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What Causes Retrograde Ejaculation?

Posted on Sat, 4 Apr 2015

Question: I am unmarried but going to get married in 2 months. I did a general health check up and found my testosterone level was to be at the 'lower end of normal'. My doctor asked me to take testosterone injection 250 mg/ml every 21 days. So far i have took 4 injections. but, for the past 2 months after i urinate about 1 to 2 ml sperms are coming out. Is this a problem or is this due to the testosterone injection i am taking. Should i stop the injection or is there a remedy for the the problem of sperms coming out.

Answered by Dr. Ajish TP (13 hours later)

Brief Answer:
Retrograde ejaculation - needs evaluation

Detailed Answer:
Hi XXXX,

Welcome to HCM.
I truly understand your concerns.

Few things I need to clarify before I answer your question.

Do you have any other medical illness like diabetes, or neurological disorders?
Are you on some medications other than testosterone?
What did your doctor tell you about the cause of hypogonadism?
Please upload the blood tests done prior to testosterone injection - like LH, FSH, Prolactin, thyroid function, semen analysis?
Did you have erection prior to testosterone injection?

Your condition is called retrograde ejaculation. That means when semen comes out, the normal bladder neck contraction which prevent it from going to urinary bladder is lost. So next time when you urinate this semen comes out. The treatment depends on severity of this condition. If you have a normal ejaculate and sperm count is normal, no treatment is needed. If not you need treatment depending on the cause of retrograde ejaculation.

Please do a urine test to make sure that the material is semen.
Do a semen analysis of your ejaculate.

Hope this will clear your concerns.
If you have any further queries, I will be happy to help you.

Regards
Dr Ajish TP
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajish TP (9 hours later)

Dear Doctor,

Thanks for your reply. I am not diabetic and i dont have any neurological disorders. I am not under any medications also. But, i am very sorry i couldnt do semen analysis as i feel very uncomfortable and couldnt masturbate in a bathroom ans give semen for analysis. Herewith i am uploading my blood report taken before taking testosterone injection.
I have normal erection and ejaulation while i masturbate in my home. And only very ocassionally 1 to 2 ml of semen comes out after i urinate. That too semen doesnt comes out in the urine. it comes out (1 to 2 ml)after i completely urinate.
Kindly give me a remedy.

Thanks.

Follow up: Dr. Ajish TP (2 minutes later)

Sorry i couldnt upload my blood report but my total testosterone was 2.93 ng/ml and my free testosterone was 8.94 pg/ml.

Answered by Dr. Ajish TP (14 hours later)

Brief Answer:
I think you should stop taking testosterone

Detailed Answer:
Hi XXXX,

Welcome back. Sorry for the delay in reply as I had a busy hospital schedule.

If your doctor has started you on testosterone injection based on a testosterone and free testosterone values alone, I think you should stop taking this injection.

If you are taking testosterone from outside, your testes will produce less testosterone and there by less sperms. That is not a good result when you are planning to get married.

So I suggest you to stop the injections and do a proper evaluation before getting concerned. If you still have retrograde ejaculation after stopping the injections, we will have to do a sperm analysis as that will decide whether you need to be treated or not. Drugs like imipramine are used for retrograde ejaculation.

Regards
Dr Ajish TP

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar