Is there a treatment for secretory azoospermia with elevated prolactin and gonadotropins?

Azoospermia is the absence of sperm in the ejaculate. We say that it is secretory, when said absence is due to the lack of sperm production in the testes (spermatogenesis). This sperm alteration can be reversible or irreversible.

When we come across a patient with secretory azoospermia, the first thing we must do is complete the diagnosis with genetic tests, laboratory tests, testicular ultrasound and evaluation by a urologist.

In the case of patients with hyperprolactinemia, an MRI of the sella turcica should be requested to rule out possible hyperprolactinemia. Depending on the result, it could be treated with surgery if necessary or with bromocriptine.

The main gonadotropins are FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone). The increase in gonadotropins of 2-3 times their value in any azoospermia is a poor prognostic factor that indicates that the germinal epithelium does not function.

Reversible azoospermia is most often due to taking medications (antiandrogens or anabolics). In these cases, it is indicated to suspend said medication and wait at least 3-6 months to see if it restores spermatogenesis.

Secretory azoospermia of unknown origin are the most frequent and do not usually remit, so they are not treated.

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