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Male Hypogonadism (Primary Hypogonadism (testicular): Low Te raises LH…

- - - - Infertility: Leydig cell hypoplasia -> decreased Te. Low Te -> impaired sperm maturation in both testes during 1st 3-6 months of life. Increased LH secretion provides adequate Te for normal virilization at puberty.
      - Adults men with subfertility have abnormal sperm or reduced numbers of sperm. Seminiferous tubule fibrosis -> lowered inhibin B -> increases serum FSH.
      - Defective prepubertal germ cell maturation in cryptorchid and contralateral testis. Male infertility (10% of infertile men have hx of CPO, 13% with 1 CPO testis are subfertile, 46% with 2 corrected CPO testes subfertile, 98% with 2 non-corrected CPO testes subfertile)
      - Increased heat stress -> infertility: Intra-abdominal tesets are 2-3 degree C warmer than scrotal testes. Heat stress -> Sertoli cell dysfunction via an increase in oxidative metabolism and ROS.
      - 5x increased risk for testicular germ cell tumors: 10% of testicular cancers occur in CPO testes. The risk may decrease if repositioned by 2 yr.
  - - - Delayed-onset puberty: Preadolescent penis and TS-2 pubic hair. Long limbs.
      - Azoospermia, low inhibin B, and elevated FSH.
      - Low Te and elevated LH: hCG administration fails to increase Te. Perform a laparoscopy to rule out nonscrotal testes.
  - - - > 12 hrs -> testicular necrosis: There ends up being an increase in LH and FSH in an effort to maintain Te and sperm production by the other testis (0.5% become subfertile).
      - Disruption of the blood-testis barrier may cause immunologic subfertility in 0.5%: Damaged Sertoli cells cause sperm Ags to come into contact with blood. Anti-sperm Abs damage sperm in semen -> agglutination, sperm immobilization, cell-mediated destruction.
  - - - Nutcracker phenomenon: anatomic variant that compresses the left renal vein between the aorta and the superior mesenteric artery.