Low levels of gonadotrophins can be improved with gonadotrophin drugs and analogues to increase testosterone levels and stimulate sperm production. Hormone replacement therapy can address issues in the hypothalamus or pituitary, and testosterone replacement therapy may help improve sexual function, libido and emotional stability. However, men over the age of 40 should be screened for prostate cancer as testosterone can promote pre-existing prostate cancer.^1,8,26

Testosterone can be given by injection, implants or applied as gels. Injections of hCG (human chorionic gonadotrophin) and hMG (human menopausal gonadotrophin or menotrophin) should stimulate spermatogenesis and boost testosterone production. However, it may take up to two years before sperm content in the semen is considered high enough to conceive.⁸

While clomifene is indicated in female infertility, its potential for off-label use in male infertility is considered a possibility by some clinics. The drug acts on oestrogen receptors in the hypothalamus and pituitary, stimulating gonadotrophin release and promoting testosterone production. Studies indicate that clomifene can enhance sperm concentration and motility.²⁷

Erectile dysfunction can be addressed by various agents, several of which are available as pharmacy (P) medicines.