Effect of cyproterone acetate (CPA) on gonadal and adrenal function in men

Discovery and Characterization of Multiple Classes of Human CatSper Blockers

The cation channel of sperm (CatSper) is a validated target for nonhormonal male contraception, but it lacks selective blockers, hindering studies to establish its role in both motility and capacitation. Via an innovative calcium uptake assay utilizing human sperm we discovered novel inhibitors of CatSper function from a high-throughput screening campaign of 72,000 compounds. Preliminary SAR was established for seven hit series. HTS hits or their more potent analogs blocked potassium-induced depolarization and noncompetitively inhibited progesterone-induced CatSper activation. CatSper channel blockade was confirmed by patch clamp electrophysiology and these compounds inhibited progesterone- and prostaglandin E1-induced hyperactivated sperm motility. One of the hit compounds is a potent CatSper inhibitor with high selectivity for CatSper over hCav1.2, hNav1.5, moderate selectivity over hSlo3 and hERG, and low cytotoxicity and is therefore the most promising inhibitor identified in this study. These new CatSper blockers serve as useful starting points for chemical probe development and drug discovery efforts.

Anti-Androgen Drugs in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review

OBJECTIVE

This study aimed to systematically investigate whether anti-androgens could significantly reduce Obsessive-Compulsive Disorder (OCD) symptoms compared to placebo or usual care in OCD patients.

METHODS

PubMed, EMBASE, CENTRAL and International Clinical Trials Registry Platform (ICTRP) databases were searched up to October 2018 using relevant keywords. All randomized and if not available non-randomized studies conducted on a population including OCD patients who were administered with anti-androgen, which reported changes in their symptoms, were included. The studies on compulsive hypersexuality were excluded. Required data were extracted from full-text of the included articles by two independent authors. One randomized and four non-randomized trials were found.

RESULTS

The only randomized trial showed that flutamide, an anti-androgen agent, was effective in reducing compulsion scores in male OCD patients with comorbid Tourette syndrome, compared to placebo. Three out of four non-randomized trials showed that different anti-androgens including finasteride, cyproterone acetate and triptorelin were effective in reducing OCD symptoms. The only study, which failed to show the efficacy of an anti-androgen agent, administered OCD patients with flutamide. Despite the positive results, available studies provide the evidence with low quality based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach.

CONCLUSION

Available studies are not sufficient for a precise answer to our study question. There is still a need for further large randomized blinded clinical trials to evaluate the effectiveness of antiandrogens in OCD patients. It is recommended that gender, comorbidities and subscales of Yale- Brown Obsessive-Compulsive Score (Y-BOCS) should be considered in designing the studies and interpreting their results.

Endocrine, seminal and peripheral effects of depot medroxyprogesterone acetate and testosterone enanthate in men

Depot medroxyprogesterone acetate (D-MPA, 250 mg) and testosterone enanthate (TE, 200 mg) were administered twice with a 4-week interval to nine healthy men, and the levels in blood of steroids, gonadotrophins, lipoproteins, sex hormone binding globulin (SHBG) and prostaglandins (PGs) were measured, as well as steroid levels in semen and the sperm count and motility. The hormones analysed were: MPA, testosterone, androstenedione (A), dihydrotestosterone (DHT), oestradiol (E2), cortisol (C), luteinizing hormone (LH), follicle stimulating hormone (FSH) and the sulphoconjugated forms (-S) of testosterone, DHT, pregnenolone (5-P) and dehydroepiandrosterone (DHEA). Peak values of MPA (10.2 +/- 4.6 nmol/l) and testosterone (28.0 +/- 10.0) were found in the first blood samples 2 days after each injection. Thereafter the levels of MPA decreased gradually and reached the limit of detection 18-20 weeks after the second injection. Blood levels of testosterone fell sharply from the peak values and were grossly subnormal 2 weeks after each injection; levels did not return to pretreatment values during 24 weeks of follow-up. The pattern of change of DHT, A, E2 and sulphonated androgens was similar to that of testosterone. These data suggest that D-MPA and TE are absorbed at similar rates, and that the TE is metabolized rapidly. The subsequent reduction in the levels of A, testosterone-S and DHT-S was less marked and reached pretreatment values earlier than did the testosterone levels. No obvious changes were found in the levels of C, 5-P-S and DHEA-S or in the seminal plasma levels of the various steroids studied. The blood levels of LH and FSH fell precipitously 2 days after the first injection, then started to increase 4 weeks after the second injection to reach pretreatment values 12 weeks later. Of the lipoproteins studied only the levels of HDL-cholesterol and SHBG were found suppressed after treatment. Severe oligozoospermia and the complete absence of progressively motile sperm, in at least one semen sample, was observed in all subjects at 3-7 and at 5-16 weeks, respectively, after the last injection, suggesting that the men were infertile for at least 1 month after treatment. A spurious increase in the PG content of semen was also observed. In spite of the low blood testosterone levels, no subject reported changes in sexual behaviour or other signs of anabolic imbalance during or after the study. However, the increase in levels of E2 in some individuals should be kept in mind as a possible cause of side-effects.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood and tissue steroid levels and their interrelationship in men with pathological conditions of the reproductive organs

We have investigated the interrelationship of the levels of 10 steroids in peripheral venous, spermatic arterial and spermatic venous blood, and in tissue specimens from the epididymis, vas deferens and testis from 8 patients who underwent orchidectomy for pathological conditions of the reproductive organs. The steroids analyzed by radioimmunoassay were: pregnenolone (5-P), dehydroepiandrosterone (DHEA), 17-hydroxyprogesterone (17-OH-P), androstenedione (A), testosterone (T), dihydrotestosterone (DHT) and the sulpho-conjugated forms (-S) of 5-P, DHEA, T and DHT. The quantitatively major steroids in peripheral venous blood were, in order of magnitude, DHEA-S, 5-P-S, DHT-S, T-S and T. No difference was observed between the levels of any of the steroids measured in peripheral venous and spermatic arterial blood. With the exception of DHEA-S and DHT-S, the levels of all steroids in spermatic venous blood were substantially higher than in peripheral venous blood (P less than 0.001). No correlation was found between steroid levels in spermatic venous and peripheral venous blood. Steroid concentrations in tissue from the epididymis, vas deferens and testis were markedly higher than in peripheral venous blood (P less than 0.01 to P less than 0.001), except for the levels of DHEA-S which were about equal in the various blood and tissue specimens. Tissue to blood ratios varied from approximately 2.0 to 500 according to the steroid in question. The peripheral blood levels of 5-P-S, DHEA-S and DHT-S were substantially higher than respective unconjugated steroid levels (P less than 0.001); the ratios (sulpho-conjugated to unconjugated) were approximately 17, 215 and 30, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Intratesticular steroid levels and their hormonal control

Litter-mate adult male rats were treated with daily intramuscular injections of ACTH (10.5 micrograms), dexamethasone (2.0 mg), ethynyl estradiol (1.7 micrograms) and hCG (5 IU) for three consecutive days. The animals were sacrificed on the fourth day and the intratesticular and peripheral plasma steroid levels were analyzed. The steroids measured by radioimmunoassay included pregnenolone, 17-hydroxypregnenolone, dehydroepiandrosterone, progesterone, 17-hydroxyprogesterone, androstenedione, testosterone and dihydrotestosterone. In addition, the sulphoconjugated forms of pregnenolone, dehydroepiandrosterone, testosterone and dihydrotestosterone were estimated in the peripheral blood. The administration of ACTH diminished the intratesticular levels of all steroids studied. Also dexamethasone and ethynyl estradiol treatment suppressed all intratesticular steroid levels, except that of pregnenolone (the former) and of 17-hydroxyprogesterone (the latter). The suppressive effect of ethynyl estradiol was strongest on the levels of the delta 5-steroids and that of dexamethasone on the delta 4-steroids; the latter was significantly stronger than the effect of ACTH. The stimulatory effect of hCG was limited to the metabolism of progesterone and was restricted to the sequence: 17-hydroxyprogesterone----androstenedione----testosterone---- dihydrotestosterone. Dexamethasone-suppression, and hCG-stimulation of the intratesticular levels of delta 4-steroids, was mirrored by corresponding changes in the peripheral plasma levels, with the exception of the plasma levels of androstenedione which were not influenced by any of the treatments studied. Also the suppression of intratesticular testosterone and dihydrotestosterone levels by ACTH, dexamethasone, or ethynyl estradiol was closely reflected by their plasma levels both in the unconjugated and sulphoconjugated forms. On the hand, the administration of ACTH diminished the intratesticular levels of pregnenolone and progesterone but significantly increased those in the plasma. Moreover, both ACTH and ethynyl estradiol reduced the levels of all delta 5-steroids in testicular tissue, but not in the peripheral plasma, although they decreased the circulating levels of pregnenolone sulphate and dehydroepiandrosterone sulphate. The data are interpreted as suggesting that the hormonal agents studied interfere with testicular steroidogenesis through different mechanisms.

Effects of cyproterone acetate with combination of testosterone enanthate on seminal characteristics, androgenicity and clinical chemistry in langur monkey

Daily oral administration of 1 mg/kg b.w. of cyproterone acetate and simultaneously administered testosterone enanthate (2 mg/kg b.w./15 days; i.m.) to adult male langur monkeys over a period of 90 days caused a gradual decrease in the count (to azoospermia) and motility of spermatozoa, concurrently with an increase in the percentage of non-motile as well as abnormal and immature sperm. Semen weight, volume, seminal fluid volume and circulating testosterone levels decreased nonsignificantly. Semen pH, libido and body weight remained unimpaired. The levels of SGOT, SGPT, serum alkaline phosphatase, LDH, bilirubin, Na+, K+ and hematological values did not alter significantly. All the changes were reversible. The results indicate that the combination regimen seems to affect the fertility in two ways, i.e. by inhibiting spermatogenesis in the testis and maturation process in the epididymis without altering the androgenicity.

Intratesticular and plasma steroid profiles in fertile and infertile men

In 24 apparently healthy men who requested sterilization by vasectomy, we have measured the intratesticular and peripheral plasma levels of 9 unconjugated and 5 sulphoconjugated steroids. These steroid levels were then compared with those found in a group of 18 men, admitted to the hospital with complaints of infertility. With the exception of higher dihydrotestosterone levels in the infertile group, no differences were found between the two groups with regard to the peripheral plasma levels of the unconjugated or sulphoconjugated steroids studied. On the other hand, the intratesticular levels of cortisol, pregnenolone, androstenedione, dihydrotestosterone, pregnenolone sulphate and testosterone sulphate (but not those of testosterone) were significantly diminished in the infertile group. With the exception of dehydroepiandrosterone levels in the fertile group, and dehydroepiandrosterone sulphate and dihydrotestosterone sulphate in the infertile group, the intratesticular steroid levels were uncorrelated with the plasma levels. The data are interpreted as suggesting that a) male infertility may be associated with intratesticular alterations of steroid metabolism which are not reflected by the peripheral steroid levels; b) the plasma and intratesticular levels of testosterone are not sensitive enough indices for the endocrine evaluation of male infertility; c) the role of the sulphoconjugated forms of steroids in the maintenance of male fertility deserves further investigation.

Effect of LHRH on cyproterone-acetate-injected adenohypophyses of castrated mice

Luteinizing hormone releasing hormone (LHRH)-treated adenohypophyses from castrated, cyproterone acetate-injected adult male mice were studied with transmission electron microscopy (TEM). LHRH-treated luteinizing hormone (LH) gonadotrophs (types a and b) in castrated mice showed accumulation of secretory granules at the capillary pole, dilated Golgi apparatus and extensive rough endoplasmic reticulum (RER) profiles. Following treatment, granular content in LH type-a gonadotrophs was decreased and profiles of secretory granules were seen in the intercellular and perivascular spaces. Some RER cisternal hypertrophy was noted, and the Golgi apparatus was dilated. In LH type-b gonadotrophs there were secretory granules lined along the plasma membranes, several lysosomes, multivesicular bodies, and short RER profiles. LHRH stimulated secretory granules release of LH gonadotrophs in cyproterone-acetate-treated castrated mice. Cyproterone acetate may have blocked hypothalamic LHRH stimulation of pituitary LH gonadotrophs.

Effects of low doses of cyproterone acetate on sperm morphology and some other parameters of reproduction in normal men

Cyproterone acetate was given to three healthy men in a dosage of 10 mg per day for 8-14 weeks. The effects on sperm count, morphology, motility and vitality was followed weekly and compared with the effects of 25 mg daily in another case. Sperm morphology included the study of live spermatozoa separately. The effects on serum levels of FSH, LH, testosterone and oestrogens was also studied. With respect to sperm count and morphology a dose-effect relationship is indicated. Abnormalities within tails and midpieces of live spermatozoa appear early and may predict sterility before azoospermia develops. FSH and oestrogens were comparatively more depressed than LH and testosterone. The results indicate that cyproterone acetate may have an androgenic (or gestagenic) effect on the hypophyseo-hypothalamic level in addition to an antiandrogenic effect on gonads and their accessory organs.