Evidence map›Paper›PMID 39820213›Full record

ReviewAsian journal of andrology2025

Clinician's guide to the management of azoospermia induced by exogenous testosterone or anabolic-androgenic steroids.

Manaf Al Hashimi, Germar-Michael Pinggera, Rupin Shah, Ashok Agarwal

Abstract readReview
In one paragraph

Review in Asian journal of andrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Manaf Al HashimiGlobal Andrology Forum, 130 West Juniper Lane, Moreland Hills, OH 44022, USA.
Germar-Michael PinggeraGlobal Andrology Forum, 130 West Juniper Lane, Moreland Hills, OH 44022, USA.
Rupin ShahGlobal Andrology Forum, 130 West Juniper Lane, Moreland Hills, OH 44022, USA.
Ashok AgarwalGlobal Andrology Forum, 130 West Juniper Lane, Moreland Hills, OH 44022, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

abstractAzoospermia, defined as the absence of sperm in the ejaculate, is a well-documented consequence of exogenous testosterone (ET) and anabolic-androgenic steroid (AAS) use. These agents suppress the hypothalamic-pituitary-gonadal (HPG) axis, leading to reduced intratesticular testosterone levels and impaired spermatogenesis. This review examines the pathophysiological mechanisms underlying azoospermia and outlines therapeutic strategies for recovery. Azoospermia is categorized into pretesticular, testicular, and post-testicular types, with a focus on personalized treatment approaches based on the degree of HPG axis suppression and baseline testicular function. Key strategies include discontinuing ET and monitoring for spontaneous recovery, particularly in patients with shorter durations of ET use. For cases of persistent azoospermia, gonadotropins (human chorionic gonadotropin [hCG] and follicle-stimulating hormone [FSH]) and selective estrogen receptor modulators (SERMs), such as clomiphene citrate, are recommended, either alone or in combination. The global increase in exogenous testosterone use, including testosterone replacement therapy and AAS, underscores the need for improved management of associated azoospermia, which can be temporary or permanent depending on individual factors and the type of testosterone used. Additionally, the manuscript discusses preventive strategies, such as transitioning to short-acting testosterone formulations or incorporating low-dose hCG to preserve fertility during ET therapy. While guidelines for managing testosterone-related azoospermia remain limited, emerging research indicates the potential efficacy of hormonal stimulation therapies. However, there is a notable lack of well-structured, controlled, and long-term studies addressing the management of azoospermia related to exogenous testosterone use, highlighting the need for such studies to inform evidence-based recommendations.

Indexed as

Anabolic AgentsAndrogensAzoospermiaTestosteroneChorionic GonadotropinClomipheneFollicle Stimulating HormoneHumansMaleSpermatogenesisAnabolic AgentsAndrogensChorionic GonadotropinClomipheneFollicle Stimulating HormoneTestosteroneanabolic–androgenic steroidsazoospermiamale infertilityrecommendationstestosterone

Identifiers

PMID39820213
PMCPMC12112917

What Socratic holds

Textmetadata
LicenceCC BY-NC-SA
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.