All posts by highlandsvas

Information for Men on Testosterone

Testosterone (T) therapy inhibits sperm production by the testes. In our experience, about 70% of men on T therapy for more than 1-2 years have no sperm in their semen.

Vasectomy: We ask men who plan to continue T therapy long term to consider undergoing semen analysis prior to vasectomy to ensure it is necessary. Most men who are on T therapy like it and will continue with it indefinitely. We have never had a patient with no sperm on T therapy who showed a return of sperm to the semen on repeat testing or who caused a pregnancy (without a vasectomy), as long as he remained on T therapy and did not add any other medications like clomiphene or HCG (which stimulate sperm production). Any man with no sperm on T therapy should reconsider vasectomy if he ever comes off testosterone or starts another med to prevent shrinkage of the testes.

If you are not ready to schedule a vasectomy but would like to determine whether there are sperm in your semen you may purchase a home test kit at your local pharmacy for about $40. One is called SpermCheck Fertility. You can also have our office perform a pre-vasectomy sperm analysis for $50.

We do not require a semen test of men on T therapy. Some men would want to proceed with vasectomy even if their semen contained no sperm and we are willing to proceed with vasectomy just like in any other patient as long as they complete the standard pre-vasectomy evaluation and understand the risks involved with having a vasectomy.

Vasectomies vs. Tubal Ligation

The following is an excerpt from an article by Dr Ken Goldberg MD Lewisville, Texas
What are your birth control options?
You and your partner are absolutely sure that you do not want to have any more children. Sterilization is an available option, offering an almost completely safe and reliable form of permanent birth control. Because it is safer and less complicated, most physicians recommend male rather than female sterilization to couples.
The vasectomy is a simple office procedure in which a segment of the tubes carrying the sperm from the testicles is removed, and the ends are sealed off. The procedure takes about ten minutes and is performed under a local anesthetic. Check to see if you can have a scalpeless vasectomy, which uses a technique in which an incision is not made. Most men readily admit that the procedure is less painful than a visit to the dentist’s office. Additionally, the only medication necessary afterward for the discomfort is a mild anti-inflammatory such as Advil or Tylenol. In order to minimize the discomfort and complications, it is important to stay off your feet for one to two days after the procedure. Most instances of complications from vasectomies occur because of too much activity following the procedure.
Family Planning: When Your Reproductive Years Are Behind You
Family size is the most difficult decision most couples ever have to make. There are so many aspects to consider: the joy children bring to the household, the cost of supporting them, your or your spouse’s career plans, the medical risks of pregnancy and temporary birth control methods, and, of course, what your faith tells you.Temporary birth control methods—condoms, the diaphragm, the pill, etc.—let couples time their births and postpone taking more permanent measures. But, used long enough, every one of them might just fail. For that reason, many couples eventually choose a more-permanent approach—voluntary sterilization.

Only you, yours and your maker can decide about sterilization. But I can tell you most couples take time—between two and five years—to become sure enough to go ahead.

That’s good. Though both common forms of sterilization can be surgically reversed, reversal is more complicated and expensive than sterilization, insurance companies usually won’t pay for it and there’s no guarantee of success. That’s why I like to call sterilization “permanent.”

Once you’re confident that you’re ready to put your reproductive years behind you, there are two options: vasectomy (male sterilization) or tubal ligation (female sterilization). Vasectomy makes you sterile by cutting the pipelines (the vas deferens) between the testicles and the penis. These small tubes are located just under the surface of the scrotal skin, and it takes less than 15 minutes in the doctor’s office to snip them and seal the ends under a local anesthetic.

Tubal ligation involves cutting and tying a woman’s fallopian tubes, which are well below muscles and other tissue in the abdomen. It requires a general anesthetic and a hospital visit.

A couple of statistics might make the differences even more clear:

  • Fatalities per 100,000: tubal ligation = 3.51; vasectomy = 0
  • Approximate cost: tubal ligation = $2,500; vasectomy = $750 – 850
Vasectomy is simpler, safer, cheaper and takes less time to recover from than tubal ligation. Their failure rates are just about the same: 1 in 2,000.Still, most men naturally squirm at the thought of anyone tampering with that part of their bodies. If you hear horror stories about vasectomy, press for details. I assure you the tale will turn out to be at least third-hand and groundless. I’ve done more than 4,500 vasectomies and have never seen a serious complication. The most frequent comment is, “You mean it’s over already?”

When a man has a vasectomy Friday afternoon and follows instructions—uses ice packs, elevates his feet and is inactive for the weekend (no matter how good he feels)—he’s back to work on Monday barely feeling a thing.

It’s worth discussing with your doctor what approach he uses and how many vasectomies he’s done. Technique and experience can make a significant difference both in how quickly you’re back on your feet and also in the likelihood of failure.

Is sex different after vasectomy? Not at all. Because the testicles supply less than 5 percent of the ejaculate, there’s no noticeable difference in the semen. Erections and sex drive are unaffected—though freedom from worry of pregnancy often enhances a couple’s sex life.

What about long-term health effects? No repeated studies have ever documented a hazard to men who have had vasectomies. And recently, researchers at Harvard University reported in the New England Journal of Medicine results from the largest study ever of vasectomized men. They were unable to associate vasectomy with any health problem in 14,607 vasectomized men.

Don’t choose vasectomy lightly. But if you and your spouse decide you’re ready for permanent birth control, get the facts and consider it carefully.

When you understand the choices, I think you’ll agree guys, it’s the least we can do for our women.