Testicular Function in Patients with Spinal Cord Damage

Je, Morley; La, Distiller; Lissoos, I; Lipschitz, R; Kay, Gillian; Dl, Searle; Katz, Maurice

doi:10.1055/s-0028-1092799

Cited by 43 publications

(14 citation statements)

References 1 publication

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“…Indeed, some investigators have reported elevated basal or stimulated levels of plasma luteinizing hormone when serum testosterone levels are low in cohorts of subjects with SCI (39–41). However, as in our report herein, other investigators have reported in persons with SCI that the basal levels of plasma luteinizing hormone were not elevated despite the presence of depressed serum testosterone concentrations (12, 42, 43). As previously discussed, a subset of our hypogonadal subjects with SCI did not have adequate responses to one or more doses of hCG.…”

Section: Discussionsupporting

confidence: 64%

Testicular responses to hCG stimulation at varying doses in men with spinal cord injury

et al. 2017

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Study design Prospective Objectives To test whether provocative stimulation of the testes identifies men with chronic spinal cord injury (SCI), a population in which serum testosterone concentrations are often depressed, possibility due to gonadal dysfunction. To accomplish this objective, conventional and lower than the conventional doses of human chorionic gonadotropin (hCG) were administered. Methods Thirty men with chronic SCI [duration of injury >1 year; 18 and 65 years old; 16 eugonadal (>12.1 nmol/l) and 14 hypogonadal (≤12.1 nmol/l)] or able-bodied (AB) men [11 eugonadal and 27 hypogonadal] were recruited for the study. Stimulation tests were performed to quantify testicular responses to the intramuscular administration of hCG at three dose concentrations (i.e., 400 IU, 2000 IU, and 4000 IU). The hCG was administered on two consecutive days and blood was collected for serum testosterone in the early morning prior to each of two injections; subjects returned on day 3 for a final blood sample collection. Results The average gonadal response in the SCI and AB groups to each dose of hCG was not significantly different in the hypogonadal or eugonadal subjects, with the mean serum testosterone concentrations in all groups demonstrating an adequate response. Conclusions This work confirmed the absence of primary testicular dysfunction without additional benefit demonstrated of provocative stimulation of the testes with lower than conventional doses of hCG. Our findings support prior work that suggested a secondary testicular dysfunction occurs in a majority of those with SCI and depressed serum testosterone concentrations.

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Section: Discussionsupporting

confidence: 64%

Testicular responses to hCG stimulation at varying doses in men with spinal cord injury

et al. 2017

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“…27 Since CA has been implicated in the acute-exercise in duced elevations in T then one might expect an exaggerated T response in SCI athletes using boosting since T levels at rest are normal in this population. [18][19][20][21][22][23][24][25] In addition AD is associated with elevated cortisol (C) levels27 which have been suggested as a direct inhibitor of testosterone produc tion.28,29 The SCI athlete thus provides a model to examine the effects of CA and C on the exercise induced increment in testo sterone levels. To date the T response in SCI to acute exercise has not been docu mented.…”

Section: Wheeler 1mentioning

confidence: 99%

Testosterone, cortisol and catecholamine responses to exercise stress and autonomic dysreflexia in elite quadriplegic athletes

et al. 1994

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Episodes of short high intensity exercise are associated with an increase in circulating total testosterone (T) in men. Mechanisms may include hemoconcen tration, decreased metabolic clearance and/or increased synthesis. Beta-blockade abolishes the T response suggesting a direct beta-adrenergic effect on the testes. Some spinal cord injured (SCI) athletes deliberately induce autonomic dysre flexia (boosting) to enhance performance. Associated with this practice are elevated catecholamine (CA) levels and exaggerated responses to serum cate cholamine levels. Since basal T levels are reported to be normal in the SCI male, the T response to acute high intensity exercise might be expected to be exaggerated by boosting and associated elevated CA levels. The acute exercise T response has not been examined in SCI men to date. To determine whether the increased CA values associated with boosting enhanced the exercise-induced T elevation we measured circulating levels of T, cortisol (C), norepinephrine (NE) and epinephrine (E) before and after maximal exertion and a simulated 7.S km race with and without boosting in eight elite quadriplegic athletes. Maximal incremental exercise and a simulated 7.S km race resulted in a rise in T similar to able bodied men under normal exercise conditions. Under boosted conditions the rise in T was eliminated while NE levels were significantly elevated above unboosted levels. The data may suggest an inhibitory role for CA on T production or release under conditions of extreme stress. Other possible mechanisms include C induced suppression, impaired gonadotropin stimulation of the Leydig cell and CA mediated alterations in gonadal blood supply.

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“…334 Ten years after spinal cord injury, testicular volumes were not different from those of healthy controls, but even in medically stable men, spinal cord injury was associated with lower testosterone and LH levels than those of healthy men, 335 with a greater prevalence of low-normal testosterone levels than reported in population-based cohorts. 334 Ten years after spinal cord injury, testicular volumes were not different from those of healthy controls, but even in medically stable men, spinal cord injury was associated with lower testosterone and LH levels than those of healthy men, 335 with a greater prevalence of low-normal testosterone levels than reported in population-based cohorts.…”

Section: Neurologic Disordersmentioning

confidence: 85%