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Testicular
Testicular atrophy is common with long term AAS use. When LH and FSH levels fall, the testis begin to shrink from disuse essentially. If this continues long enough, there will even be a loss of leydig cells through apoptosis. Leydig cells produce testosterone. Once this occurs, the capacity of the testis to produce testosterone is greatly reduced. This poses a significant problem once the individual decides to discontinue use of AASs. The atrophied testis are often unable to produce enough testosterone to maintain levels in the normal range. Testicular atrophy can also cause infertility. (1,2)
Treatment options: Pregnyl (hCG) is the recommended treatment to prevent testicular atrophy while using supraphysiological doses of AASs. Menotropins Intramuscular (hMG) is often useful as adjunct therapy to return the testis to full functionality and ensure fertility.
Testicular atrophy can be corrected while the individual is using AASs by intermittent hCG therapy. If using Pregnyl alone, 500 IUs 2-3 times per week should be used until the testis return to normal size as measured with a Prader orchidometer. Normal testicular size is defined as 15–25 ml. Having baseline values for testicular size for that patient is helpful. After normal testicular size is achieved, hCG can be used intermittently to maintain normal testicular volume.
Prior to menotropins/hCG therapy to stimulate spermatogenesis in males with primary or secondary hypogonadotropic hypogonadism, pretreatment with hCG alone is required. The usual pretreatment dosage of hCG is 500 USP units 3 times weekly until normal serum testosterone concentrations are achieved. Pretreatment with hCG may require 4–6 months if the individual has used AASs in high doses for several years. Once normal testosterone levels have been achieved, concomitant therapy with menotropins can be initiated. The usual initial dosage of menotropins to stimulate spermatogenesis is 75 IU of FSH and 75 IU of LH 3 times weekly in conjunction with hCG 500 USP units 2 times weekly.
Menotropins/hCG therapy should be continued for at least 4 months to ensure normal sperm count, since it takes approximately 70–80 days for germ cells to reach the spermatozoa stage. If evidence of increased spermatogenesis does not occur following 4 months of menotropins/hCG therapy, treatment can be continued at the same dosage, or dosage of menotropins may be increased to 150 IU of FSH and 150 IU of LH 3 times weekly; dosage of hCG should not be changed.