Keith D. Smith

Relation of psychologic measures of aggression and hostility to testosterone production in man.

&NA; Plasma testosterone level and testosterone production rate were determined in a group of 18 healthy young men, 15 healthy older men and 6 hospitalized dysphoric male patients. A battery of anxiety, depression and hostility tests were administered simultaneously. Production rate of testosterone was found to be highly correlated with a measure of aggression derived from the Buss‐Durkee Hostility Inventory in the younger men. Age, on the other hand, was the principal correlant of production rate in the older group. A multivariate regression equation was obtained between testosterone production rate and four psychologic measures of aggression and hostility which accounted for 82% of the variance in the production rate of testosterone for the younger group. This equation was not valid for the older men.

Cigarette smoking and semen quality

In order to further investigate the findings of earlier studies the authors conducted a study of semen quality in 437 consecutively seen male partners of infertile couples and excluded 181 men who exhibited factors which could have influenced semen quality. A group of 97 men with varicocele was considered separately. Of the remaining 159 men, 101 were nonsmokers and 58 were smokers, age being approximately 31 years. The average percentage of normal spermatozoa was 44.7% for the group of 101 nonsmokers and 44.8% for the group of smokers. Average sperm motility, mean sperm count and frequency distribution of sperm were also not very different between the 2 groups. Amount of cigarettes smoked per day did not matter. The group of 97 men with varicocele which was analyzed separately showed no differences between smokers and nonsmokers although when compared with the group of 159 men without varicocele a significantly higher percentage of men with varicocele had sperm counts of 20 million/ml. It is difficult to explain the differences between these findings and those that claim that smoking does affect sperm quality. The subject of possible detrimental effects of cigarette smoking on semen quality is controversial and studies of larger groups need to be done.

Polycystic ovarian disease: A report of 301 patients

Abstract A group of 301 women with polycystic ovarian disease is presented. The 127 patients, whose diagnoses were confirmed surgically, were divided into those with normal or thickened tunica albuginea for purposes of classification. They were further subdivided on the basis of ovarian size (i.e., normal or enlarged). Presenting symptoms of hirsutism, menstrual dysrhythmia, and infertility were compared in each group. No significant differences were noted except that hirsutism occurred more commonly in those with thickened tunica. The effect of prednisone therapy on each of these symptoms was evaluated. Improvement compared favorably with results of wedge resection reported in a recent review. 12

Acne and hyperandrogenism

Elevated serum androgen levels have been reported in patients with acne resistant to conventional dermatologic therapy. This study was designed to investigate the relationship between serum androgen levels and the presence of acne in an unselected population of women seen consecutively by a dermatologist for various dermatologic complaints. Elevated serum testosterone levels were associated with acne regardless of whether this was the presenting complaint or an incidental finding. Women with both acne and hirsutism had higher serum testosterone levels than those with acne alone. Higher incidence of irregular menstrual cycles was noted in women complaining of acne. Normal serum testosterone levels were found only in those patients with regular menstrual cycles and the absence of acne or hirsutism. In conclusion, this study suggests that elevated serum testosterone levels are related to the presence of acne. Attention is called to the possibility that acne may be a clinical manifestation of a disorder with systemic and reproductive consequences.

A Familial Centric Chromosome Fragment

An extra centric chromosome fragment was found in the karyotype of an oligospermic male and his apparently normal mother. Both karyotypes were otherwise normal and the origin of the fragment could not

3 Glucocorticoid therapy in hyperandrogenism

Summary Hyperandrogenism is a common disorder in the reproductive age female. It is associated with cutaneous manifestations and ovulatory dysfunction. The degree of hyperandrogenaemia is directly related to the severity of ovulatory dysfunction. The ovulatory dysfunction frequently leads to infertility. The most common form of hyperandrogenism is idiopathic glucocorticoid-suppressible hyperandrogenism (IGSH). The management of this disorder involves appropriate use of physiological doses of glucocorticoids. This treatment leads not only to normalization of serum androgen levels but also to amelioration of cutaneous symptoms and improvement in ovulatory function. In infertile women with ovulatory dysfunction secondary to IGSH, occurrence of pregnancy after treatment with glucocorticoids is directly related to the degree of the suppression of serum androgen levels. In other words, this treatment does not ‘induce ovulation’, but its effectiveness in improving ovulatory function is a result of a correction of the hyperandrogenic state. At physiological doses glucocorticoid therapy does not appear to be associated with significant side-effects. With appropriate management, androgen levels can be maintained within the normal range indefinitely. Furthermore, in a majority of patients, androgen levels remain within the normal range for a long time (years) after discontinuation of chronic glucocorticoid therapy.

Relation of In Vitro Metabolism of Steroids in Human Testicular Tissue to Histologic and Clinical Findings

The first definitive evidence for androgen secretion by the human testis was provided by experiments demonstrating the formation of radioactive testosterone and androstenedione in spermatic venous effluent following perfusion of the testis with acetate l4C (l). Lucas et al. (2) isolated testosterone from spermatic vein blood, and subsequently a number of investigators demonstrated conversion of suitable steroidal precursors to androgens by human testicular tissue in vitro (3–7). Deficiency of the side-chain cleaving enzyme in testicular tissue of an older man was shown by Axelrod (5). Car-stensen (3) demonstrated in vitro an increased conversion of 17a-hy-droxypregnenolone to testosterone in the presence of ICSH. He suggested that the side-chain cleaving enzyme may be activated by gonadotropins. A suppression of the activity of the side-chain cleaving enzyme and the 17α-hydroxylase, but no change, or possibly an increase, in the activity of 17 s-hydroxysteroid dehydrogenase was demonstrated in the microsomal fraction of testicular tissue from a patient with prostatic carcinoma treated with estrogens (8). If the assumption is made that estrogen suppressed patients’ endogenous gonadotropins, the decrease in 17–20 lyase may be interpreted as confirmation of Carstensen’s findings.

The relationship of serum androgens and ovulatory status to blood pressure in reproductive-age women

The objective of this cross-sectional study was to determine the relationship between hyperandrogenemia and blood pressure in women with menstrual irregularities seen at an endocrinology clinic. Women with serum testosterone levels (T) > or = 30 ng/dL were more likely to have general obesity (odds ratio [OR] = 6.8, 95% confidence intervals [CI] = 2.2-27.2) and central obesity (OR = 14.5, 95% CI = 6.1-38.7) than euandrogenemic women. Hyperandrogenemic women (HA) had an OR of 2.4 (95% CI = 1.0-6.2) for elevated SBP and an OR of 2.7 (95% CI = 0.8-8.8) for elevated DBP, independent of age and ovulatory status. Obese HA had an OR of 4.7 (95% CI = 2.3-10.4) for elevated SBP and an OR of 2.9 (95% CI = 1.9-9.9) for elevated DBP. In conclusion, T is associated with an increased risk for obesity and central adiposity. T predicts BP elevation independent of age and ovulatory status. There was a synergistic relationship between obesity and androgens in their affect on BP.

Effects of Long-Term Storage of Human Spermatozoa in Liquid Nitrogen1

The development of long-term storage techniques of human spermatozoa in the attempt to delay the aging of the male gamete are reviewed. Fresh semen gives a successful conception rate by artivicial insemination of about 70% while specimens frozen in liquid nitrogen have a rate of about 50%. Semen specimens of sperm counts between 40-200 million/ml and prefreeze motility of above 60% have the best mean long term survival (over 3 years) based on data from 1764 vials of frozen semen from 533 ejaculations of 207 donors. Additional study

A Possible Mechanism for the Detrimental Effect of Varicocele on Testicular Function in Man**Supported in part by National Institutes of Health Center Grant 5 P50 HD08338 and by departmental funds.

Seminiferous epithelium histology, Leydig cell density, and in vitro testosterone synthesis were quantitated in bilateral testicular biopsies from men with varying degrees of unilateral or bilateral varicoceles. Results were correlated with plasma levels of gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) and testosterone (T), as well as with semen quality. In patients with bilateral varicoceles, spermatogenesis, Leydig cell density, plasma T levels, and in vitro T synthesis were significantly lower than in patients with unilateral varicoceles. Varicoceles appeared to affect maximally the latest stages of spermatogenesis. A negative correlation between FSH and LH levels and spermatogenesis was observed; however, a dissociation between the two gonadotropins occurred when spermatogenesis declined. Plasma T levels were within the normal range in all patients. The T:LH ratio was significantly correlated with spermatogenesis and sperm motility. Leydig cell density was abnormally low in oligospermic patients, and it was significantly correlated with in vitro T synthesis, spermatogenesis, sperm motility, and semen volume. Sperm count and motility were significantly correlated in this group of patients, suggesting a common pathophysiology for the effect of varicocele on spermatogenesis and sperm motility. This common pathophysiology appears to be disturbed Leydig cell function resulting in decreased testicular androgen production, in turn causing inadequate spermatogenesis and epididymal function.