An article in press in Fertility and Sterility is getting a lot of media attention. The study connected men seeking infertility care to a cancer registry in the State where the clinic was located. The researchers found that men with infertility had almost twice the chance of getting cancer and almost three times the chance if the man had no sperm in his ejaculate.
The authors of the study have a few theories about why cancer and male infertility may be connected. Cells need to divide just right to make sperm in the testes, and problems with division could lead to both problems with making sperm and the kind of bad division that makes cancer. It could also be that toxic substances in the environment may lead to both infertility and cancer.
Whatever the reason, we’re beginning to understand that problems with male fertility are just a tip of a much bigger iceberg that involves health in general. It’s more than just about the testicles.
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The abstract of the article did not say if there is a difference between patients with obstructive azoospermia vs. patients with non-obstructive azoospermia in regards to cancer risk. Is there a difference?
Hi Kate, men who had vasectomies were excluded, but judging from their description of who was included, other forms of obstructive azoospermia weren’t, so I can’t answer the question. It’s a limitation of the database that was studied.
Doctor Niederberger,
Thank you for the great website, I’ve learned so much from the posts. I had a few general questions about the use of Clomid in male patients:
1) when you place a patient on Clomid for low-T
A- what is the usual initial start dose that you prescribe? What factors do you consider in deciding the initial dose?
B- what is the average rate of increase in dosage and after how long? For instance, if
you start with 25mg/day, how long will the patient be on that dosage before it’s
increased to 50mg/day, 75mg, or 100mg?
C- In patients who respond to Clomid, what is the average increase in Testosterone
levels that you normally see per dose increase?
D- Any idea on how to take Clomid? on empty stomach? with food?
night/morning? (Want to know if that makes any difference in
effectiveness/absorption)
E- In a scenario where the primary cause of low-T is from the pituitary only, and nothing wrong with the testis, is it possible for a patient not to respond to high doses of 100mg/day? And when a patient doesn’t respond to that high dose, can we assume it’s because the problem is only from the testis? What is the main reason for not responding to 100mg/day?
F- In what percentage of your cases do you see the need to go to 100mg/day? I read that you mentioned Clomid is generally safe for men, but there haven’t been any longterm studies. That said, would you consider keeping a patient on 100mg/day under any circumstance for longterm, meaning more than a year or two? Or is it safer/easier to go on HCG if it’s for that long. (not considering the possible higher cost of HCG vs. 100mg/day, if there is any cost differences at that dosage.)
G- Is it possible to have a large increase in T-levels without any increase in sex drive? There are so many factors affecting sex drive, but I’m assuming when T-levels go up considerably, or maybe double , there would be at least some increase in sex drive, but I could be wrong.
2) Assuming you order blood tests be done before each dose increase, what tests do
you order besides Total-T, and Bioavailable T ? Any LH or Estradiol?
3) Have you ever come across cases were an Epididymal Cyst is the direct cause of low-
T because of damage done to the testis and Leydig cells? I don’t think it’s common,
but is there great risk/low risk if an Epidiymal cyst is left untreated for several years?
B- Is there any way to treat or reduce the size of an Epidimyal cyst with antibiotics
only or other medication, without surgery?
4) I’m currently seeing a physician whose practice is mainly fertility issues, he’s a Reproductive Endocrin/OBGYN board certified but prescribes Clomid for men. Do you see any advantage to switching to a urologist who specializes in male reproductive/Endocrin issues? or any other specialist that you would recommend?
It’s very difficult to find a doctor who’s comfortable prescribing Clomid for low-T, even here in California where I am. I’ve tried the referral link on this site, but it’s too general and pulls up all kinds of doctors who are just not willing to prescribe Clomid for men, or deal with this specific low-T male issue. Some do it, if it’s a couple trying to conceive but if you’re single, almost none of them will deal with you.
Disclaimer: I understand that your responses to above questions do not establish a patient-physician relationship and such responses do not constitute medical advice in any way, and that I must consult my physician.
Thank You,
There are a lot of male reproductive specialists in California! You may have to travel to a city to see one, but it has some of the best in the world. Paul Turek in San Francisco, Mike Eisenberg in Palo Alto, and Jake Rajfer in Los Angeles are naming just a few.