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Fertility and Sterility May 2014To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management.
DESIGN
Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria.
SETTING
Not applicable.
PATIENT(S)
Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS.
INTERVENTION(S)
History and physical examination followed by medical intervention if necessary.
MAIN OUTCOME MEASURES(S)
Serum testosterone and gonadotropin levels, symptoms, and fertility restoration.
RESULT(S)
Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators.
CONCLUSION(S)
Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management.
Topics: Anabolic Agents; Humans; Hypogonadism; Male; Recovery of Function; Treatment Outcome
PubMed: 24636400
DOI: 10.1016/j.fertnstert.2014.02.002 -
Genes Mar 2023Klinefelter syndrome (KS), caused by the presence of an extra X chromosome, is the most prevalent chromosomal sexual anomaly, with an estimated incidence of 1:500/1000... (Review)
Review
Klinefelter syndrome (KS), caused by the presence of an extra X chromosome, is the most prevalent chromosomal sexual anomaly, with an estimated incidence of 1:500/1000 per male live birth (karyotype 47,XXY). High stature, tiny testicles, small penis, gynecomastia, feminine body proportions and hair, visceral obesity, and testicular failure are all symptoms of KS. Endocrine (osteoporosis, obesity, diabetes), musculoskeletal, cardiovascular, autoimmune disorders, cancer, neurocognitive disabilities, and infertility are also outcomes of KS. Causal theories are discussed in addition to hormonal characteristics and testicular histology. The retrieval of spermatozoa from the testicles for subsequent use in assisted reproduction treatments is discussed in the final sections. Despite testicular atrophy, reproductive treatments allow excellent results, with rates of 40-60% of spermatozoa recovery, 60% of clinical pregnancy, and 50% of newborns. This is followed by a review on the predictive factors for successful sperm retrieval. The risks of passing on the genetic defect to children are also discussed. Although the risk is low (0.63%) when compared to the general population (0.5-1%), patients should be informed about embryo selection through pre-implantation genetic testing (avoids clinical termination of pregnancy). Finally, readers are directed to a number of reviews where they can enhance their understanding of comprehensive diagnosis, clinical care, and fertility preservation.
Topics: Infant, Newborn; Pregnancy; Child; Female; Humans; Male; Klinefelter Syndrome; Sperm Retrieval; Semen; Testis; Spermatozoa; Chromosome Aberrations
PubMed: 36980920
DOI: 10.3390/genes14030647 -
Seminars in Interventional Radiology Sep 2016Varicoceles are relatively common clinical problem that are associated with pain, testicular atrophy, and reduced fertility rates. After a brief historical perspective... (Review)
Review
Varicoceles are relatively common clinical problem that are associated with pain, testicular atrophy, and reduced fertility rates. After a brief historical perspective is presented, this article reviews the anatomy, indications, treatment options, and potential complications related to varicoceles.
PubMed: 27582603
DOI: 10.1055/s-0036-1586147 -
SpringerPlus 2014Open and laparoscopic tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice with an excellent patient comfort and a low recurrence... (Review)
Review
Open and laparoscopic tension-free techniques of hernia repair using synthetic meshes are a well-accepted practice with an excellent patient comfort and a low recurrence rate. It is well known that, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. Whether different operative techniques or mesh materials used have an effect on the integrity of the testicle, the influence of the resulting fibrosis on testicular perfusion, and spermatic cord structures is still unclear. Our objective is to review whether there is an association between inguinal hernia and hernia repair techniques, pitfalls of various manipulations and also specific applications on spermatic cord structures and testicular perfusion in view of the literature. Most of the clinical and experimental studies result support the idea that inguinal mesh application for hernioplasty is still a safe procedure in patients. Testicular blood flow may be influenced during open and laparoscopic inguinal hernia surgery. But, so far, there is no evidence for a significant impairment of cord structures after open or laparoscopic hernia repair using tension free techniques. It is clear that fine surgical dissection and reconstruction, doing respect for anatomy and using proper prosthetic material could be obtain the best results. Whether changes in flow parameters remain in the late postoperative period, and whether they have an impact on complications should be evaluated in further clinical and experimental studies.
PubMed: 24616842
DOI: 10.1186/2193-1801-3-107 -
Cureus Oct 2022Background There is a clear association between testicular cancer and microlithiasis when there are predisposing risk factors such as the history of germ cell tumors in...
Background There is a clear association between testicular cancer and microlithiasis when there are predisposing risk factors such as the history of germ cell tumors in first-degree relatives, testicular atrophy, Klinefelter's syndrome, and cryptorchidism. This study aimed to establish an association between microlithiasis and the histological subtype of testicular cancer by analyzing data on Hispanic population. Methods A retrospective cohort, longitudinal, comparative, and analytic study was conducted on patients with a confirmed diagnosis of primary testicular cancer. The testicular ultrasounds were checked before any surgical treatment to find microlithiasis. We performed a binary logistic regression to establish an association between microlithiasis and the type of testicular cancer. Results A total of 130 clinical files were analyzed. Binary logistic regression showed no association between testicular microlithiasis and the subtype of testicular cancer (p = 0.438, 95% CI: 0.80-1.64). The result of the Pearson chi-square test showed no association (p = 0.184). We also analyzed the association between age and microlithiasis using the one-way ANOVA test (p = 0.82) and the association between age and the dichotomic subtype of testicular cancer (seminomatous and non-seminomatous) using the ANOVA one-way test, which showed no significant association in age and testicular cancer subtype (p = 0.178). Conclusions There was no association between testicular microlithiasis and the histological subtype of testicular cancer in our study. As mentioned before, we recommend conducting a more extensive study to provide further scientific evidence to establish a reliable association between microlithiasis and the subtype of testicular cancer since there is a discrepancy in the results of our study with the information previously reported. We encourage the study of characterization of risk factors among ethnic groups as this field has not been explored yet.
PubMed: 36348894
DOI: 10.7759/cureus.29946 -
Reproductive Sciences (Thousand Oaks,... Oct 2021Coronavirus disease 2019 (COVID-19), which resulted from the pandemic outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a massive... (Review)
Review
Coronavirus disease 2019 (COVID-19), which resulted from the pandemic outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a massive inflammatory cytokine storm leading to multi-organ damage including that of the brain and testes. While the lungs, heart, and brain are identified as the main targets of SARS-CoV-2-mediated pathogenesis, reports on its testicular infections have been a subject of debate. The brain and testes are physiologically synchronized by the action of gonadotropins and sex steroid hormones. Though the evidence for the presence of the viral particles in the testicular biopsies and semen samples from COVID-19 patients are highly limited, the occurrence of testicular pathology due to abrupt inflammatory responses and hyperthermia has incresingly been evident. The reduced level of testosterone production in COVID-19 is associated with altered secretion of gonadotropins. Moreover, hypothalamic pathology which results from SARS-CoV-2 infection of the brain is also evident in COVID-19 cases. This article revisits and supports the key reports on testicular abnormalities and pathological signatures in the hypothalamus of COVID-19 patients and emphasizes that testicular pathology resulting from inflammation and oxidative stress might lead to infertility in a significant portion of COVID-19 survivors. Further investigations are required to monitor the reproductive health parameters and HPG axis abnormalities related to secondary pathological complications in COVID-19 patients and survivors.
Topics: Animals; Atrophy; COVID-19; Fertility; Gonadotropins; Host-Pathogen Interactions; Humans; Hypothalamo-Hypophyseal System; Hypothalamus; Incidence; Infertility, Male; Male; SARS-CoV-2; Testis; Testosterone
PubMed: 33415647
DOI: 10.1007/s43032-020-00441-x -
Translational Andrology and Urology Jun 2019Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing... (Review)
Review
Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.
PubMed: 31380227
DOI: 10.21037/tau.2019.05.09 -
Cancers Oct 2020The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe... (Review)
Review
OBJECTIVE
The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors.
METHODS
A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports.
RESULTS
Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%).
CONCLUSION
TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.
PubMed: 33036134
DOI: 10.3390/cancers12102867