Human Testicular Disorders: Serum and Urinary Hormone Patterns and in vitro Conversion of [21-14C,7-3H]Progesterone

Steroid metabolism and morphologic features of the human testis

Serum FSH, LH, and testosterone were studied in 114 infertile men with poor sperm production. Testicular biopsies were taken and classified morphologically. In 90 specimens, the pattern of conversion of progesterone was determined in vitro and expressed as the ratio of 20 alpha-hydroxy-4-pregnene-3-one to 17 alpha-hydroxyprogesterone. An excess of the former metabolite indicates a prepubertal type of steroid metabolism. The normal limit of this ratio is given. The collected data indicate that the prepubertal type of steroid metabolic pattern is related to the thickness of the lamina propria of the seminiferous tubules only, and not to peripheral hormone levels. In particular, the presence of hyaline deposits in the lamina propria seems to determine the metabolic pattern. It is suggested that the character of the lamina propria separating the tubular and interstitial compartments of the testis is of crucial importance for the functional interrelationship between these compartments. This supports the concept of an intratesticular regulatory mechanism of both steroid metabolism and spermatogenesis.

Testosterone concentration within the tunica vaginalis of boys and adult men

The testosterone level in fluid contained in the tunica vaginalis has been determined in 25 adult men referred for infertility and in 20 boys aged 0-10.5 years operated on for hydrocele. The median concentrations of testosterone were found to be 392 nmole/1 (range 78-957) and 1.1 nmole/1 (range 0.16-182), respectively. The median value for adult men was 20 times the concentration of testosterone found in the peripheral blood of that group while the median value for the boys was 4 times that found in their peripheral blood. It is concluded, firstly, that the high level of testosterone in the peritesticular space of adult men strongly indicates that diffusion of testosterone through the testicular capsule does take place. Secondly, testosterone levels in fluid from the peritesticular space which significantly exceeds those in peripheral blood in prepubertal boys furnishes evidence of testicular secretion of testosterone in that age group. Consequently, the peritesticular tissues such as the epididymis, gubernaculum and scrotum are exposed to quantities of testosterone far exceeding those brought by the general circulation.

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.

Effect of clomiphene citrate on testicular steroid metabolism in man

Administration of clomiphene citrate to males with normal peripheral testosterone levels increased the serum levels of FSH, LH, testosterone and low polar oestrogens and also the urinary excretion of LH, low polar oestrogens, dehydroepiandrosterone, androsterone and aetiocholanolone. No significant change was noted for the urinary excretion of 17-oxogenic steroids. Addition of clomiphene citrate (10(-4) to 2 X 10(-3) M) to incubations of [7-3H, 21-14C] progesterone with human testicular biopsy specimens in vitro caused a slight inhibition in the formation of 17 alpha-hydroxyprogesterone and a slightly increased formation of 20 alpha-hydroxy-4-pregnen-3-one but no measurable changes in the C19 steroid formation. The results support the hypothesis that there is selective action of clomiphene citrate upon the adrenal C19 steroid biosynthesis in the human male, combined with an indirect effect upon the testes via the hypothalamic-pituitary system. A direct effect on the gonadal steroidogenesis can, however, not be ruled out.