Serrano Journal Club 3

Paper: Converting Men from Clomiphene Citrat to Natesto for Hypogonadism Improves Libido, Maitains Semen Parameters, and Reduces Estradiol

Authors: Kavoussi, Machn, Gilkey, Chen, Kavoussi, Esqueda, Wininger, Barsky, Kavoussi

Publication Date: Nov 23, 2020

What are the Main Points:

Natesto may be an alternative TRT replacement option in men seeking to retain fertility

What are the General Findings:

Summarize in your own words:

Men who had insufficient libido on CC were transitioned to Natesto. Over three months they were able to maintain semen quality

Compare this information to existing understanding of the topic (what’s the new, different, contrary to your previous understanding:

New: traditionally would not consider TRT in men who desired to maintain fertility. Would consider it using this product. Still uncertain why there is relatively little change on LH and FSH. Presume it’s the dosing and not necessarily the location of administration. Very well could be due to the route as nasal plexus has vascular connection to brain and potentially hypothalamus/pituitary.
Different: surprised at the relative stability of LH and FSH on Natesto. I would be curious to see LH level changes based on dosing schedule of the Natesto and quantity of the Natesto.
Contrary: Would not make the assumption that the route would keep LH and FSH stable. Surprised that the level of these hormones didn’t change.

What conclusion do you come to based on the information and why:

That Natesto increases testosterone levels using relatively equivocal dosing to IM test (70mg per week vs traditional 100mg). That typically men are closer to 700-800 with IM test at 100mg per week. Thus Natesto may not inhibit sperm production because of the relatively lower dose. This is somewhat consistent with some patients. They do not abuse tesosterone and their fertility is maintained. Supra dosing 250 and up per week likely inhibits spermatogenesis
Elevated estrogen levels may negatively influence libido

What findings would you share with your audience, apply practically:

I would like to continue watching for longer outcome studies. While I think CC is a cheap and relatively safe option, this product may be desirable for some. Currently the price difference of $30 per month for clomid versus $200 per month (goodrx) for Natesto would still make me lean towards using clomid in this population.
I would be excited about using Natesto as an alternative TRT option in the hypogonadism group. Uncertain about pharmacy availability at this point. I do like the BID dosing in Natesto.