MALE SEXUAL DEFICIENCY AND INFERTILITY-TREATMENTS

MALE SEXUAL DISORDERS-MALE INFERTILITY

Sexual disorders and infertility are not uncommon in both male and female in modern days.These defects are frequently correlate with our diet,lifestyle,and emotional atmosphere.Stress and diet are playing important roles for hypogonadism the sexual dysfunctions of the male and female gonads followed by diseases and other organal disorders.In this post we concentrate about male sexual problems such as infertility,impotence and over activity of the sex organs.

The Hormones Of Sex in Men

There are variety of sex hormones are produced in men by various organs such as testes,the male sex organs prostate adipose tissues and adrenal glands.The predominant and the active forms are testosterone and dihydrotestosterone secreted by testes.These two hormones are accounting 99% male sexual characters.Out of these two hormones the dihydrotesosterone is more powerful and produce variety of androgenic reactions in our body.The most unwaned effect of his hormone is the enlargement of prostate gland and we will not deal with this here.

Testis also produce Androsterone,Androstenedione a testosterone metabolite.Androsterone is a weak horemone and its role of male sexual nature is negligible and it is formed by metabolizing dihydrotestosterone..The precursor hormone androstenedione will be converted into testosterone by peripheral tissues as per the need.

Adrenal glands also secretes in small amount of a male sex hormone known as Dehydroepiandrosterone which is also not very active.

There are metabolites of dihydrotestosterone  known as 5-a-androstane-3-a,17-beta-diol,and androsterone which are also weak in action.
In out side the testes some tissues especially brain tissues metabolise testosterone into female sex hormone the estradiol in men which is accounting and giving calmness and closure of the penis in resting periods most probably after a coitus or ejaculation.Esradiol is produced by testes also.Approximately 50 mic grams of estradiol is produced in normal man.Overproduction may result in feminism in men.
For treatments of hypogonadism it is found to be moral to administer Testosterone either by mouth or by other routes according to above studies.But the problem is the liver which readily metabolize testosterone 100% on administration by any route and inactivate it.To prevent this there are oral and pareneral preparations testosterone which is esterified to protect it from inactivation.These esters when they pass liver they get metabolized by liver and release testosterone into the circulation without inactivation.Oral testoserone and dihydrotestosterone are not effective than injections.
Recent findings have given an advantage oral preparation of modified testosterones such as methaneolone acetate and testosterone undecanoate.and these orally successful.
In oral preparations fluoxymesterone is a good androgen but a poor precursor of estrogen
But 19-nortestosterone is as strong as dihyrotestosterone in androgenic effects. 

SYNTHESIS AND SECRETIONS OF MALE SEX HORMONES

Testosterone in plasma usually occurs at high concentrations usually in three phases of life.

1.At the embryonic phase in this stage the plasma testosterone beginst to appear when a ovum is fertilized as a male embriyo and rises day by day reaches its peak high level at the eighth week and declines to bottom at the time of delivery.

2.At the neo natal period. After the birth it sarts again to reach its peak level at neonatal period of about one year and decline to bottom at the age pre-puberty.At puberty the pituitary hrough the hypothalamus secretes two hormones known as Luteinizing Hormone(LH) and Follicle Stimulating Hormone (FSH).

Gonadoropins begins to secrete in a pulsative manner as puberty progresses during both sleep and wake positions.During puberty the hypothalamus and pituitary both respond to the feed back mechanism of gonadotropin secretions very weakly.

Prior to puberty when the organs not well matured the plasma concentration of testosterone in a male 20 ng/dl.(0.7 nM)

as the puberty progresses the secretions also correlate with it and the male reaches the adult age the plasma concentrations of the testosterone is 300 to1000 ng/dl(10 to 35 nM) and the rate of production is 2.5 to 11 mg per day.In plasma 40% of the testosterone are bound to androgen binding globulin,58% are bound to other plasma proteins.2% is free in plasma which contributes to the androgenic activity.
Albumin bound testosterone is dissociating in the capillary bed for ready entry into the cells for actions.
LH and FSH from pituitary are regulating the development of testicles,and the production of sperm.Growth hormone also synergize the activities of LH and FSH.Estrogens suppress the LH action and reduce the secretion of testosterone.
Testoserone is a steroid and it is synthesized from cholesterol by the testes by the stimulating effect of pituitary LH on the Ledig cells of the testes.FSH on the other hand stimulate the seminiferous tubules to produce sperm.FSH also has an augumenting effect on LH.The spermatogenetic effects of both LH and FSH are all through the production of testosterone.
The injection of Human Chorionic Gonadotropin represents only the effects of LH. 
Administration of testosterone to men with hypogonadism and men who have been castrated(Eunuchism) is affecting the functions of LH and FSH.
In normal man estradiol is produced by testes and as well as brain.Brain and other tissues are converting a fraction of male sex hormone o female sexhormone the estradiol in a similar manner to testes.15% of he estradiol secreted by testes in a normal man.
In normal man the adrenal cortex is producing a minor quantity of testosterone through its precursor androsenedione but is not sufficient to represent the male nature.But in case of adrenocortex hyperplasia or cancer the production will be large.
Physiological effects of Male Sex Hormones
Androgens at the embroyanic age minutely secreted by testes and adrenal cortex withou any pituitary stimulation is virilizing regulating and maintaining the male urogenital parts of the male embryo.
In neo natal age they help the sexual developments within the central nervous system
At puberty they help the boy to become a well developed adult man.At this age the testes begins to enlarge.The penis and scortum start to grow,and pubic body hair beard and mustache begins to appear.Early in puberty,penial erections,nocturnal ejaculation and masturbations are frequent in most boys.
At the same time the growth promoting nature of the androgens contribute to increase in height,well established bone structure and musculin protein anabolic developments will leads into increase in height and weight.Physical vigor is increased.Testes developed into its full size.The skin become thick and oily.More proliferated sweat glands which are prone to plugging ang infections which results in pimples and acne formations.
Subcutaneous fat is lost and the veins under the skin appear prominently.Voice becomes deep. 
Secondary sexual characters begins to appear.
Heriditary appearance like baldness may begins to start like recession of the hairline at the temples and thinning of the hair at the crown.
At the end of this stage the bone growth attains to end.After this a further 1 or 2 cm growth is possible.
On behavior also androgens have major role.Men's aggressive rough and rude behavior are all due to androgens.Administration of male sex hormones may definitely influence the mood of a normal individual.These are the bases for treatments of male insufficiency with androgens.
When androgens are given to an prepuberty boy or a eunucoid young man the events of normal puberty are duplicated but there may be a time of laps (1 to 2 or more years) may take to establish the full virilization.
Shortly after starting the treatment inapropriate  erections with embarrassing frequencies may begins to surface with discomforts.Tolerance will develop as the treatment continues and these discomfort will be eased and subsided.Increased physical vigor and a general feelings of wellbeing ensued after a few weeks of the treatments.
The penis begins to grow followed by a distinct change in the voice.
Auxillary and pubic hair become more luxuriant.
The rapidity of the skeletal and muscular growth is very impressive in boys treated at or before the time of normal puberty.
The height growth increase 10 cm or more during the first year of treatments followed by diminishing for next 2,3 years.
With continued treatment development with the growth of a beard and body hair as a late expression of therapy.

Actions of Androgens On Normal Male

Normally,at the second month of the fetal life androgens start to be secreted by the baby's testicles and establish their important role of differentiation and development of the male reproductive system.

 

 

INFLAMMATORY DISEASES-I -ASTHMA

ASTHMA

ASTHMA a tracheobronchial  inflammatory disease in which air flow restrictions happen due to bronchospasm results in wheezing,breathing difficulty,cough and cold.Of the two types of asthma namely allergic and non allergic the allergic type is more common which 95% of the people suffer.

In many cases of asthma increased numbers of inflammatory cells such as eosinophils,lymphocytes and macrophages are found to be present in the alveolar fluids.These are not found much in the alveolar lavage of the normal individual.These inflammatory cells are even found in the asthmatic person's broncho alveolar lavage who's lung function is at normal baseline and no recent asthma exacerbations.These inflammatory cells are found in both allegic and non allergic asthmatic patients.

Hence asthma is purely an inflammatory disease. 
Causes of Asthma  
1.Inflammation of the bronchial wal
2.Constriction of the bronchial smooth muscle
3.Increased mucus secretions
Clinical symptoms
Shortness of breath
coughing
Wheezing
Use of accessary muscles of respiration such as mouth breathing
Chest tightness
Precipitators of Asthma
Allergens  
These agents stimulate mast cells to release various inflammatory agents like histamins,leucotriens,and chemotactic factors that promote bronchiolar spasm and thickening of the
 mucus.
Infections  
Like viral upper respiratory infections exclusively in children in whom commonly these infections precipitate asthma.
Psychological factors 
These factors like stress and other confused states may cause asthma but not readily recognizable 

Treatments

The treatment options are as follows and fortunately all the available asthma treatment options described below are safely and aggressively can be used for pregnant ladies without any harm.

1.Sympathomimetic agents 

Mostly beta-2 adrenergic agonists are more suitable in this class of drugs as they are powerfully dilating the bronchial trunk by increasing cyclic Adinosine Monophosphate (cAMP)

(e.g)Pirbuterol;

        Terbutalin

        Albuterol and

        Salmeterol

These medicines can be safely administered by inhalation and because heir absorption in the systemic circulation is poor and hence side effects are minimal

These are the drugs of choice to get immediate releif from an acute attack as the onset of their action is quick.

Side effects Tremor and tachycardia.

2.Corticosteroids

Steroids reduce inflammations by reversing mucosal edema,by decreasing the capillary permiability and they inhibit the release of inflammatory agents such as leucotrienes,and cytokines.

Corticosteroids can be used both acute and chronic asthma.Since corticosteroids are not broncho dilators and hence a bronchodilator also must be included in the treatment regimens.

For acute exacerbations systemic steroids should be given via oral or i.v. routes followed by a maintenance therapy by inhalation.

(e.g.) 1.Beclomethasone

          2.Flunisolide

          3.Triamcinolone

          4.Fluticasone.

Side effects

Inhaled steroids may sometimes produce cough,oral thrush and dysphonia

Systemic steroids like prednisone can cause glucose metabolism defects,increased hungry;weight gain;hypertension,adrenal deficiency

3.Anticholinergics

Anticholinergics can cause bronchodilation and decreased mucosal secretions by blocking cholinergic nervous system. 

(e.g.) Ipratropium (Atrovent) is the best example in this class of anti asthmatics.

Uses 1.Asthma

         2.Chronic Obstructive Pulmonary Disease (COPD)

Side effects

1.Dry mouth

2.Sedation

3.Blurred vision

4.Urinary retension

5.Constipation. 

Because of inhalation many of the above side effects may not be seen as the drug is poorly go into the circulation.

4.Leucotriene Inhibitors

They inhibit the formation of leucotrienes from ecosatetranoic acid (Arachidonic acid)

e.g. 1.Zileuton (Zyflo)

        2.Zafirlucast (Accolate)

They can be taken orally

These medicines are used for chronic maitenance therapy and should not be used for acute attacks.

Side Effects

1.Zileuton is causing liver damage

2.Zafirlukast-Allergy

5.Theophyllin

Similar to sympathomimetic agents this also causes bronchodilation by increasing cAMP level.It is also having anti inflammatory effect.

Drug interactions Serious drug interactions are observed if theophyllin is used concomitantly with cimetidine end erythromycin as the later medicines will increase the theophyllin plasma concentration by competitively inhibiting its metabolism by liver cytochrom 450 enzyme.

Side effects and symptoms of overdose

1.Tremor;2.Insomnia;3.G.I.distress.

6.Mast cell stabilizers

e.g.Cromolin and Nidocromil

Can be used for prevention

Side effects Cromolyn causes pulmonary edema,cough and wheezing

Nedocromil causes mouth bitterness 
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