with testosterone level identified deficiency in 16.7% of men with obstructive azoospermia, 45% of men with non-obstructive azoospermia, 42.9% of men with oligozoospermia and/or asthenozoospermia and 35.3% of men with normal sperm parameters. Testosterone replacement therapy, although effective in addressing most symptoms of hypogonadism, has negative effects on testicular function. Counseling should include a thorough discussion of risks and benefits with an emphasis on spermatogenesis suppression for men of reproductive age who wish to maintain their reproductive potential.