Editing Testosterone Deficiency (2018) (section)

==== Alternatives to testosterone therapy in males desiring fertility ====
* '''<span style="color:#ff0000">Options (as stand-alone or combination) (3):</span>'''
*# '''<span style="color:#ff0000">Selective estrogen receptor modulators (clomiphene citrate, tamoxifen):</span>'''
*#* '''MOA: Inhibit the negative feedback of estrogen on LH production at the level of the hypothalamus and pituitary gland'''
*# '''<span style="color:#ff0000">Aromatase inhibitors (anastrazole):</span>'''
*#* '''MOA: Inhibits conversion of testosterone to estrogen'''
*# '''<span style="color:#ff0000">Human chorionic gonadotropin (hCG):</span>'''
*#* '''MOA: Acts as an LH agonist and stimulates Leydig cell production of testosterone'''
** '''Exogenous testosterone has inhibitory effects on the production of intratesticular testosterone''', which is imperative to maintain normal spermatogenesis. For this reason, alternative therapies, including aromatase inhibitors, hCG, and SERMs (clomiphene citrate), are commonly used to promote the endogenous production of testosterone and maintain intratesticular testosterone levels.
** '''Of these agents, only hCG has been approved by the FDA for use in males''', specifically to treat males with hypogonadotropic hypogonadism. The overall quantity and quality of studies investigating the use of these alternative agents in males are limited.