REPRODUCTIVE SYSTEM DISORDERS IN THE MALE

The symptoms of male reproductive system disorders are often ASSOCIATED WITH SELF-DENIAL by the patient or ignored by the physician despite the fact that in many instances one deals with a serious hormonal deficiency state, specifically the deficiency of male sex hormone, testosterone. On the other hand a very active public relations campaign has been conducted to point out the dramatic increases in cardiovascular risk, in osteoporosis-related fracture risk and in deterioration of emotional as well as general physical well-being in the female sex hormone (estrogen) deficient women. With a longer life span some aging men suffer from associated decreases in testosterone levels that may further the risk of osteoporosis, sexual dysfunction, fatigue and mood disturbances in a fashion similar to their female counterparts. Just as breast cancer has been a concern in women, prostate cancer in men also remains a problem that demands further research efforts. It still is an issue in the consideration of testosterone replacement therapy or in therapy involving stimulation of the testes to produce increased levels of testosterone. In addition to general and sexual health concerns related to inadequate testosterone production, the male reproductive system may suffer from a defect in the ability to produce sperm. This may diminish the male’s fertility potential or render him sterile.

Individuals who require the services of an endocrinologist dealing with the hormonal disorders of the reproductive system:

1.) Males with primary testicular failure (hypergonadotropic hypogonadism) who require testosterone replacement therapy.
2.) Males with gonadotropin deficiency (hypogonadotropic hypogonadism) clinical or subclinical, who may require testosterone replacement therapy or testicular stimulation to produce spermatozoa in the cases of infertility.
3.) Aging men with symptoms suggestive of testosterone deficiency who could benefit from testosterone replacement therapy.

Preliminary evaluation of the patient requires complete history and physical examination and determination of blood levels of several hormones: (plasma testosterone, free testosterone, sex hormone-binding globulin, follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin. Other tests which may be indicated by the results of the initial testing include semen analysis, pituitary imaging studies, genetic studies, bone densitometry, testicular biopsy, testicular ultrasound and specialized hormonal dynamic testing.

Therapy depends very much whether it is directed only towards restoration of the androgenic function or also towards restoration or induction of fertility. In the former case the therapy consists of administration of an appropriate androgen preparation, e.g. one of the forms of injectable testosterone, of a testosterone-impregnated skin patch or, when available, an oral preparation of testosterone. When fertility induction or restoration is desirable therapy with gonadotropic preparations is required. This requires injections with gonadotropins such as follicle stimulating hormone (FSH), or luteinizing-like hormone, HCG. Sometimes administration of an estrogen antagonist(clomiphene citrate) which stimulates gonadotropin secretion is helpful.

A variety of other forms of therapy to treat inadequate sperm production were recommended at different points in time; these included different vitamins, amino acids, metals, trace minerals, pharmaceutical compounds, etc. Their efficacy still remains to be determined.

For the purpose of inducing fertility, reproductive technology may be of help. ICSI (Intra Cellular Sperm Insertion) is particularly effective in patients with untreatable very low sperm count and poor motility.

In general, the most qualified physician to manage the endocrine disorders of the reproductive system is an endocrinologist with special training in the endocrine disorders of the reproductive system.

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