Effect of Lower Versus Higher Doses of Tamoxifen on Pituitary-Gonadal Function and Sperm Indices in Oligozoospermic Men

Abstract

Administration of the antiestrogen tamoxifen for one month to 12 patients with idiopathic oligozoospermia significantly increased the mean basal testosterone (T) level and the responses of luteinizing hormone (LH) and follicle stimulating hormone (FSH) to constant luteinizing hormone releasing hormone (LHRH) infusion but did not significantly influence the mean oestradiol (E,) levels or the Ez over testosterone ratio. Mean sperm concentration and total sperm output increased by about 70% after a mean treatment period of 5.5 Ifr 0.4 months. No statistically significant difference was found between the two subgroups of patients treated with either the lower (5 or 10 mg once daily) or higher dose of tamoxifen (1 0 mg twice daily) with respect to basal or LHRH I stimulated gonadotropin and testosterone response or the E2/T ratio and the effect on sperm density and total sperm output. In both subgrounps the sperm motility and morphology remained unchanged.In conclusion higher doses of tamoxifen in this study prove not to be superior to lower doses in improving mean sperm density and total sperm output. The relative small percentage of patients achieving normalisation of only these sperm parameters pleads for further search for more effective selection of patients and other more effective treatment modalities in patients with idiopathic oligozoospennia. Der Effekt niedriger bzw. hoher Tamoxifen-Dosen auf die Hypophysen-Gonadenachse und Spermaparameter bei OligozoospermieZusammenfassung: 12 Patienten mit idiopathischer Oligozoospermie erhelten fur 1 Monat das Antioestrogen Tamoxifen. Dabei stiegen der Mittelwert des basalen Testosteronspiegels sowie die Ausschuttung von LH und FSH auf LHRH-Infusion signifikant an. Eine signifikante Auswirkung auf die nuttleren EZ -Spiegel oder den E2 /T-Quotienten war nicht nachweisbar. Der mittlere Spermatozoenkonzentration sowie deren Gesamtzahl stiegen um etwa 70% nach einer Behandlungszeit von 5,s Zwischen zwei Untergruppen von Patienten, von denen die eine mit niedriger (5 oder 10 mg per die), die andere mit hoherer (1 0 mg 2 de die) Dosis behandelt wurden, fand sich hinsichtlich der basalen Hormonspiegel, der LHRH stimulierten Gonadotropin-und Testosteronausschuttung, den Ez /T-Quotienten und dem Effekt auf Spermatozoenkonzentration und -Gesamtzahl kein signifikanter Unterschied. In beiden Untergruppen blieben Spermatozoenmotilitat und -morphologie unverandert. Zusammenfassend waren hohere Tamoxifendosen bei der Erhohung von Spermatozoenkonzentration und Cesamtzahl der niedrigeren Tamoxifen-Dosis nicht iiberlegen. 0,s Monaten.

Hormonal Changes in Tamoxifen Treated Men with Idiopathic Oligozoospermia

“…The details of the effect of tamoxifen treatment on spermiologic parameters are given elsewhere (Lachman et al, 1987). Our results are in agreement with the most studies reported by others (Buvatet al, 1983;Török, 1985;Pony et al, 1985;Schiferstein et al, 1986;Schill and Schillinger, 1987) but are in contrast to the recent double blind cross-over study of AinMelk et al (1986). With regard to this discrepancy, attempts were undertaken to predict the effective.…”

Oral tamoxifen citrate treatment is more effective in normogonadotropic patients who have follicle-stimulating hormone levels within the lower half of normal

“…In our previous study, we reported that a 20-mg daily dosage of TC significantly increased sperm count and concentration in the normogonadotropic group. The fact that TC does not affect other semen values, such as volume, pH, motility, morphology, and viability [4,8,11,18,19], has led us to conclude that TC is effective on the seminiferous tubules during the early stages of spermatogenesis [8,15,16]. This effect is exerted by increasing GnRH, which causes endogenous FSH and LH to increase and is more physiological than exogenous administration of these.…”

Estrogens as Antioxidant Modulators in Human Fertility

“…Both clomiphene citrate and tamoxifen (TMX) have been suggested as empiric treatments for male infertility, with different reports in the last decades. TMX has reached a leading role as a suitable gonadotropin stimulator rising directly and indirectly the testicular function with a clear advantage on clomiphene that, according to its estrogenic effect, would seem to lower the sex-hormone binding protein and testosterone levels depressing spermatogenesis [46–50]. …”