MALE INFERTILITY-TREATMENTS -PART -II

MALE HYPOGONADISM-TREATMENT OPTIONS

We have already seen in the last post a normal healthy male has  well developed male sex organs as he receives proper androgenic expression from the second month of his fetal life in his mother's womb.The developing testes in the fetal life also produce another poly peptide hormone known as Mullerian Inhibiting Hormone that

inhibit the development of the Mullerian Duct in the fetus.In this stage Testosterone act subsequently,on the Wolffian ducts and differentiate it into the epididymis,vas deferens and semen vesicles.

On the other side dihydrotestosterone causes fusion and elongation of the labioscrotal fold to form male urithra,penis,and scortum and virilize the urogenital sinus to form the prostate.

After doing these works the plasma concentrations of androgens begins to decline and at birth it is essencially undetectable in the baby's blood.

At the age of puberty the androgens will magically reappear in the blood and act directly on the testes to produce male puberty signs.

Lack of sufficient androgen secretions at the fetal life will result in male sexual insufficiency or Male Hypogonadism in later life.

Symptoms of Male Hypogonadism

1.Underdevelopments of the male sex organs

2.Feminism-Female characters because of the estrogenic effects like soft voice,soft and shining skin with evenly distributed fat throughout the body etc.

3.Absence of virilzation

4.Absence of puberty

5.Declined spermatogenesis results in male infertility

6.Impotence

7.Weight Loss

8.Anemia

Unfortunately all the above defects can be corrected by the androgen replacement therapies except the declined sperm production for which upto date there are no known guaranteed therapies.

Androgens have two effects such as Andrgenic and Anabolic accordingly they can be divided into two as per their purposes of use as follows

1.Androgenic Androgens

 These androgens are used to produce purely androgenic effects in those individuals who suffers hypogonadal functions.Eventhough they have considerable anabolic effects that can be undermined are can be used for added benefits.

(e.g)1.Testosterone injections

        2.Esters of testosterone for oral use such as testosterone-17-enanthate (Delatestryl) is a long acting one

        3.Methyl testosterone or fluoxymesterone a potent orally acting testosterone ester.

2.Anabolic Androgens

These compounds are mostly synthetic or structurally modified testosterones in order to abolish the unwanted androgenic effects.

(e.g) 1.Oxandrolone (Oxandrin)

         2.Stanozolol (Winstrol)

         3.Fluoxymesterone

         4.Nandrolone phenylpropionate (Durabolin)

Causes of Male Hypogonadism

Testosterone by itself not active in all tissue receptors to produce the male functions unless it is converted into the more potent dihydrotestosterone.There are two enzymes present in our body for the conversion of tesosterone as follows

1)5-a-reductace-1 This enzyme is present in all the non genital skin and liver.Any damages in these areas may result in the lack of this enzyme and cause hypogonadism in spite of the testosterone production is normal

2)5-a-reductase-2 This enzyme is present in the skin of the genitals and the urogenital pathways.Any disease or damages may result in suppression of this enzyme and causes male hypogonadism  
Treatments for both hypogonadism and anabolic therapies are all subjected to be under Doctor's supervision.Since all the above mentioned androgens as either androgenic or anabolic

 are all hormones with serious side effects.
Side effects of Androgens
1.Over musculinization
2.Extra virilization in male
3.Hirutism in women (mustache and beard formed)
4.Depression of menses,acne and clitoral enlargement.
5.Rarely liver carcinomas and adenomas
6.Cholestatic jaundice
7.Prostate enlargement.