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be discussed prior to dispensation. At present, no standards exist on how to best manage this type of a situation clinically. It is advised that prior to initiation of TST, baseline reproductive function should be assessed. All men should be given the option of obtaining a semen analysis and serum FSH level before starting exogenous testosterone. Coupled with a focused genital examination and documentation of testicular size, this approach has numerous potential benefits. First, it acts as a reference point for reproductive potential and may uncover unsuspected occult azoospermia or compromised reproductive capacity before the potential side effects of testosterone are manifested. Physical examination can also identify other potential causes for hypogonadism including varicocele and resultant testicular atrophy.4 While controversial, varicocele repair could then be offered as a “natural” way to improve native testosterone levels and prevent further testicular damage. Pretreatment semen analysis values can also serve as target levels for the resolution of post-TST spermatogenic dysfunction. This approach offers a combination of vigilance, physical examination, and laboratory monitoring that virtually eliminates the uncertainty of determining whether a man’s compromised testicular function was innate, or due to exogenous testosterone supplementation.

The importance of understanding baseline reproductive function prior to the administration of exogenous testosterone