Aim: It was the aim of this study to investigatethe effect ofalow testosterone/estradiol (T/E2) ratio and the normalization of this ratio by an aromatase inhibitor, anastrozole, on the treatment results of tamoxifen citrate (TAM) in idiopathic oligoasthenoteratozoospermic patients with a normal T/E2 ratio. Patients and Methods: 127 normogonadotropic men were included in this study. TAM (10 mg twice daily) was applied to 103 of the patients (group 1). The control group consisted of 25 patients who did not receive any treatment (group 2). After 3 months, TAM therapy was continued in 42 of the patients with a normal T/E2 ratio (group 1A). Of the remaining 61 patients with low ratios, 30 continued with TAM (group 1BTAM), while the remaining 31 patients underwent additional anastrozole therapy (1 mg/day) to TAM (group 1BANA). Results: In the 3rd month of the study, while the sperm concentration and motility were found significantly improved in group 1 (p < 0.05), they were significantly lower in groups 1BTAM and 1BANA than in group 1A (p < 0.01). In the 6th month of the study, the mean T/E2 ratio was normal in group 1A and group 1BANA, but was lower than normal ranges in group 1BTAM. The sperm concentration and motility significantly increased in groups 1A and 1BANA (p < 0.05). Conclusions: A significant decrease in the T/E2 ratio was seen in the majority of the patients during TAM treatment. Normalization of this ratio by addition of anastrozole to the treatment regimen improved the treatment outcomes. However, a placebo-controlled study is needed to confirm our results.

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