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Use of Exogenous Testosterone for the Treatment of Male Factor Infertility: A Survey of Nigerian Doctors

Olufunmilade Akinfolarin Omisanjo,1 Stephen Odunayo Ikuerowo,1 Moruf Adekunle Abdulsalam,2 Sheriff Olabode Ajenifuja,2 and Khadijah Adebisi Shittu3
1Department of Surgery, Lagos State University College of Medicine and Teaching Hospital (LASUCOM/LASUTH), Ikeja, Lagos, Nigeria
2Department of Surgery, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
3Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria

Correspondence should be addressed to Olufunmilade Akinfolarin Omisanjo

Received 6 April 2017; Accepted 20 July 2017; Published 29 August 2017

Abstract

Background. Though exogenous testosterone is known for its contraceptive effects in men, it is sometimes prescribed by medical practitioners for the treatment of male factor infertility in the mistaken belief that exogenous testosterone improves sperm count. The aim of this study was to evaluate the scope of testosterone use in the treatment of male factor infertility by medical practitioners in Lagos, Nigeria. Methods. A survey using a structured questionnaire was carried out amongst doctors attending a regular Continuing Medical Education (CME) programme in Lagos, Nigeria. Results. There were 225 respondents. Most of the respondents (69.8%,n=157 ) indicated that exogenous testosterone increases sperm count. Only 22 respondents (9.8%) indicated (correctly) that exogenous testosterone decreases sperm count. Seventy-seven respondents (34.2%) had prescribed some form of exogenous testosterone in the treatment of male factor infertility. The vast majority of respondents who had prescribed testosterone (81.8%, n=63 ) thought exogenous testosterone increases sperm count. There was no statistically significant difference in the pattern of prescription across the respondents’ specialty (p=0.859) or practice type (p=0.747). Conclusion. The misuse of exogenous testosterone for the treatment of male infertility was common amongst the respondents, with most of them wrongly believing that exogenous testosterone increases sperm count.

1. Introduction

The World Health Organization defines infertility as the inability of a sexually active, noncontracepting couple to achieve spontaneous pregnancy in one year [1]. Infertility affects approximately 15% of couples [2]. The male factor is estimated to be solely responsible in up to 20% of affected cases, with an additional 30–40% of cases involving both male and female factors [3, 4].

Causes of male infertility vary and include congenital or acquired abnormalities, immunological factors, malignancies, urogenital tract infections, endocrine disturbances, and the presence of varicoceles [1, 5].

There are different treatment options for male factor infertility and these may range from lifestyle modification, use of various combinations of medications, and hormones, for example, clomiphene citrate and human chorionic gonadotrophin, to surgical procedures like varicocele ligation and orchidopexy [6]. The advent of assisted reproduction has revolutionized the treatment of infertility leading to the setting up of dedicated fertility centers.

While some of the couples with infertility are treated in these established fertility centers, a sizeable number of them get their initial evaluation and even treatment started by general practitioners and gynaecologists.

The dearth of urologists in underdeveloped countries also means that most of the couples with male factor infertility are treated by gynaecologists and general practitioners without any urology review in countries like Nigeria.

It is not unusual for some male patients with infertility to present with features of hypogonadism. While exogenous testosterone may be useful in the alleviation of some of the symptoms of hypogonadism in such males, its use leads to reduction in sperm count [7]. It is therefore not recommended that exogenous testosterone be used alone in the treatment of male factor infertility even when there are associated features of hypogonadism.

In spite of the above, it is not uncommon for doctors to place patients with male factor infertility on testosterone alone in the mistaken belief that administration of exogenous testosterone improves sperm count.

Samplaski et al. found that 1.3% of 4400 patients in their male infertility database were on exogenous testosterone and the majority of these patients had their therapy prescribed to them by endocrinologists and family practitioners [8].

In 2012, Ko et al. in a survey of the American Urological Association (AUA) had expressed concern that 25% of the respondents in a survey of urologists use exogenous testosterone, a medication known for its contraceptive potential for male infertility treatment [9].

There are no reports in Nigeria on the pattern of use of exogenous testosterone in the treatment of male infertility, though a review of the referrals to our urology clinic over the years suggests that this practice is not uncommon.

The aim of our study was therefore to document the pattern of use of exogenous testosterone in the treatment of male infertility by doctors in Lagos, Nigeria.

2. Materials and Methods

A survey was carried out amongst doctors attending a regular Continuing Medical Education (CME) programme at the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos. The CME which was under the auspices of the Association of General and Private Medical Practitioners of Nigeria (AGPMPN) included broad topics across general practice and was open to doctors from different backgrounds.

A structured questionnaire was used.

Data were captured with Microsoft Excel and data analysis was done with the Statistical Package for Social Sciences (SPSS version 21).

Comparison of means was performed using Student’s t-test while Fischer’s exact test was used for contingency table analysis with a two-tailed p value of <0.05 accepted as being statistically significant.

3. Results

There were 225 respondents available for analysis out of the 241 questionnaires administered (93.4% response rate).

One hundred and eighty-six (82.7%) were general practitioners and 38 (16.9%) were gynaecologists. One respondent did not indicate his specialty.

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