This investigation was conducted to evaluate the effect of thyroid dysfunction on the pituitary-gonadal axis. Ten men with Graves' disease and 5 hypothyroid patients were studied; 10 normal males were studied as a control group. In untreated conditions hyperthyroidism was associated with a normal serum-free testosterone concentration, an increased serum of 17OHP levels, a reduced testosterone response to hCG stimulation, and a hyperresponse of LH to GnRH. These abnormalities reverted after normalization of high FT4 serum levels. Untreated hypothyroid men showed a normal hormone sex response to hCG, but the LH responst to GnRH was reduced, with a tendency to improve after T4 supplementation. There was a strong and significant negative correlation between FT4 and testosterone response, expressed as an area under the curve, and a positive correlation with LH response to GnRH. Despite normal basal free testosterone concentrations, 70% of hyperthyroid and 60% of hypothyroid patients had complaints of decreased libido. The results suggest that thyroid hormones play an important dual pituitary-gonadal effect that is reflected by an impairment of testicular testosterone synthesis associated to hyperresponse to LH in hyperthyroidism and a defective LH response to GnRH in hypothyroidism.

The benefits conferred by testosterone replacement therapy are substantial, both in the short term for the eradication of symptoms of androgen deficiency, and in the long term for the prevention of osteoporosis. As with any long-term treatment there are risks that must be considered, but overall the benefits achieved far outweigh potential risk. Ideally, androgen replacement therapy should provide physiological serum testosterone levels, as well as DHT and estradiol levels, and correct the clinical symptoms of androgen deficiency in hypogonadal men. This goal is difficult to achieve because the dose dependency of androgen-dependent physiological processes is not known. Androgen preparations that are currently available do not fulfill all criteria for an ideal androgen replacement therapy. Parenteral testosterone esters are effective, safe, practical, and inexpensive. The transdermal testosterone systems provide an alternative to testosterone esters in selected patients but these preparations are expensive. Ongoing studies are showing the benefits of testosterone replacement therapy in aging men, but there is concern about side effects on cardiovascular system and prostate. Thus, clinical decision regarding testosterone therapy in older men should be better defined.

To determine the possible changes in semen quality of Venezuelan men from 1981 to 1995, a retrospective analysis of semen volume and sperm concentrations was carried out for 2313 men from infertile couples. According to the sperm counts the sample was categorized in four groups: A, 0 sperm; B, <20 x 10(6) sperm/mL; C, 20-200 x 10(6) sperm/mL; D, 2200 x 10(6) sperm/mL. The percentage of men in each group was 9.1, 18.8, 63. 1, and 9.0%, respectively. The frequency of azoospermia and oligozoospermia (groups A and B) did not change over the last 15 years. On the contrary, the frequency showed a significant increase in group C and a decrease in group D. The range of the means of semen volume was 2.6-3.6 mL, linear regression analysis did not show a decrease in seminal fluid volume over time. The range of the means of sperm concentrations were 6.2-12.0 x 10(6) sperm/mL, 73-100 x 10(6) sperm/mL), and 230-340 sperm x 10(6)/mL in groups B, C, and D, respectively. Linear regression analysis revealed a significant reduction in the means of sperm concentrations only in group D. Excluding the azoospermic group, the analysis of pooled data (B + C + D), did not show a significant change in the means of sperm density throughout time. In the semen samples with sperm counts below 200 x 10(6)/mL the means of sperm concentration did not change in the 15-year period of observation.