How to Reverse Testicular Atrophy

Low Testosterone Small Testicles

Free Methods On How To Get Bigger Testicles. Download the free ebook today to start to see rapid boosts in testicular performance and size within 2 or 3 days. Inside, youll learn: A cutting edge sexual technique to get instantly bigger testes after lovemaking. An unusual tip to fire up your testicles and increase your ejaculations within a week. A subliminal trick to restore morning wood and get your sack feeling heavy in the morning. How to avoid for Good this nasty chemical found in food and normal substances that causes testicular atrophy in men. Elevated estrogen is the leading cause of testicular atrophy in human males. So you need to keep estrogen levels in check if you want to avoid this testicular shrinkage and weak libido. A simple way to do this is to eat cruciferous veggies like broccoli, cabbage and Brussels sprouts Because these vegetables contain phytonutrients that flush bad estrogens out of your body. The most potent of these is Diindolymethane. Take in just enough of this nutrient and your testicles will be protected. But if you take in too much youll actually increase the aromatase enzyme in your body. Because Mark is a pro researcher on testosterone, testicular function and male fertility, so he will reveal the hard facts. But he also explains to you exactly how to reverse the whole process in just a few weeks. Continue reading...

Low Testosterone Small Testicles Overview

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Are there different types of hormone therapy Do I need to have my testicles removed

Hormone therapy is a form of prostate cancer treatment designed to eliminate the male hormones (androgens) from the body. The most common androgen is testosterone. Androgens are primarily produced by the testicles, under control of various parts of the brain. A small number of androgens are produced by the adrenal glands, which are small glands located above the kidneys and produce many important chemicals. Prostate cancer cells may be hormone sensitive, hormone insensitive, or hormone resistant. Cancer cells that are hormone sensitive require androgens for growth. Thus, elimination of the andro-gens would prevent the growth of such cells and cause them to shrink. Normal prostate cells are also hormone sensitive and also shrink in response to hormone therapy. Prostate cancer cells that are hormone resistant continue to grow despite hormone therapy. Removal of the androgen production, the testicles, are removed. Medical therapy is designed to stop the production of androgens by the...

Case finding and testicular selfexamination

Having concluded that TSE may be beneficial at least for men who have risk factors for testicular cancer, if not for all young men, its teaching should emphasize the following points. First, men must gain familiarity with the surface, texture, and consistency of their testicles in the normal state. Second, the ideal time for TSE is during or after a warm bath or shower. Third, the man examining himself should rotate both testicles between thumb and forefinger until he determines that the entire surface of each is free of lumps. Fourth, the man should learn the location of the epididymis and that this structure is not a tumor. Fifth, any detected lump should be reported to a physician immediately 65 . Most importantly, as noted earlier, physicians must convey the benefit of TSE to affect the intention to perform it regularly. Education must include possible consequences of not performing TSE, such as delay in diagnosis with resulting advanced stage of disease the need for intensive...

Are there medications that may affect the PSA Does testosterone therapy cause the PSA to increase

Yes, some medications can affect the PSA. Finasteride (Proscar) and Dutasteride (Avodart), medications used to shrink the prostate in men with benign enlargement of the prostate, decrease the PSA up to 50 . This decrease in PSA occurs predictably no matter what your initial PSA is. Any sustained increases in PSA while you are taking Proscar or Avodart (provided that you are taking the Proscar or Avodart regularly) should be evaluated. The percentage of free PSA (the amount of free PSA the amount of total PSA) is not significantly decreased by these medications and should remain stable while you are taking Proscar or Avodart. Other medications that can decrease the amount of testosterone produced by your testicles, such as ketoconazole, may decrease the PSA. Decreasing the amount of testosterone may cause both benign and cancerous prostate tissue to shrink. Testosterone is broken down in the body to a chemical, dihy-drotestosterone, which is responsible for the stimulation of prostate...

Kennedy syndrome spinobulbar muscular atrophy SBMA

A rare inherited neurodegenerative disease, Kennedy syndrome or spinobulbar muscular atrophy (SBMA), is characterized by progressive neuromuscular weakness resulting from a loss of motor neurons in the spinal cord and brain stem. The onset of this disease occurs in the third to fifth decades of life and is often preceded by muscular cramps on exertion, tremor of the hands and elevated muscle creatine kinase (Kennedy etal. 1968). The initial description of Kennedy syndrome also contains one case with gynaecomastia. Subsequent reports confirmed the presence of androgen insensitivity in men with SBMA, showing various degrees of gynaecomas-tia, testicular atrophy, disorders of spermatogenesis, elevated serum gonadotropins and diabetes mellitus (Arbizu et al. 1983 Shimada et al. 1995). An alteration in the AR was regarded as a pathophysiological sign for SBMA and the expansion of a CAG tract encoding a polyglutamine (polyQ) stretch within the N-terminal region of the receptor was...

Kennedy syndrome a pathological expansion of the AR gene CAG repeats

X-linked spinobulbar muscular atrophy (X-SBMA) or Kennedy syndrome, is a rare inherited neurodegenerative disease characterized by progressive neuromuscular weakness being caused by a loss of motor neurons in the brain stem and spinal cord. Disease onset developing in the third to fifth decade of life is likely to be preceded by muscular cramps on exertion, tremor of the hands and elevated muscle creatine kinase. The initial description of one of the individuals affected with Kennedy syndrome also includes gynaecomastia, a hypoandrogenic symptom (Kennedy et al. 1968). Subsequent reports emphasized the presence of symptoms indicating the development of androgen insensitivity in men with X-SBMA exhibiting varying degrees of gynaecomastia, testicular atrophy, disorders of spermatogenesis, elevated serum gonadotropins and also diabetes mellitus (e.g. Arbizu et al. 1983). Thus, the AR was regarded as candidate gene for X-SBMA and the expansion of the polyglutamine repeat within the...

Historical Considerations

Another interesting association is the subconscious linking of ''eyeball'' with genitalia. Blindness can symbolize castration because testicles and eyeballs have the same shape and are important in the development of the sense of identity. This linking goes back to the legend of Oedipus, who pierced his eyeballs when he discovered that he had been married to his mother and had killed his father. This can be thought of as an act of self-castration, as well as a means of cutting oneself off from all worldly relationships. Throughout literature, the blinding of an individual was frequently a form of punishment for lust. The age-old notion that masturbation causes blindness further reinforces this close association of organs.

Key theoriesstages of physical development

Physical development shows a significant change at puberty - defined as the point where sexual maturity is reached. In girls this is easier to define as it is marked by the first menstrual period (menarche) and increased breast size, while in boys it is more subtle and marked by growing penis and testicles, change in voice and, in both cases, growth of pubic hair. A growth spurt will also occur in both sexes, although this will generally be later in boys than girls and takes the form of increases in both height and weight.

Heat and Oxidative Stress in the Germ Line

Abstract Spermatogenesis is highly dependent on scrotal temperature. In the testis, germ cells but not somatic cells are vulnerable to heat stress. In response to heat stress, germ cells undergo apoptosis, autophagy, necrosis, and cell cycle arrest these behaviors are different in each testicular component. Heat induces oxidative stress in the testicles in a variety of ways, mainly by lipid peroxidation of the cellular membrane and mitochondria-derived reactive oxygen species (ROS), and heat-induced oxidative stress is involved in all of these cellular behaviors. Heat-shock factor 1 (HSF1) protects the cells by regulating the expression of heat-shock proteins (HSPs), promoting cell survival. Paradoxically, HSF1 promotes apoptosis of germ cells by heat stress, indicating that injured germ cells actively undergo apoptosis to maintain the quality of gametes. The pattern of heat stress (degree, duration, and interval of the elevated temperature) in humans (e.g., cryptorchidism,...

Clinical relevance of animal models for the study of androgen actions

An alternative route of stimulating testosterone production from Leydig cells has apparently developed in the common marmoset (Callithrix jacchus). In the intact and normal marmoset, LH receptor exon 10, although genomically present, is not expressed (Zhang etal. 1997). For the human LH receptor, this exon is necessary for the expression of receptor protein (Zhang etal. 1998). Interestingly, a clinical case lacking LH receptor exon 10 has been described (Gromoll etal. 2000). This boy had developed a male phenotype but presented with retarded pubertal development, small testes and delayed bone maturation, all indicative of androgen deficiency. Given the similarity to marmoset LH receptor status, this patient was successfully treated with hCG, indicating that exon 10 is involved in differential LH hCG recognition. More recently it was found that marmoset pituitary expresses hCG (Gromoll et al. 2003) raising the possibility that marmoset Leydig cells are driven by hCG rather than LH. It...

Indications For Treatment

Varix ligation is indicated in patients with a palpable varix and at least one of the following (i) pain that is not attributable to other intrascrotal pathology (17) (ii) adolescent ipsilateral testis volume loss of 2 ml or greater than 20 of volume (18-21) or (iii) infertility attributable to the male partner based upon abnormal semen analysis or abnormal results of sperm function tests associated with a female partner who is fertile or suffers a treatable cause of subfertility (16). Treatment of varicocele is not indicated for infertility if the male partner has normal semen quality or a subclinical varicocele (16). Men with palpable varicoceles and abnormal semen quality who are not currently attempting conception but are interested in preservation of fertility may wish to undergo varix ligation when informed of the progressive deterioration of semen quality associated with varicocele (5,7,9). Varix ligation is cost-effective in comparison to alternate treatments, which might...

Surgical Technique Patient Preparation

In our series to date, all varix ligations have been completed laparoscop-ically. Each patient should be aware that successful varix ligation results in improvement in semen parameters and or reduction in pain in most but not all patients. In fact, there is a nominal risk of testicular atrophy due to compromise of testicular arterial blood flow. In a recent study laparoscopic varix ligation for painful varicocele resulted in complete resolution of pain in 84.5 at a median follow-up of six months (41).

Impact of Varicoceles

On the contrary, another research group 129 presented data questioning an impact of clinical varicocele on testicular size and seminal ROS levels on male fertility, at least in fertile men. For patients with unknown fertility status, these authors conclude that increased ROS levels may be indicative of an early sign for a decline in fertility if the condition is untreated. Thus, these authors differentiate regarding varicocele-associated fertility problems between fertile and infertile men.

What happens if my sex drive libido is low What causes it can it be treated

Loop between the brain and the testes. The brain, through the release of luteinizing hormone (LH), tells the testicles to produce testosterone. The production of testosterone by the testicles acts on the brain to decrease the release of LH. If the testicles don't produce enough testosterone, the brain releases more LH in an attempt to stimulate the testicles to produce more testosterone. If the brain does not release enough LH, the testicles won't produce enough testosterone. This problem may occur in men with brain tumors or congenital abnormalities. Abnormalities of the testicles themselves that lead to impaired function of the testes may cause the testosterone levels to be low. Such abnormalities may include a history of testicular torsion, a history of unde-scended testes, prior testicular infections, and other congenital anomalies that affect the testes. Removal of both testes (bilateral orchiectomy) for prostate cancer or (rarely) bilateral testicular cancers causes a...

Transilluminate Scrotal Masses

If a scrotal mass is detected, transillumination is necessary. In a darkened room, a light source is applied to the side of scrotal enlargement. Vascular structures, tumors, blood, hernias, and normal testicles appear opaque on transillumination. Transmission of the light as a red glow indicates a serous fluid-containing cavity, such as a hydrocele or a spermatocele. A hydrocele is an abnormal collection of clear fluid in the tunica vaginalis. The testicle is contained within this cystic mass, preventing actual palpation of the testis itself. By transillumination, it may be possible to view the orientation of the normal-sized testicle within the hydrocele. A spermatocele

Supportive Laboratory Findings

There doesn't seem to be any doubt that females are different from males when it comes to drug taking. The question is Why The thing that comes to mind most readily is that females have different hormones than men. Estrogen is known as the female hormone, and testosterone is the male hormone. Are the sex differences in drug use based on the hormonal differences It is now clear that estrogen is a key factor in the sensitivity of females to cocaine and other drugs. This has been shown in basic experiments with animals that manipulate hormone levels in females and males. An effective way of removing or lowering estrogen in females is to surgically remove the ovaries likewise, the way to remove or lower testosterone in males is to remove the testicles. If there is an effect of removing the ovaries, then the way to see if it is due to estrogen is to give estrogen back to the animals. Table 12-1 shows data from one of the many experiments By using surgically manipulated males and females,...

Considerations For Orchidopexy

It has been shown that undescended testicles at birth and throughout the first year of life have normal histology, and that includes a normal population of germ cells. Kibel and coworkers recommend that healthy males with undescended testicles undergo orchiectomy until the age of 50 years. For patients with comorbid conditions American Society of Anesthesiologists (> 2) the risks of surgery might contraindicate orchiectomy even before the age of 50 years (17).

History and Geography

In the fifth century B.C., Hippocrates is believed to have first recognized mumps as a distinct clinical entity in his work Epidemics I. He described an outbreak of an illness on the island of Thasus, noting that swelling appeared about the ears, in many on either side, and in the greatest number on both sides in some instances earlier, and in others later, inflammations with pain seized sometimes one of the testicles, and sometimes both. Greek and Roman medical writers of antiquity as well as medieval practitioners at various times recorded cases of mumps-like illnesses, but there was relatively little study of the disease. Outbreaks of mumps in Paris in the sixteenth century were recorded by Guillaume de Baillou. In 1755 Richard Russell described mumps and expressed his opinion that the disease was communicable.

Adrenocortical Carcinoma

Adrenocortical carcinoma is a rare malignant disease with a dismal prognosis and an estimated incidence of 0.5 cases per 1 million individuals per year.45 Patients with nonfunctioning tumors have manifestations attributable to a large abdominal mass. Forty percent to 70 of adrenocortical carcinomas are secretory,4546 and these patients usually present with clinical features of hormone excess. The clinical features depend on the predominant excess steroid production glucocorticoid-secreting tumors cause Cushing's syndrome androgen-secreting tumors lead to virilization mineralocorticoid-secreting tumors cause hypertension and hypokalemia and estrogen-secreting tumors result in gynecomastia and testicular atrophy in men and menstrual irregularities and precocious puberty in girls.45,46 Diagnosis is confirmed by elevated levels of urinary steroids. Eighty percent of patients demonstrate a suprarenal mass on CT scan.45-46 Pooled data from several institutions confirm that more than 60 of...

From the Sushruta Samhita ca 3000 bce

Electro Stimulation Erection Penis

Circumcision is one of the oldest known surgical procedures in medicine. Male circumcision has been widely practiced as a religious rite since ancient times. An initiatory rite of Judaism, circumcision is also practiced by Muslims, for whom it signifies spiritual purification. Although the origin is unknown, circumcision is often depicted on the walls of temples dating from 3000 bce. In the Egyptian Book of the Dead, it is written, ''The blood falls from the phallus of the Sun God as he starts to incise himself.'' By the time of the Roman takeover of Egypt in 30 BCE, the practice of circumcision had a ritual significance, and only circumcised priests could perform certain religious rites. The Hindus regarded the penis and testicles as a symbol of the center of life and sacrificed the prepuce as a special offering to the gods.

Testicular Torsion IR Injury in Testis and Oxidative Stress

Testicular torsion has been used in the laboratory animals to reproduce the clinical situation and to study the biological effects of ischemia on both testes and fertility. The end-points include testicular size, weight, histopathology, testicular biopsy score index (Johnsen score), biochemical enzyme parameters, semen characteristics, apoptosis, and general endocrine changes 131-134 . Testicular size correlates primarily with germinal epithelial mass. It has been known that the ratio of ischemia determines testicular salvage. Endocrine function (testosterone production from the Leydig cells) appears to be unaffected if the testis remains viable. Nevertheless, exocrine function (spermatogenesis) is unusually abnormal because ipsilateral ischemia has affected the contralateral testis. Spermatogenesis is significantly impaired in most patients after testicular torsion. Antisperm antibodies have been implicated as a result of the exposure of testicular tissue to the bloodstream after...

Pathophysiology of Varicocele

An adverse effect of varicocele on male fertility is suggested by the testicular atrophy that is frequently associated with this condition 16-22 . In men with a left varicocele, mean left testicular volume is less than right testicular volume 18, 22 . However, the relationship between varicocele grade and the degree of testicular atrophy is less clear. Zini et al. 23 found that in men with unilateral left varicocele, the loss of left testicular volume relative to the right (i.e., right minus left) increased with increasing varicocele grade, whereas Alukal et al. 24 found no such correlation between varicocele grade and volume differential. The impact of testicular atrophy on male fertility remains to be established, even though most studies indicate that testicular atrophy is associated with poor sperm parameters. Sigman and Jarow 20 have reported that in men with left varicocele, those with testicular atrophy have poorer semen parameters than do men without atrophy. Similarly,...

Issues concerning contralateral testicular biopsy

However, routine biopsy remains controversial because of the low numbers of men who actually have ITGCN on biopsy, the potential for undesirable physical and emotional effects of a second orchiectomy, and an excellent prognosis if or when a second tumor develops 35 . In a recent review of the literature on screening of the contralateral testicle, three large studies reported the prevalence of ITGCN to be 4.9 , 5.7 , and 6.1 . On multivariate analysis the highest risk patients were those with testicular atrophy (< 12 mL), history of an undescended testicle, and age younger than 30 28 . Based on these and other studies, most urologists in the United States have not recommended routine biopsy of the contralateral testicle. However, some urologists in the United States, United Kingdom and other countries favor selected biopsy for informed patients who are at high risk for ITGCN (cryptorchidism, testicular atrophy, age, gonadal dysgenesis, testicular microlithiasis). These criteria...

What happens when hormone therapy fails

Ketoconazole is a medication that decreases androgen production from both the testicles and the adrenal glands and also works directly on the prostate cancer cells. In patients who have not responded to first-line hormone therapy (LHRH analogue or antagonist plus antiandrogen), Ketoconazole plus hydrocortisone decreases the PSA in about 15 of patients. In those who have not

Ascites In Pathophysiology In Book

Portal Vein Anatomy

Changes in steroid hormone production, as well as changes in the conversion and handling of steroids are also prominent features of cirrhosis. These changes can result in decreased libido, gynecomastia (development of breast tissue in men), testicular atrophy, and features of feminization in male patients. Another deleterious effect of changes in sex hormone metabolism is the development of spider angiomata (nevi). Spider angiomata are vascular lesions found mainly on the trunk. The lesion has a central arteriole (body) surrounded by radiating legs. When blanched, the lesions fill from the center body outward toward the legs. Spider angiomata are not specific to cirrhosis, but the number and size do correlate with disease severity, and their presence relates to risk of variceal hemorrhage.12

Laparoscopic Evaluation

As mentioned, laparoscopy has proven itself to be an excellent localization and diagnostic tool (23-26). It is useful in patients with bilateral undescended testicles as well as in cases of unilateral undescended testicles. It also has been helpful in allowing the surgeon to plan subsequent therapy (i.e., to decide whether orchidopexy or testicular removal is indicated). Motility of the testis and its vas deferens as well as the vascular supply can be assessed on laparoscopic diagnosis. Analyzing the existing data, 50 to 60 of all cases of nonpalpable testicles are identified as an intra-abdominal testicle or peeping testicle, 30 as an atrophic nubbin, and 20 as an absent or vanished testicle. A testicle located within 2 cm of the internal ring or is proven to be peeping in about 38 of cases and those testicles are usually normal in size with a normal vessel leash, vas, and epididymis. Testicles located higher in the abdomen are either along the normal path of descent, 44.8 , or are...

The Use of Chemotherapy and Chemoradiation

Penis Needle

Fig. 8.7 Interstitial brachytherapy of the penile urethra using hypodermic needle and plastic template. The penis is kept away from the testicles using a sponge (From Gerbaulet et al.34. Reprinted with permission) Fig. 8.7 Interstitial brachytherapy of the penile urethra using hypodermic needle and plastic template. The penis is kept away from the testicles using a sponge (From Gerbaulet et al.34. Reprinted with permission)

Androgen action on spermatogenesis

Testosterone within the testis is aromatized to estradiol. Whether estradiol directly regulates spermatogenesis is unknown. The occurrence of testicular atrophy in estradiol receptor-deficient mice has been attributed to back-pressure effects of lack of fluid resorption in the efferent ducts (Hess etal. 1997). Aromatase activity is present in Sertoli cells but has also been found in germ cells (spermatocytes, spermatids and sperm) (Carreau et al. 2001). The use of aromatase inhibitors has not resulted in clear suppression of spermatogenesis (Turner etal. 2000) except in the studies by Shetty et al. (1997 1998) in bonnet monkeys. This group reported impaired spermiogenesis and altered sperm chromatin condensation on the basis of flow cytometric analysis. Mice bearing lack of estrogen receptor expression or aromatase expression or overexpression of aromatase (Murata et al. 2002) display various degrees of spermatogenic disturbance. Clinically, isolated cases with estrogen receptor...

Risk factors for ITGCN development

The finding of contralateral testicular microlithiasis on ultrasound in a patient who has had a TGCT has been reported to increase the risk of having ITGCN by approximately 30 times 23 . The clinical importance of testicular microlithiasis remains a controversial subject. Several studies have shown the prevalence of tes-ticular microlithiasis to be approximately 2 in the asymptomatic population 24,25 . These studies disagree on the association of microlithiasis with TGCTs. Serter and colleagues 24 reported 2.4 of healthy male volunteers (age 17-42) had testicular microlithiasis on screening ultrasound, but none had palpable lesions on physical exam and all had undetectable levels of testicular tumor markers. Other known risk factors are cryptorchi-dism (RR 4.8), familial testicular cancer (RR 3 to 10) and gonadal dysgenesis (> 6 ) 26 . Studies of males with first-degree relatives having TGCTs have demonstrated a genetic defect on the X-chro-mosome at Xq27. Infertility,...

Malignant Epithelial Tumors with Clear Cell Features 3461 Clear Cell Carcinoma

Extramammary Paget's disease (EMPD) shares many clinicopathological features with its mammary homologue but also presents remarkable differences regarding pathogenesis and association with underlying malignancies.73-75 EMPD has a predilection for the perianal region, perineum, groin, pubic area, scrotum, and penis, although it has been observed in other apocrine gland-rich areas (such as axilla and ear) in isolated cases.)3,76 An exclusively penile location is very rare as the penis is usually affected as part of a more disseminated disease extending throughout the scrotum, perineum, and penis. In most cases the lesion is limited to the epidermis (primary EMPD) but in 11 of patients an underlying malignancy is found (secondary EMPD), usually from the prostate or bladder but also from the testicles, ureter, or kidney.77 Primary EMPD is a form of intraepithelial adenocar-cinoma in which large round neoplastic cells with ample and clear cytoplasm (Paget cells) are found throughout the...

Making Holes in the Dark

Macaque) have a considerably greater proportion of sex-cell producing glandular tissue and a smaller proportion of connective tissue than have the primates (langur, gibbon and man) with comparatively small testes.' He calculated, for example, that a macaque has seventeen times more sperm-producing tissue in its testes than a langur of similar size. Human males have relatively small testes in relation to body weight 'Man' falls just below the regression line in Figure 2.1, slightly above the orangutan, but well above the gorilla. It is relevant to note that Harcourt et al. included data on only four men in their studies of relative testes size and mating systems in anthropoid primates. Human testes weight averaged 40.5 g in these individuals, three of whom had been measured by Schultz (1938), whilst the fourth set of measurements was obtained from a paper by Benoit (1922). It may seem unusual that only four men had been sampled. However, the focus of Harcourt et al.'s study was on...

Osteosclerotic Myeloma

One or more additional features of the POEMS syndrome often are observed, but in many cases, these are not prominent and must be carefully sought. Hepatomegaly may be found in up to 50 percent of patients, whereas lymphadenopathy and splenomegaly are less common. Manifestations of endocrinopathy include diabetes mellitus, hypothyroidism, impotence, gynecomastia, testicular atrophy, amenorrhea, hyperprolactinemia, and hyperestrogenemia. Skin changes include hyperpigmentation, thickening of the skin, hypertrichosis, skin angiomas, clubbing, and white nails. Some skin changes are suggestive of scleroderma. Peripheral edema, ascites and pleural effusions may also be seen. POeMs syndrome, sometimes referred to as Crow-Fukase syndrome, is not unique to osteosclerotic myeloma. It has been observed in multiple myeloma, Waldenstrom's macroglobulinemia, and angiofollicular lymph node hyperplasia, also referred to as Castleman's disease.y

Androgen dependence of spermatogenesis

Long-term studies were also conducted in two nonhuman primate models, the rhesus monkey and the common marmoset. In these studies, neonatal androgen secretion was either blocked by the administration of GnRH agonist or antagonist. This interference delayed pubertal onset and attenuated the testicular weight gain (Mann etal. 1993 1998 McKinnell etal. 2001 Sharpe etal. 2000). Penile length and detachment of prepuce were also affected transiently but recovered by week 52 (Brown et al. 1999). Animals were followed until adulthood and various male reproductive parameters including fertility and mating behaviour (Lunn etal. 1994) were assessed. No untoward effects on testicular function and fertility could be detected (Lunn et al. 1997). Hence, on the basis of available data, it appears that the neonatal testosterone peak is not related to subsequent development of male reproductive functions, timing of puberty and fertility. The only effect of loss of neonatal testosterone production that...

Pubertal Growth and Development

The first sign of puberty in boys is an increase in growth of the testes and scrotum, with reddening and wrinkling of the scrotal skin. Pubic hair appears within 6 months, followed by phallic enlargement in 12 to 18 months and peak height velocity 2 to 2.5 years after testicular enlargement (Copeland, 1986). Axillary hair usually appears 2 years after the beginning of pubic hair growth (stage 4 pubic hair), but there is considerable variability. Some boys may have enlargement of the breasts midway through adolescence. Following the attainment of peak height velocity, boys develop mature spermatozoa, full facial hair, and voice change. However, breaking of the voice is a late and often gradual process.

Normal Sexual Development

Sexual maturation in females starts with breast development (thelarche) at a mean age of 11 years, followed by pubic hair development and menses (menarche). In males it starts with scrotal corrugation and testicular enlargement at a mean age of 11.5 years, followed by growth of the penis and pubic hair.

True screening

Should be performed only on patients who have risk factors, such as those with a history of crypt-orchidism or testicular atrophy 37,41 . Aside from age, the only currently known main risk factors for testicular cancer include cryptorchidism, Caucasian race 42 , prior testicular tumor, and family history. Screening of these risk groups may be beneficial, although the value has not been proved.

Treatment

However, before treatment for any TGCT or ITGCN is begun, sperm cryopres-ervation should be discussed with the patient. Treatment depends on a combination of factors such as age, testicular size, fertility, unilateral or bilateral cancer, and patient physician philosophy. Orchiectomy, the most invasive treatment, is curative, but will leave the patient infertile and dependent on exogenous testosterone. Additionally, the emotional stress of castration can be difficult for any male to handle. Partial orchiec-tomy has been reported as an option for patients with a solitary testicle who develop a well-de marcated TGCT 39,40 . The goal of partial orchi-ectomy is to preserve endocrine function and fertility. However, in most cases, ITGCN is diffusely spread throughout the nontumorous portion of the testicle and can eventually develop into another TGCT. Partial orchiectomy for TGCT is currently not considered standard of care and should be performed only in highly selected...

Cancer

The large amount of space devoted to recipes and other therapeutic forms for swellings and abscesses (e.g., by Cato, Paul of Aegina, Pliny, and Hippocrates) strongly suggests that malignant, often fatal, conditions were not uncommon, despite the lack of consensus on signs and symptoms and the equally obvious lack of a standardized nomenclature. Slightly more certain to have involved cancer is a series of inoperable, incurable, or fatal conditions of specific organs or bodily parts that were, more or less, amenable to examination, such as the breast, testicles, nose, and throat. It is even more problematic that neoplastic growths of internal organs were recognized, but perhaps it was to these that Hippocrates was referring by the phrase xeujitol xaexicooi (hidden cancers).

Genitalia and Anus

The male infant should have two palpable testicles of similar size within the scrotum. If the infant is cold during the examination, the testicles may be retracted and might even be found at the distal end of the inguinal canal. Each testicle, however, should be able to be easily brought down into the scrotum. The testicles should be similar in size and shape, although presence of significant hydrocele is a common transient finding in newborns. A hydrocele should transil-luminate, and any testicular mass that does not transillumi-nate should be further evaluated.

Alcohol

Elicits in the testes an enhancement in mitochondrial lipid peroxidation and a decrease in the GSH level, which appear to be correlated to the gross testicular atrophy observed. It is well known that peroxidation injury can be attenuated when it occurs in association with dietary vitamin A supplementation. Thus, it is of interest to note that vitamin A, acting as an antioxidant, stabilizes testicular membranes by reducing lipid peroxidation and prevents the alcohol-induced atrophy that occurs in animals not receiving vitamin A-enriched diets. Vitamin A supplementation attenuates the changes in lipid peroxidation, glutathione, and testicular morphology 46 .

Scrotal Enlargement

Swellings in the scrotum can be related to testicular or epididymal enlargement, a hernia, a varicocele, a spermatocele, or a hydrocele. Testicular enlargement can result from inflammation or tumor. Most of the time, enlargement is unilateral. Painful scrotal enlargement can result from acute inflammation of the epididymis or testis, torsion of the spermatic cord, or a strangulated hernia. Varicoceles are often a cause of decreased fertility.

Myotonic Dystrophy

In males, testicular atrophy, Leydig cell hyperplasia, and slightly reduced serum testosterone is common. In females, no consistent ovarian problems have been documented, but the spontaneous abortion rate is high. Fertility in both sexes seems to be reduced to about 75 percent of normal. Finally, in the ocular system, cataracts with characteristic multicolored crystalline subcapsular opacities have been documented since the recognition of DM as an entity. Retinal degeneration, low intraocular pressure, and saccadic eye movement defects have been reported. y

Delayed Puberty

Delayed puberty for girls and boys is identified by the absence of breast development by age 13 years or the absence of testicular enlargement by age 14 years, respectively. Testosterone enanthate and conjugated estrogen are used to treat delayed puberty in boys and girls, respectively. In a double-blind, placebo-controlled crossover study of sexual behavior in boys and girls with idiopathic delayed puberty, sex hormone treatment impacted overt behavior and thoughts (Finkelstein et al. 1998). Specifically, boys reported more nocturnal emissions and sexual touching with a partner following testosterone treatment, whereas girls reported more necking. Both sexes reported more sexual thoughts following hormone treatment (Finkelstein et al. 1998). Using the same study design and participants, Finkelstein et al. (1997) also assessed self-reported aggressive behavior. Following sex hormone treatment, aggressive impulses and physical aggression increased for both boys and girls.

Renal disease

Men with chronic renal failure exhibit many features of classical androgen deficiency including gynecomastia, impotence, testicular atrophy, impaired spermato-genesis and infertility as well as somatic disorders of bone, muscle and other androgen-responsive tissues (Handelsman 1985 Handelsman and Dong 1993 Handelsman and Liu 1998). Yet there is little information on androgen replacement therapy in patients with end-stage renal disease, during dialysis or after renal transplantation. Only a single randomised controlled study has examined androgen replacement therapy in uremic men (van Coevorden et al. 1986). Nineteen regularly hemodialysed men were randomised to receive either oral testosterone undecanoate (240 mg daily) or placebo for 12 weeks. Although libido and sexual activity increased, hemoglobin was unchanged and no other androgen effects on bone, muscle, cognition and well-being were reported. Future studies examining physiological replacement therapy using testosterone patches...

Muscular dystrophies

The effects of androgen therapy on neuromuscular disorders have been best studied by Griggs et al. in a series of careful studies of myotonic dystrophy (MD), a genetic myopathy due to a trinucleotide (CTG) repeat mutation in the myotonin (protein kinase) gene. MD is associated with testicular atrophy and biochemical androgen deficiency compared with age-matched healthy men or men with other neuromuscular wasting diseases (Griggs etal. 1985), although serum testosterone does not correlate with extent of muscle wasting. Since life expectancy in MD is determined by respiratory muscular weakness leading to terminal pneumonia, androgen therapy aiming to improve muscular strength might prolong life. To test this hypothesis, a randomised placebo-controlled study was undertaken in 40 men

Other Possibilities

Surgical cutting of the vasa deferentia, the ducts that carry sperm from the testicles, is a common form of male contraception. Studies carried out in the 1980s and early 1990s suggested that men who had had a vasectomy, especially if it had been performed when they were relatively young, were at increased risk for prostate cancer. Subsequent studies have refuted this finding a 1998 review of fourteen studies, for example, concluded that ''no causal association was found between vasectomy and prostate cancer.''35 It is now believed that earlier studies did not correct for selection bias men who had had vasectomies were more likely to go to urologists for follow-up, and urologists in turn would have been more likely to look for prostate cancer in these men.

General prospects

For the male there are ways to eliminate both procreation and sex at the same time. Such methods have been used in the past and are still being practiced on a limited scale. Castration has been employed since ancient time to destroy enemies by abolishing their ability to reproduce and transmit their genes. Until the end of the imperial period in China (1912), men were willing to sacrifice their testicles (and often with them their lives) in return for high-ranking positions and political influence at the emperor's court. Meanwhile, in the West, up until almost the same time, some promising boys were forced to give up their manhood for the sake of preserving their prepubertal voice and achieving fame as singers, often without success. Abstinence is a less bloody means of eliminating procreation, but few men are willing to give up both sex and procreation for extended periods of time, let alone their entire lives.

The Road to Truth

Despite the fact that testes sizes are much smaller in man than in the chimpanzee, many authors adhere to the view that sperm competition must have played a significant role in the evolution of human reproductive biology (Smith 1984 Baker and Bellis 1995 Buss 2003 Shackelford et al. 2005 Shackelford and Pound 2006). This problem was not addressed by Darwin (1871), as he was unaware of the important role played by sexual selection in shaping the anatomy and physiology of the primary genitalia. These insights were achieved much later, principally as a result of Parker's (1970) pioneering work on sperm competition and Eberhard's (1985 1996) seminal contributions to the concept of sexual selection by cryptic female choice. Unfortunately, when considered in isolation, comparative measurements of mammalian relative testes sizes are not sufficient to resolve the question of whether sperm competition has played any significant role in human evolution. This problem was discussed in some detail...

Genitalia

In the term male infant, the scrotum is relatively large and rugate. The foreskin of the penis is tight and adherent to the glans penis. Inspect the glans for the location of the external urethral meatus. Hypospadias is a condition in which the meatus is located in an abnormal ventral position, anywhere from the lower glans of the penis to the scrotum. It is important to detect hypospadias in the neonatal period because it represents a contraindication to circumcision indeed, the penis may look partially circumcised, because in this defect, the foreskin usually does not cover the entire glans. Penile erections are common, often preceding the voiding of urine. The testicles should be descended into the scrotum or the inguinal canals. Palpate the testicles by a downward movement, which counteracts the active cremasteric reflex. Are any masses present Hydroceles or hernias are common in newborns. A hydrocele, which can be transilluminated, should be monitored until the child is 6 months...

Relapsed ALL

Extramedullary relapse while once common, has decreased to 5 or less because of effective prophylaxis. Site of relapse and the length of the first remission are important predictors of second remission and OS. Marrow relapses occurring less than 18 to 24 months into first remission are associated with a poor survival,

Precocious Puberty

Normal pubertal development requires activation of the hypothalamic-pituitary-gonadal axis (see Figure 19-3). In girls, the first sign of puberty is typically breast development, occurring between ages 8 and 13 years, followed by the appearance of pubic hair and menarche. In boys, the first sign of puberty is usually testicular enlargement, occurring between ages 9 and 14 years, followed by the appearance of pubic hair and penile growth. Generally speaking, pediatricians and pediatric endocrinologists consider the appearance of secondary sex characteristics to be precocious in white girls prior to age 8 years, in black girls prior to age 7 years, and in boys of any race prior to age 9 years (Rodriguez and Pescovitz 2003).

Hormone Treatment

Testosterone, the male sex hormone produced by the testicles, stimulates the growth of prostate cancers. It was discovered more than a century ago that surgical removal of the testicles castration improves symptoms for men with advanced prostate cancer. Charles Huggins, a urologist at the University of Chicago, undertook experiments in 1941 to bring about the same effect by giving men with prostate cancer female sex hormones to block testosterone. This work, which in essence produces a chemical castration, was the first successful treatment of any form of cancer using medication. For his research, Huggins was awarded a Nobel Prize in Medicine in 1966. A third method of reducing testosterone is cutting off the hormone (called luteinizing hormone, or LH) that stimulates the testicles to produce testosterone. This LH is made by the pituitary gland in response to instructions from the hypothalamus in the brain. A group of drugs called luteinizing hormone-releasing hormone (or LHRH)...

Fragile X

Because it is an X-linked disorder, fragile X affects males and females differently. In boys, fragile X is associated with variable presentations of mental retardation, difficulties with visuospatial and memory functioning, gaze avoidance, stereotypic behaviors, hyperactivity, and abnormal speech patterns, including echolalia, high-pitched speech, poor articulation, and dysfluency. Aggression and self-injurious behaviors are prominent in some individuals. Persons with fragile X commonly have a characteristic appearance that includes an elongated face, a large protruding jaw, large ears, enlarged testicles, and accentuated secondary sexual characteristics. In girls who are heterozygous for the fragile X full mutation, the syndrome is associated with a normal physical appearance, variable cognitive functioning that ranges from normal to mildly mentally retarded, and difficulties with mathematics, attention, social communication, and the regulation of anxiety (Reiss et al., 2000a)....

Male Hypogonadism

Male hypogonadism is defined as inadequate gonadal function manifested by deficiency in gametogenesis or secretion of gonadal hormones. Primary hypogonadism is caused by dysfunction in the testes from either chromosomal or acquired disorders (Box 35-8). Secondary hypogonadism is caused by an abnormality of the hypothalamic-pituitary axis. Males may present with infertility, decreased testicular size, changes in libido, impotency, gynecomastia, delayed puberty, or a combination of these (Swerdloff and Wang, 2004). Klinefelter's syndrome is the most common genetic cause of male infertility. It is caused by a chromosomal aberration, most often 47,XXY. Phenotypic males can present with small firm testicles, infertility, tall height, long legs, gynecomastia, and varying symptoms of androgen deficiency and undervir-ilization. Treatment is replacement of testosterone to prevent the sequelae of androgen deficiency.

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