How do I install the Icsm Avoid Tt For Fathering skill?

Run npx skillmds@latest add dromlakhani/icsm-avoid-tt-for-fathering in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Icsm Avoid Tt For Fathering safe to use?

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Which AI agents work with Icsm Avoid Tt For Fathering?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Icsm Avoid Tt For Fathering free to use?

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Who published Icsm Avoid Tt For Fathering?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Icsm Avoid Tt For Fathering by dromlakhani

Name: Icsm Avoid Tt For Fathering
Rating: 4.2 (5 reviews)
Author: dromlakhani

Icsm Avoid Tt For Fathering

This skill advises against initiating testosterone therapy in men who express a desire for future fathering, as exogenous testosterone suppresses spermatogenesis and can lead to infertility. It is triggered when a patient reports wanting children and the clinician contemplates prescribing testosterone, raising the question of whether testosterone therapy is safe for future fertility or should be avoided.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Avoid testosterone therapy in men seeking fathering

STEP 1 — Gather Information

Assess patient’s reproductive goals: explicitly ask about desire for fathering now or in the future. Document baseline total testosterone, symptoms of hypogonadism, and any prior fertility evaluation.

STEP 2 — Rule In / Rule Out

Does the patient desire fathering?

Yes → proceed to Step 3 (contraindication for testosterone).
No → evaluate standard indications for testosterone therapy per other guidelines.

STEP 3 — Classify or Stratify

If desire for fathering is present: classify as testosterone therapy contraindicated due to spermatogenic suppression.
If no desire for fathering: proceed to assess eligibility for testosterone therapy based on symptomatic hypogonadism and low testosterone levels.

STEP 4 — Decide

If contraindicated: avoid testosterone therapy and discuss fertility‑preserving alternatives (e.g., hCG, FSH, SERMs, aromatase inhibitors).
If not contraindicated: consider testosterone therapy if symptomatic and testosterone <12 nmol/L, following shared decision‑making.

Clinical Guardrails / Mimics / Pitfalls

Do not prescribe testosterone to men seeking fertility; it reliably suppresses LH/FSH and spermatogenesis, often causing azoospermia.
Avoid assuming that low testosterone alone justifies therapy when fertility is desired.
Be aware that recovery of spermatogenesis after stopping testosterone can take 3–24 months.
Do not rely on testosterone monotherapy for fertility; use gonadotropin‑based regimens instead.

Concrete Clinical Example

A 32‑year‑old man presents with decreased libido and total testosterone 8 nmol/L. He states he and his partner are trying to conceive. The clinician notes his desire for fathering, avoids testosterone, and initiates hCG 1500 IU three times weekly to stimulate endogenous testosterone and spermatogenesis.

Source: Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), International Society for Sexual Medicine, 2025, DOI: 10.1093/sxmrev/qeaf036

---name: icsm-avoid-tt-for-fatheringdescription: This skill advises against initiating testosterone therapy in men who express a desire for future fathering, as exogenous testosterone suppresses spermatogenesis and can lead to infertility. It is triggered when a patient reports wanting children and the clinician contemplates prescribing testosterone, raising the question of whether testosterone therapy is safe for future fertility or should be avoided.---# Avoid testosterone therapy in men seeking fathering## STEP 1 — Gather InformationAssess patient’s reproductive goals: explicitly ask about desire for fathering now or in the future. Document baseline total testosterone, symptoms of hypogonadism, and any prior fertility evaluation.## STEP 2 — Rule In / Rule OutDoes the patient desire fathering? - Yes → proceed to Step 3 (contraindication for testosterone). - No → evaluate standard indications for testosterone therapy per other guidelines.## STEP 3 — Classify or StratifyIf desire for fathering is present: classify as **testosterone therapy contraindicated** due to spermatogenic suppression. If no desire for fathering: proceed to assess eligibility for testosterone therapy based on symptomatic hypogonadism and low testosterone levels.## STEP 4 — DecideIf contraindicated: **avoid testosterone therapy** and discuss fertility‑preserving alternatives (e.g., hCG, FSH, SERMs, aromatase inhibitors). If not contraindicated: consider testosterone therapy if symptomatic and testosterone <12 nmol/L, following shared decision‑making.## Clinical Guardrails / Mimics / PitfallsDo not prescribe testosterone to men seeking fertility; it reliably suppresses LH/FSH and spermatogenesis, often causing azoospermia. Avoid assuming that low testosterone alone justifies therapy when fertility is desired. Be aware that recovery of spermatogenesis after stopping testosterone can take 3–24 months. Do not rely on testosterone monotherapy for fertility; use gonadotropin‑based regimens instead.## Concrete Clinical ExampleA 32‑year‑old man presents with decreased libido and total testosterone 8 nmol/L. He states he and his partner are trying to conceive. The clinician notes his desire for fathering, avoids testosterone, and initiates hCG 1500 IU three times weekly to stimulate endogenous testosterone and spermatogenesis.**Source:** Male hypogonadism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024), International Society for Sexual Medicine, 2025, DOI: 10.1093/sxmrev/qeaf036

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