精索静脉曲张或无精子症男性的睾酮水平

doi:10.19723/j.issn.1671-167X.2022.02.016

Abstract

Abstract:

Objective: Androgen deficiency is common in aging males and may have unfavourable health consequences. Large-scale studies suggested low testosterone level might increse mortality and morbidity in ageing males. However, young men with low testosterone level might be neglected. Recent studies reported young men with infertility may have reduced testosterone level. To investigate the incidence of androgen deficiency in males with infertility and possible factors affecting the low testosterone level. Methods: Between January 2011 and December 2012, 407 men with infertility caused by varicocele (VC), obstructive azoospermia (OA) and nonobstructive azoospermia (NOA) in our center were included. The number of men in each group of OA, NOA and VC was 141, 97 and 169, respectively. All the eligible patients underwent a serum testosterone assessment by a single morning blood draw (between 8:00 to noon) to test for concentration of the total testosterone. All serum samples were determined by radioimmunoassay in our andrology laboratory. Androgen deficiency was defined as having a total testosterone level less than 300 ng/dL. Results: The mean age was (30.4±5.8) years. The mean testosterone level was (4.18±1.64) ng/dL (range 0.30 to 11.32 ng/dL). The overall incidence of androgen deficiency was 26.5% (108/407). The incidences of androgen deficiency in NOA, OA and VC groups were 40.2% (39/97), 19.1% (27/141) and 24.9% (42/169), respectively, which were significantly higher in the NOA than in the VC and OA groups (P<0.001). The incidences had no difference between the VC and OA groups (P=0.229). Univariate analysis revealed the cause of infertility, FSH and the mean testis volume as possible affecting factors for androgen deficiency. However, on multivariate analysis the only cause of infertility was an independent predictor. The incidence of androgen deficiency was the highest in the NOA group [OR 0.492 (95% confidence interval 0.288-0.840)]. Conclusion: NOA and varicocele might be risk factors of androgen deficiency. Young men with NOA may have a higher possibility of low testosterone level. Testosterone level should be followed up after NOA and varicocele treatment. Androgen deficiency should be assessed in males with infertility in clinical practice.

Key words: Androgen efficiency, Infertility, Varicocele, Azoospermia

CLC Number:

R698

PENG Jing,FANG Dong,ZHANG Zhi-chao,GAO Bing,YUAN Yi-ming,TANG Yuan,SONG Wei-dong,CUI Wan-shou. Testosterone levels in patients with varicocele and azoospermia[J].Journal of Peking University (Health Sciences), 2022, 54(2): 294-298.

Figures/Tables 3

Table 1

Table 2

Table 3

References 26

[1]	Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men[J]. J Clin Endocrinol Metab, 2007, 92(11):4241-4247. doi: 10.1210/jc.2007-1245
[2]	Harman SM, Metter EJ, Tobin JD, et al. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore longitudinal study of aging[J]. J Clin Endocrinol Metab, 2001, 86(2):724-731. doi: 10.1210/jcem.86.2.7219
[3]	Zarotsky V, Huang MY, Carman W, et al. Systematic literature review of the risk factors, comorbidities, and consequences of hypogonadism in men[J]. Andrology, 2014, 2(6):819-834. doi: 10.1111/andr.274 pmid: 25269643
[4]	Tanrikut C, Goldstein M, Rosoff JS, et al. Varicocele as a risk factor for androgen deficiency and effect of repair[J]. BJU Int, 2011, 108(9):1480-1484. doi: 10.1111/j.1464-410X.2010.10030.x pmid: 21435152
[5]	Reifsnyder JE, Ramasamy R, Husseini J, et al. Role of optimizing testosterone before microdissection testicular sperm extraction in men with nonobstructive azoospermia[J]. J Urol, 2012, 188(2):532-536. doi: 10.1016/j.juro.2012.04.002 pmid: 22704105
[6]	Takada S, Tsujimura A, Ueda T, et al. Androgen decline in patients with nonobstructive azoospemia after microdissection testicular sperm extraction[J]. Urology, 2008, 72(1):114-118. doi: 10.1016/j.urology.2008.02.022
[7]	Jarow JP, Espeland MA, Lipshultz LI. Evaluation of the azoospermic patient[J]. J Urol, 1989, 142(1):62-65. doi: 10.1016/s0022-5347(17)38662-7 pmid: 2499695
[8]	Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2006, 91(6):1995-2010. doi: 10.1210/jc.2005-2847
[9]	Mulligan T, Frick MF, Zuraw QC, et al. Prevalence of hypo-gonadism in males aged at least 45 years: The HIM study[J]. Int J Clin Pract, 2006, 60(7):762-769. pmid: 16846397
[10]	Araujo AB, O’Donnell AB, Brambilla DJ, et al. Prevalence and incidence of androgen deficiency in middLe-aged and older men: estimates from the Massachusetts male aging study[J]. J Clin Endocrinol Metab, 2004, 89(12):5920-5926. doi: 10.1210/jc.2003-031719
[11]	Zhou SJ, Lu WH, Liang XW, et al. Surveys of serum reproductive hormone levels and the prevalence rates of late onset of hypo-gonadism in Chinese ageing males[J]. J Reprod Med, 2011, 20(Suppl 2):27-32.
[12]	Liu CC, Wu WJ, Lee YC, et al. The prevalence of and risk factors for androgen deficiency in aging Taiwanese men[J]. J Sex Med, 2009, 6(4):936-946. doi: 10.1111/j.1743-6109.2008.01171.x
[13]	Petak SM, Nankin HR, Spark RF, et al. American association of clinical endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients: 2002 update[J]. Endocr Pract, 2002, 8(6):440-456.
[14]	Kelleher S, Conway AJ, Handelsman DJ. Blood testosterone threshold for androgen deficiency symptoms[J]. J Clin Endocrinol Metab, 2004, 89(8):3813-3817. doi: 10.1210/jc.2004-0143
[15]	Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality due to all causes, cardiovascular disease, and cancer in men: European prospective investigation into cancer in Norfolk (EPIC-Norfolk) prospective population study[J]. Circulation, 2007, 116(23):2694-2701. doi: 10.1161/CIRCULATIONAHA.107.719005
[16]	Haring R, Volzke H, Steveling A, et al. Low serum testosterone levels are associated with increased risk of mortality in a population-based cohort of men aged 20-79[J]. Eur Heart J, 2010, 31(12):1494-1501. doi: 10.1093/eurheartj/ehq009 pmid: 20164245
[17]	Laughlin GA, Barrett-Connor E, Bergstrom J. Low serum testosterone and mortality in older men[J]. J Clin Endocrinol Metab, 2008, 93(1):68-75. doi: 10.1210/jc.2007-1792
[18]	Araujo AB, Dixon JM, Suarez EA, et al. Clinical review: Endogenous testosterone and mortality in men: a systematic review and meta-analysis[J]. J Clin Endocrinol Metab, 2011, 96(10):3007-3019. doi: 10.1210/jc.2011-1137 pmid: 21816776
[19]	Morgentaler A. Testosterone deficiency and cardiovascular mortality[J]. Asian J Androl, 2015, 17(1):26-31. doi: 10.4103/1008-682X.143248 pmid: 25432501
[20]	Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men[J]. Eur Heart J, 2015, 36(40):2706-2715. doi: 10.1093/eurheartj/ehv346 pmid: 26248567
[21]	Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middLe-aged men: longitudinal results from the Massachusetts male aging study[J]. J Clin Endocrinol Metab, 2002, 87(2):589-598. doi: 10.1210/jcem.87.2.8201
[22]	Wu FC, Tajar A, Pye SR, et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: The European male aging study[J]. J Clin Endocrinol Metab, 2008, 93(7):2737-2745. doi: 10.1210/jc.2007-1972
[23]	Samplaski MK, Loai Y, Wong K, et al. Testosterone use in the male infertility population: prescribing patterns and effects on semen and hormonal parameters[J]. Fertil Steril, 2014, 101(1):64-69. doi: 10.1016/j.fertnstert.2013.09.003 pmid: 24094422
[24]	Ramasamy R, Armstrong JM, Lipshultz LI. Preserving fertility in the hypogonadal patient: an update[J]. Asian J Androl, 2015, 17(2):197-200. doi: 10.4103/1008-682X.142772 pmid: 25337850
[25]	Liu PY, SwerdLoff RS, Christenson PD, et al. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: An integrated analysis[J]. Lancet, 2006, 367(9520):1412-1420. doi: 10.1016/S0140-6736(06)68614-5
[26]	Madhukar D, Rajender S. Hormonal treatment of male infertility: Promises and pitfalls[J]. J Androl, 2009, 30(2):95-112. doi: 10.2164/jandrol.108.005694 pmid: 18930905

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Variable	Value
Age/years	30.4±5.8
FSH/(IU/mL)	8.16±6.9
LH/(IU/mL)	7.16±3.01
Testosterone level/(ng/dL)	4.18±1.64
Mean testis volume/mL	13.06±3.48

Items	<300 ng/dL	≥300 ng/dL	P value
Age/years	30.88±6.23	30.27±5.61	0.352
FSH/(IU/mL)	9.87±8.32	7.54±6.22	0.009
LH/(IU/mL)	6.99±3.28	7.22±2.91	0.484
Mean testis volume	12.33±3.89	13.32±3.29	0.010
Infertility causes/%			<0.001
VC	24.9	75.1
NOA	40.2	59.8
OA	19.1	80.9

Factors	Univariate analysis OR (95%CI)	P value	Multivariate analysis OR (95%CI)	P value
Age/years	0.982 (0.946-1.020)	0.351	-	NS
FSH/(IU/mL)	0.957 (0.928-0.986)	0.004	-	NS
LH/(IU/mL)	1.028 (0.952-1.109)	0.484	-	NS
Mean testis volume	1.086 (1.019-1.158)	0.011	-	NS
Infertility causes
OA	1	-	1	-
VC	1.396 (0.809-2.410)	0.230	1.396 (0.809-2.410)	0.230
NOA	0.492 (0.288-0.840)	0.009	0.492 (0.288-0.840)	0.009

Testosterone levels in patients with varicocele and azoospermia

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