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Synthetic Testosterone Seemed Like a Good Idea. Then Came Fertility Issues.
By KAREN ALEXANDER
Published: June 20, 2005
BROWSE the Internet for information about anabolic steroids, and you will discover a story of turbocharged manhood: huge muscles, adoring women, powerful erections and youthful energy.
John Locher for The New York Times
Surprised: Thomas McNutt of Las Vegas started taking hormone injections to counter the sperm-depleting effects of testosterone replacement therapy.
Some of that story is true. But for men also hoping to father children, there may be some vital information missing. Using testosterone supplements can most likely cause a man's sperm count to plummet, often to zero. Getting it back can be costly and take years. Among heavy steroid users, it may never return.
Even in the medical community, the effects of testosterone on a man's ability to reproduce are often misunderstood. Several top fertility experts say they often see patients whose regular doctors have placed them on testosterone replacement therapy to treat various ailments - often successfully - without explaining that it might also make them infertile.
When artificial testosterone is introduced into the body, the pituitary gland in the brain senses its presence and shuts off the supply of hormones that stimulate the testicles to make their own testosterone and sperm. The brain cannot differentiate natural testosterone from synthetic, so it shuts down its own sperm-making mechanisms.
"There's a chemical castration going on," said Dr. Paul J. Turek, an associate professor of urology at the University of California, San Francisco. Dr. Turek said it was odd that men abuse testosterone to increase their manliness. "In fact, they've become less of a man," he said. "They can't do what men are supposed to do."
Dr. Rebecca Z. Sokol, a male-fertility specialist and professor at the Keck School of Medicine of the University of Southern California, said that about 10 percent of her patients were seeking to reverse the damage from testosterone supplements. She estimated that half of those patients were taking the steroids under a doctor's care and half bought them on the black market.
The typical black-market steroid user often doesn't admit he has been taking them, Dr. Sokol said. "Most of them have no comprehension that this can make you sterile," she said. "These guys won't tell you what they're taking or how much."
Even if her patients do not acknowledge steroid use, Dr. Sokol said, she often persuades them to stop by suggesting that they may have been getting testosterone unknowingly through supplements they had been given by friends or trainers at the gym. "If they don't tell me they're taking testosterone, and they don't take my hint to go off it, there's nothing else I can do," she said.
Eric, a 39-year-old bodybuilder in San Francisco, who spoke on the condition that his last name not be used, said that such denial is rampant among bodybuilders. That makes it difficult for men to share reliable information about potential health threats.
"I've been in these gyms for 20 years," said Eric, who has two children but has watched close friends struggling with infertility. "You don't hear about fertility problems at all. People are very uncomfortable talking about it."
Testosterone supplements are not only used by athletes and bodybuilders, but are also becoming more popular among older men. "I am seeing a ton of guys who are 55 years old and older, who want to be 25," Dr. Turek said.
This is particularly unsettling, he said, because it has not been determined if the use of testosterone might accelerate the progression of prostate cancer, which is most common among older men. In addition, he said, these men - often affluent - tend to have younger wives who may want children.
Many professional and other high-level athletes take excessive amounts of the drugs, while the dosages among amateur users can vary widely. For those who take relatively small doses, sperm counts can return to levels approaching normal within 6 to 12 months after they stop using.
Thomas McNutt, a patient of Dr. Sokol who lives in Las Vegas, was receiving testosterone replacement therapy because a pituitary disorder had caused his body to stop producing the hormone about seven years ago. Mr. McNutt and his wife, Carol, who have a 7-year-old child, hope to have another.
Mr. McNutt's first doctor, a urologist, treated him for erectile dysfunction and prescribed a testosterone patch. Mr. McNutt said the medication made him feel somewhat better, but he hadn't known it would make him infertile.
"No one told me that if I used this synthetic testosterone it wouldn't allow me to produce sperm," he said. "I didn't find out for another year. A lot of men may not even go to doctors to find out because it was very embarrassing. The essence of being a man is testosterone, and I didn't have any."
Some temporary side effects occur when a man stops taking testosterone supplements. He may not feel well for a couple of weeks, at least until his body starts making the hormone itself again, Dr. Sokol said. Common symptoms of low testosterone include fatigue, depression and poor erections.
If waiting doesn't work, a patient can sometimes be treated with a series of hormone injections that kick-start the testicles back into action, Dr. Sokol said.
The typical regimen includes a combination of the pituitary hormones LH and FSH, which are the same hormones given to women undergoing in-vitro fertilization. Men usually require two or three injections a week for a year or longer, a cost that can reach several thousand dollars a month.
If a man's sperm count still does not improve after the injections, another procedure may work. Under general anesthesia, a man can have sperm retrieved from his testicles and combined with a woman's egg in the laboratory to create a test-tube baby.
For Mr. McNutt, nearly a year and a half of twice-weekly injections seemed to have done little to improve his sperm count. He was feeling dejected.
Then in May, his sperm count soared to more than a million per milliliter. That is well below the norm of 20 million per milliliter, but Mr. McNutt said he felt more optimistic than he had in seven years.
He hopes that more men will be aware of the potential risks of testosterone supplements, even though he expects to go back on them as soon as he and his wife can have another child.
"People need to look at how it's going to affect all aspects of their life, not just the body beautiful," he said.
By KAREN ALEXANDER
Published: June 20, 2005
BROWSE the Internet for information about anabolic steroids, and you will discover a story of turbocharged manhood: huge muscles, adoring women, powerful erections and youthful energy.
John Locher for The New York Times
Surprised: Thomas McNutt of Las Vegas started taking hormone injections to counter the sperm-depleting effects of testosterone replacement therapy.
Some of that story is true. But for men also hoping to father children, there may be some vital information missing. Using testosterone supplements can most likely cause a man's sperm count to plummet, often to zero. Getting it back can be costly and take years. Among heavy steroid users, it may never return.
Even in the medical community, the effects of testosterone on a man's ability to reproduce are often misunderstood. Several top fertility experts say they often see patients whose regular doctors have placed them on testosterone replacement therapy to treat various ailments - often successfully - without explaining that it might also make them infertile.
When artificial testosterone is introduced into the body, the pituitary gland in the brain senses its presence and shuts off the supply of hormones that stimulate the testicles to make their own testosterone and sperm. The brain cannot differentiate natural testosterone from synthetic, so it shuts down its own sperm-making mechanisms.
"There's a chemical castration going on," said Dr. Paul J. Turek, an associate professor of urology at the University of California, San Francisco. Dr. Turek said it was odd that men abuse testosterone to increase their manliness. "In fact, they've become less of a man," he said. "They can't do what men are supposed to do."
Dr. Rebecca Z. Sokol, a male-fertility specialist and professor at the Keck School of Medicine of the University of Southern California, said that about 10 percent of her patients were seeking to reverse the damage from testosterone supplements. She estimated that half of those patients were taking the steroids under a doctor's care and half bought them on the black market.
The typical black-market steroid user often doesn't admit he has been taking them, Dr. Sokol said. "Most of them have no comprehension that this can make you sterile," she said. "These guys won't tell you what they're taking or how much."
Even if her patients do not acknowledge steroid use, Dr. Sokol said, she often persuades them to stop by suggesting that they may have been getting testosterone unknowingly through supplements they had been given by friends or trainers at the gym. "If they don't tell me they're taking testosterone, and they don't take my hint to go off it, there's nothing else I can do," she said.
Eric, a 39-year-old bodybuilder in San Francisco, who spoke on the condition that his last name not be used, said that such denial is rampant among bodybuilders. That makes it difficult for men to share reliable information about potential health threats.
"I've been in these gyms for 20 years," said Eric, who has two children but has watched close friends struggling with infertility. "You don't hear about fertility problems at all. People are very uncomfortable talking about it."
Testosterone supplements are not only used by athletes and bodybuilders, but are also becoming more popular among older men. "I am seeing a ton of guys who are 55 years old and older, who want to be 25," Dr. Turek said.
This is particularly unsettling, he said, because it has not been determined if the use of testosterone might accelerate the progression of prostate cancer, which is most common among older men. In addition, he said, these men - often affluent - tend to have younger wives who may want children.
Many professional and other high-level athletes take excessive amounts of the drugs, while the dosages among amateur users can vary widely. For those who take relatively small doses, sperm counts can return to levels approaching normal within 6 to 12 months after they stop using.
Thomas McNutt, a patient of Dr. Sokol who lives in Las Vegas, was receiving testosterone replacement therapy because a pituitary disorder had caused his body to stop producing the hormone about seven years ago. Mr. McNutt and his wife, Carol, who have a 7-year-old child, hope to have another.
Mr. McNutt's first doctor, a urologist, treated him for erectile dysfunction and prescribed a testosterone patch. Mr. McNutt said the medication made him feel somewhat better, but he hadn't known it would make him infertile.
"No one told me that if I used this synthetic testosterone it wouldn't allow me to produce sperm," he said. "I didn't find out for another year. A lot of men may not even go to doctors to find out because it was very embarrassing. The essence of being a man is testosterone, and I didn't have any."
Some temporary side effects occur when a man stops taking testosterone supplements. He may not feel well for a couple of weeks, at least until his body starts making the hormone itself again, Dr. Sokol said. Common symptoms of low testosterone include fatigue, depression and poor erections.
If waiting doesn't work, a patient can sometimes be treated with a series of hormone injections that kick-start the testicles back into action, Dr. Sokol said.
The typical regimen includes a combination of the pituitary hormones LH and FSH, which are the same hormones given to women undergoing in-vitro fertilization. Men usually require two or three injections a week for a year or longer, a cost that can reach several thousand dollars a month.
If a man's sperm count still does not improve after the injections, another procedure may work. Under general anesthesia, a man can have sperm retrieved from his testicles and combined with a woman's egg in the laboratory to create a test-tube baby.
For Mr. McNutt, nearly a year and a half of twice-weekly injections seemed to have done little to improve his sperm count. He was feeling dejected.
Then in May, his sperm count soared to more than a million per milliliter. That is well below the norm of 20 million per milliliter, but Mr. McNutt said he felt more optimistic than he had in seven years.
He hopes that more men will be aware of the potential risks of testosterone supplements, even though he expects to go back on them as soon as he and his wife can have another child.
"People need to look at how it's going to affect all aspects of their life, not just the body beautiful," he said.
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