title: Intratesticular androgens and spermatogenesis during severe gonadotropin suppression induced by male hormonal contraceptive treatment.
abstract: Male hormonal contraceptive regimens function by suppressing gonadotropin secretion, resulting in a dramatic decrease in testicular androgen biosynthesis and spermatogenesis. Animal studies suggest that persistent intratesticular (iT)-androgen production has a stimulatory effect on spermatogenesis in the setting of gonadotropin suppression. We hypothesized that men with incompletely suppressed spermatogenesis (>1,000,000 sperm/mL) during male hormonal contraceptive treatment would have higher iT-androgen concentrations than men who achieved severe oligospermia (<or=1,000,000 sperm/mL). Twenty healthy men ages 18-55 years enrolled in a 6-month male contraceptive study of transdermal testosterone (T) gel (100 mg/d) plus depomedroxyprogesterone acetate (300 mg intramuscularly every 12 weeks) with or without the gonadotropin releasing hormone (GnRH) antagonist acyline (300 microg/kg subcutaneously every 2 weeks for 12 weeks) were studied. During the 24th week of treatment, subjects underwent fine needle aspirations of the testes and iT-T and iT-dihydrotestosterone (iT-DHT) were measured in testicular fluid by liquid chromatography-tandem mass spectrometry. All men dramatically suppressed spermatogenesis; 15 of 20 men were severely oligospermic, and 5 of 20 suppressed to 1.5 million-3.2 million sperm per milliliter. In all subjects, mean iT-T and iT-DHT concentrations were 35 +/- 8 and 5.1 +/- 0.8 nmol/L. IT-androgen concentrations did not significantly differ in men who did and did not achieve severe oligospermia (P = .41 for iT-T; P = .18 for iT-DHT). Furthermore, there was no significant correlation between iT-T or iT-DHT and sperm concentration after 24 weeks of treatment. In this study of prolonged gonadotropin suppression induced by male hormonal contraceptive treatment, differences in iT-androgens did not explain differences in spermatogenesis. Additional studies to identify factors involved in persistent spermatogenesis despite gonadotropin suppression are warranted.
authors.affiliation: Department of Medicine, University of Washington, Seattle,Washington, USA. page@u.washington.edu
authors.forename: Stephanie T
authors.initials: ST
authors.lastname: Page
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Kalhorn
authors.forename: William J
authors.initials: WJ
authors.lastname: Bremner
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Anawalt
authors.forename: Alvin M
authors.initials: AM
authors.lastname: Matsumoto
authors.forename: John K
authors.initials: JK
authors.lastname: Amory
mesh_terms: D000328:Adult; D013196:Dihydrotestosterone / Q000097:blood / Q000378:metabolism*; D006062:Gonadotropins / Q000037:antagonists & inhibitors* / Q000097:blood; D006801:Humans; D008297:Male; D013091:Spermatogenesis / Q000187:drug effects*; D013092:Spermatogenesis-Blocking Agents / Q000494:pharmacology*; D013737:Testis / Q000378:metabolism*; D013739:Testosterone / Q000097:blood / Q000378:metabolism*; D017211:Treatment Failure
chemical_list: D006062:Gonadotropins; D013092:Spermatogenesis-Blocking Agents; D013196:Dihydrotestosterone; D013739:Testosterone