HDCN Article Review/Hyperlink

Masala A, Faedda R, Alagna S, Satta S, Chiarelli G, et al

Use of testosterone to prevent cyclophosphamide-induced azoospermia

Ann Int Med (Feb) 126:292-295 1997

The alkylating agent cyclophosphamide (CPA) has been used successfully in the treatment of a number of glomerular diseases. A major factor limiting its use is the frequent development of gonadal toxicity. These investigators designed a pilot study to test the hypothesis that testosterone (TES) would lower activity of germinal cells in men aged 23-35 and thereby preserve sperm producing capacity. Study subjects, all with glomerulonephritides, were divided into groups of 5 patients each. Group A received 150 mg daily oral CPA for 6-8 months, group B and C received 15 mg/kg intravenous boluses of CPA monthly for 6-8 months. In addition, the 5 patients in group C also received testosterone 150 mg intramuscularly every 15 days, starting 30 days before CPA therapy. Baseline characteristics were similar between groups, but 6 months after treatment there was a marked reduction in follicle-stimulating hormone levels in the TES treated group and sperm counts were within normal limits (45.78 +/- 3.89 x 1000,000/mL). In comparison, FSH levels were markedly elevated and only 1 of 10 patients had a normal sperm count 6 months after treatment with CPA without TES. Lutenizing hormone levels remained unchanged, and there were no side effects related to TES use in this study. All patients had clinical remission of their renal disease.

Comment: This pilot study is most encouraging for clinicians who treat males with future reproductive potential with cyclophosphamide. Coverage during cytotoxic treatment with testosterone may afford safe and effective gonadal protection, thus allowing us to increase the use of cyclophosphamide. Amazingly, all 15 patients with various forms of GN in this study got better with cytotoxics. This and future similar studies in males and females deserve our close attention. (Sri Narsipur, MD, SUNY-HSC at Syracuse, NY)