BACKGROUND

With the cancellation of testosterone replacement therapy, the gonadotropic function of the hypophysis and spermatogenesis may remain suppressed. Evaluation of effectiveness of restoring these functions by using an antiestrogen is of interest.

OBJECTIVE

To evaluate the dynamics of indicators of suppressed testosterone-replacement therapy of gonadotropic hypophysis function and spermatogenesis in type 2 diabetes mellitus against the background of the use of antiestrogen clomiphene citrate.

MATERIAL AND METHODS

A pilot observational prospective study included 34 men with type 2 diabetes, with suppressed gonadotropin production and spermatogenesis on the background of testosterone replacement therapy. Patients were divided into 2 groups — those who received clomiphene citrate (n=17) and those who did not receive therapy (t=17). The study period lasted from October 2021 to August 2022. The level of total testosterone, blood gonadotropins, and spermogram parameters were determined initially and after 6 months. The differences were considered statistically significant at p<0.05.

RESULTS

In the group of patients cured with clomiphene citrate, a statistically significant increase in testosterone levels, gonadotropins and the number of spermatozoa in 1 ml of ejaculate was revealed. In 71% of patients from this group, oligozoospermia was eliminated. In the group of patients who did not receive therapy, there was a statistically significant increase only in the level of FSH; testosterone levels, LH and the number of spermatozoa in 1 ml of ejaculate increased, but the increase in statistical significance did not reach. Oligozoospermia was eliminated in 24% of patients from this group. Improvements in mobility and the number of morphologically normal forms of spermatozoa were not observed in any of the groups.

CONCLUSION

The use of antiestrogens after the cancellation of testosterone replacement therapy contributes to the restoration of the gonadotropic function of the hypophysis and normalize spermatogenesis.