Dynamics of estradiol and testosterone and seminal fluid indexes in smokers and nonsmokers

Cigarette smoking and testosterone in men and women: A systematic review and meta-analysis of observational studies

Recently Health Canada and the Food and Drug Administration warned about the cardiovascular risk of testosterone, making environmental drivers of testosterone potential prevention targets. Cotinine, a tobacco metabolite, inhibits testosterone breakdown. We assessed the association of smoking with testosterone in a systematic review and meta-analysis, searching PubMed and Web of Science through March 2015 using ("testosterone" or "androgen" or "sex hormone") and ("smoking" or "cigarette"). Two reviewers independently searched, selected, assessed quality and abstracted with differences resolved by consensus or reference to a third reviewer. The initial search yielded 2881 studies; 28 met the selection criteria. In 22 studies of 13,317 men, mean age 18-61years, smokers had higher mean testosterone than non-smokers (1.53nmol/L, 95% confidence interval (CI) 1.11 to 1.96) using a random effects model with inverse variance weighting. In 6 studies of 6089 women, mean age 28-62years, smoking was not clearly associated with testosterone (0.11nmol/L, 95% CI -0.08 to 0.30). Fixed effects models provided similar results, but suggested a positive association in women. Whether products which raise cotinine, such as e-cigarettes or nicotine replacement, also raise testosterone, should be investigated, to inform any regulatory action for e-cigarettes, which emit nicotine into the surrounding air, with relevance for both active and passive smokers.

Human exposure to endocrine disrupters and semen quality

Reproductive pathology in the male represents about 20% of infertility cases. Male infertility may be attributed to a number of causes, including genetic and congenital abnormalities, infection, multisystemic diseases, varicocele, and others; however, a significant number of cases are idiopathic. Global declines in semen quality were suggested to be associated with enhanced exposure to environmental chemicals that act as endocrine disrupters as a result of our increased use of pesticides, plastics, and other anthropogenic materials. A significant body of toxicology data based upon laboratory and wildlife animals studies suggests that exposure to certain endocrine disrupters is associated with reproductive toxicity, including (1) abnormalities of the male reproductive tract (cryptorchidism, hypospadias), (2) reduced semen quality, and (3) impaired fertility in the adult. There is, however, a relative paucity of studies designed to measure exposure to endocrine disrupters on semen quality parameters (sperm concentration, motility, morphology). An overview of the human semen quality literature is presented that examines the role of endocrine disrupters including organochlorines (OC), dioxins, phthalates, phytoestrogens, and chemical mixtures (pesticides and tobacco smoke).

Endogenous testosterone levels and smoking in men. The fifth Tromsø study

Smoking is a risk factor of coronary heart disease (CHD), while the role of testosterone in the development of CHD is controversial. The reported effects of cigarette smoking on testosterone levels in men are conflicting, and smoking may be an important confounding factor when evaluating the relationship between testosterone levels and CHD. Thus, the objective of the present study was to examine the associations of smoking status and number of cigarettes smoked per day with total and free testosterone levels in a cross-sectional population-based study of 3427 men participating in the fifth Tromsø study. Total testosterone, luteinizing hormone, follicle-stimulating hormone and sex hormone-binding globulin levels were measured with immunoassay while free testosterone levels were calculated. Waist circumference was also measured and two standardized questionnaires were completed, including smoking status and number of cigarettes smoked. The data were analysed with analysis of variance and covariance and multiple regression analysis. Smoking men had significantly higher levels of total and free testosterone compared with men who never smoked (p < 0.001 and <0.01 respectively). Both total and free testosterone levels increased significantly with increasing number of cigarettes smoked daily (p < 0.001). Smoking men had 15% higher total and 13% higher free testosterone levels compared with men who never smoked. Thus, smoking seems to be an important confounding factor when evaluating testosterone levels, and could possibly mask borderline hypogonadism.

Cigarette smoking is related to a decrease in semen volume in a population of fertile men

OBJECTIVE

To evaluate the semen quality and hormonal levels in fertile men according to their level of cigarette smoking.

SUBJECTS AND METHODS

We evaluated 889 fertile men who came for a vasectomy for sterilization purposes. The men included 522 non-smokers, 143 mild smokers (<10 cigarettes/day), 154 moderate smokers (11-20/day), and 70 heavy smokers (>20/day). We evaluated sperm concentration, motility, motion variables and hormonal levels in these men.

RESULTS

There were no significant differences among the groups in sperm concentration or motility, or in levels of follicle-stimulating hormone, luteinizing hormone, or serum total testosterone. Also, sperm motion characteristics did not differ across the groups. Semen volume was the only semen variable which tended to decrease according to the number of cigarettes smoked.

CONCLUSIONS

Cigarette smoking had no apparent effect on sperm concentration, motility or reproductive hormonal levels, but tended to reduce semen volume.

Smoking and hormones in health and endocrine disorders

Smoking has multiple effects on hormone secretion, some of which are associated with important clinical implications. These effects are mainly mediated by the pharmacological action of nicotine and also by toxins such as thiocyanate. Smoking affects pituitary, thyroid, adrenal, testicular and ovarian function, calcium metabolism and the action of insulin. The major salient clinical effects are the increased risk and severity of Graves' hyperthyroidism and opthalmopathy, osteoporosis and reduced fertility. Smoking also contributes to the development of insulin resistance and hence type 2 diabetes mellitus. An important concern is also the effect of smoking on the foetus and young children. Passive transfer of thiocyanate can cause disturbance of thyroid size and function. Furthermore, maternal smoking causes increased catecholamine production, which may contribute to under perfusion of the foetoplacental unit.

Effect of ‘PC Game Room’ use and polycyclic aromatic hydrocarbon exposure on plasma testosterone concentrations in young male Koreans

BACKGROUND

'PC Game Rooms' were first popularized in Korea, although the concept is now becoming popular worldwide. PC Game Rooms provide users with high-performance PC connected to the high-speed internet, and access to computer games. However, PC Game Room users are exposed to various hazardous agents such as cigarette smoke in a confined environment, and thus it is likely that excessive PC Game Room use involves abnormal exposure to polycyclic aromatic hydrocarbons (PAH) as well as being associated with disturbed sleep or circadian rhythm.

METHODS

In this cross-sectional study, the exposure to PAH was evaluated by measuring urinary 1-hydroxypyrene (1-OHP) and 2-naphthol. The correlations between PC Game Room use and PAH exposure and plasma testosterone and LH levels were analysed in 208 young male Koreans.

RESULTS

Urinary 1-OHP concentrations increased (P = 0.0001) and plasma testosterone levels decreased (P = 0.0153) significantly with increased duration of PC Game Room use. Correlation analysis showed that plasma testosterone concentrations were significantly negatively correlated with urinary 1-OHP (r = -0.22, P = 0.0012) and 2-naphthol (r = -0.15, P = 0.0308) concentrations. Moreover, these associations persisted after adjusting for other independent variables. However, the duration of PC Game Room use itself was not found to be an independent significant determinant of plasma testosterone level. Rather, PC Game Room use increased PAH exposure, which decreased plasma testosterone level. The younger age group (15-19 years) showed a more prominent decrease in plasma testosterone concentrations with increasing duration of PC Game Room use than the older age group (20-24 years) (r2 = 0.355, P = 0.0301 versus r2 = 0.213, P = 0.0001).

CONCLUSIONS

These results imply that the excessive use of PC Game Rooms is related to an adverse impact on sex hormonal status in young male Koreans via PAH exposure. This effect was more prominent in the younger age group.

Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility

Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals - both natural and synthetic - that can interact with the endocrine system.

Common medications and drugs: how they affect male fertility

Numerous drugs and medications have been shown to have adverse effects on male fertility, acting through diverse mechanisms. These drugs are summarized in Table 2. Mechanisms of impaired fertility include direct effects on germ cells or their supporting cells, effects on the delicately balanced HPG axis, effects on erectile or ejaculatory function, and effects on libido. In a thorough fertility evaluation of the male partner, the physician should determine what medication the patient is taking and his social habits involving alcohol consumption, tobacco, and recreational drug use. Most adverse effects from drugs and medications can be reversed by simply discontinuing the offending agents; however, in some instances, such as chemotherapeutic regimens, the medications cannot be discontinued, and pretreatment sperm cryopreservation remains critical. It is essential for urologists treating infertile men to be familiar with the more commonly encountered drugs and medications that may affect the potential for fertility.

An electron microscope study of the axonemal ultrastructure in human spermatozoa from male smokers and nonsmokers

OBJECTIVE

To investigate possible abnormalities or deterioration of the sperm axonemal ultrastructure in men who have smoked a large quantity of cigarettes (> 20 per day) for a prolonged period.

DESIGN

Semen specimens were collected by patients via masturbation; qualitative characteristics of the sperm were assessed and ultrastructural analysis of the sperm axoneme was performed using standard operating procedures for electron transmission microscopy.

SETTING

The Andrology Institute of Lexington, Lexington, Kentucky, and the Department of Histology and Embryology, University of Salonika, Greece (collaborative effort).

PATIENT(S)

Twenty-nine men (mean age +/- SD, 30.7 +/- 2.1 years) who smoked a mean (+/- SD) of 30.7 +/- 2.1 cigarettes per day for 10.7 +/- 0.7 years and 15 men who never smoked (mean age +/- SD, 30.4 +/- 2.2 years) participated in this study.

MAIN OUTCOME MEASURE(S)

Ultrastructural organization of the sperm axoneme in male smokers and nonsmokers.

RESULT(S)

Changes in the number and the arrangement of axonemal microtubules were noted in the smoker group when compared to the nonsmoker group. The incidence of axonemal abnormalities was higher in spermatozoa from smokers compared with that in spermatozoa from nonsmokers.

CONCLUSION(S)

Smoking a large quantity of cigarettes per day, under the conditions of the current study, severely affected the ultrastructure of the flagellum and, more specifically, it affected the axoneme of the human spermatozoon.

Effects of seminal plasma from cigarette smokers on sperm viability and longevity

OBJECTIVE

To evaluate the effects of cigarette smoking on the ability of seminal plasma (SP) to maintain sperm viability.

DESIGN

Clinical randomized study. Spermatozoa from cigarette smoking or nonsmoking subjects were reconstituted in SP from smokers and nonsmokers and in modified Ham's F-10 medium, followed by sperm quality assessment during a 48-hour incubation period.

SETTING

Andrology Institute of Lexington, Lexington, Kentucky.

PATIENT(S)

Twenty men who had been smoking cigarettes for longer than 3 years (30 cigarettes per day or more) and 20 nonsmokers participated in this study.

MAIN OUTCOME MEASURE(S)

Improvement in sperm viability by removal of SP--and associated detrimental factors present in the SP--from smoker subjects.

RESULT(S)

The results obtained indicate that the quality of spermatozoa obtained from nonsmokers was superior to that of smokers. The SP from the two patient groups had a definite effect on their respective sperm quality, i.e., beneficial effects for the nonsmokers, detrimental effects for the smokers. Exposure of spermatozoa from the nonsmokers to SP from the smokers resulted in a significant reduction in sperm viability. However, exposure of spermatozoa from the smokers to SP from the nonsmokers or to Ham's F-10 medium yielded significant improvements in sperm viability.

CONCLUSION(S)

The detrimental effects of smokers' SP on nonsmokers' spermatozoa was prominent and a rather unique phenomenon. The results generated in this study could be of clinical significance since removal of smokers' SP and subsequent reconstitution and incubation in physiological media seems to enhance the viability, longevity, and possibly the fertilizing ability of these spermatozoa for use in various assisted reproductive technologies.

Tobacco smoke disrupts testicular microcirculation in the rat

Anaesthetized adult rats were exposed repeatedly to cigarette smoke for 2 s interspersed with exposure to fresh air for either 10, 15 or 30 s using a smoking apparatus. The acute effects of this treatment on testicular microcirculation were studied using laser Doppler flowmetry. Peripheral tissue O2 saturation was measured continuously in the foot during the experiment. Exposure to cigarette smoke caused a moderate acute increase in the testicular blood flow and it inhibited vasomotion. Blood flow and the pattern of vasomotion were normalized after termination of smoke exposure. The time between the last smoke exposure and flow normalization was dependent on the smoke/air dose. Peripheral tissue O2 saturation did not change during the experiments. The effects on testicular microcirculation of local injections of an aqueous extract of cigarette smoke and passive smoking were also studied. Local injection of smoke extract increased blood flow and inhibited vasomotion. Passive smoking caused a moderate decrease in the frequency of vasomotion and amplitude. The observation that cigarette smoke influences testicular microcirculation acutely is discussed in relation to possible adverse effects on spermatogenesis.

Relationship of smoking cessation and nicotine gum use to salivary androstenedione and testosterone in middle-aged men

Cross-sectional studies have associated cigarette smoking in men with elevated androstenedione and little net effect on other sex steroids. However, it is not clear if such findings reflect the impact of nicotine exposure or if sex hormone levels change following smoking cessation. The relationship of the reported number of cigarettes smoked per day and salivary cotinine to salivary testosterone and androstenedione was examined in 221 men aged 35 to 59 years at baseline and 1 year following randomization into a clinical trial including a smoking-cessation intervention. At baseline, salivary cotinine was related to increased salivary androstenedione and testosterone following control for age, body mass, alcohol intake, and time of day of specimen collection (partial r = +.14 and +.30 P < .05 and .01, respectively). The reported number of cigarettes smoked per day was unrelated to either hormone. At the first annual visit, there was a significant decrease in the salivary androstenedione of men who had quite smoking and were currently using nicotine gum (94 v 60 pg/mL, P < .05, n = 34) and of men who had quit smoking and were not exposed to nicotine (86 v 56 pg/mL, P < .05, n = 48), whereas the salivary androstenedione of men who remained smokers at the first annual visit was unchanged (83 v 85 pg/mL, n = 139). Salivary testosterone levels were not significantly affected by a change in smoking status.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of elevated estradiol with remote testicular trauma in young infertile men

OBJECTIVE

To determine the incidence of remote testicular trauma and of possible related permanent hormonal and seminal changes in infertile men.

DESIGN

Retrospective clinical study of hormonal and seminal parameters in a subpopulation of infertile men.

SETTING

Andrology Clinic in an academic research environment.

PARTICIPANTS

Infertile men, with and without history of remote testicular trauma, and fertile volunteers.

MAIN OUTCOME MEASURES

Percentage of infertile men with history of blunt testicular trauma, concentrations of reproductive hormones, and semen parameters.

RESULTS

Significant remote blunt testicular trauma was reported by 16.8% of infertile men. This had occurred 2 to 17 years (mean, 16.4 years) before evaluation, mostly with contact sports at adolescent age. Estradiol concentrations after testicular trauma were 19% and 25% higher than in infertile men without history of testicular injury and in fertile controls. Elevated E2 levels did not correlate with T. Infertile men with and without history of testicular trauma showed changes in seminal parameters.

CONCLUSION

The incidence of remote blunt testicular trauma in infertile men is unexpectedly high. After injury, FSH-stimulated aromatization of T may increase testicular E2 production, interfere with spermatogenesis, and cause infertility. Consistent use of protective devices in contact sports is recommended.

Use of a sealed minichamber for direct observation and evaluation of the in vitro effect of cigarette smoke on sperm motility

OBJECTIVE

To determine the in vitro effect of cigarette smoke on sperm motility and survival in an attempt to find a possible association with clinical studies that had pointed to the existence of such an effect in vivo.

DESIGN

Laboratory experiments in which the effect of cigarette smoke on human sperm placed in a sealed minichamber was directly observed and determined by motion analysis.

PATIENTS

High-quality fresh semen specimens were obtained from healthy donors and used for the experimental studies.

INTERVENTIONS

Various doses of filtered and nonfiltered cigarette smoke, collected by an improvised manual smoking machine, were streamed at a rate of 2 mL/s into sealed chambers containing samples of washed spermatozoa. Evaluation of the changes in sperm motility was performed in real time by direct microscopical observation and repeated determinations by the multiple exposure photography technique until their complete immobilization.

RESULTS

Streaming of 100 mL of cigarette smoke induced a dramatic drop in sperm motility, which caused sperm immobilization in about 15 minutes. This effect showed a clear dose-response relationship either with the amounts streamed or with the time during which sperm were exposed to cigarette smoke. The harmful effect was almost the same whether sperm were exposed to filtered or nonfiltered cigarette smoke. The role of carbon monoxide and hydrogen cyanide on these findings was studied separately, and it was shown that the inhibitory effect was not due to the presence of these two important components of cigarette smoke.

CONCLUSIONS

The clear evidence of the in vitro harmful effect of crude cigarette smoke on sperm motility points to the possibility that in heavy smokers certain toxic agents may reach mature spermatozoa or their precursors via the blood stream and induce their harmful effect on sperm motility in vivo.

Routine hormone load tests are unnecessary in infertile men

A sample of 225 men examined at the Infertility Service Unit of this hospital had spermiograms, standardized in accordance with WHO guide lines, and a hormone stimulation test with injection of gonadotropin releasing hormone, thyrotropin releasing hormone, and ACTH. The serum concentrations of the following hormones were assessed: follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, oestradiol (E), thyroid stimulating hormone, cortisol, 21-desoxycortisol, 17-hydroxypregnenolone, 17-hydroxyprogesterone, dehydroepiandrosterone, dehydroepiandrosteronesulphate, androstenedione, testosterone (T), and dihydrotestosterone. The results of the spermiograms were found to be related to the concentrations of the following hormones: FSH, LH, T, and E. Thyroid and adrenal function in men without signs of endocrinological diseases failed to influence spermatic parameters.

Corneal deposits associated with flecainide

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The antiestrogenic effect of cigarette smoking in women

Epidemiologic results indicate that women who smoke cigarettes are relatively estrogen-deficient. Smokers have an early natural menopause, a lowered risk of cancer of the endometrium, and an increased risk of some osteoporotic fractures. Moreover, women who smoke may have a reduced risk of uterine fibroids, endometriosis, hyperemesis gravidarum, and benign breast disease. Several possible mechanisms for these effects have been identified. Smoking does not appear to be clearly related to estradiol levels, at least in postmenopausal women, although levels of adrenal androgens are increased. Moreover, smoking appears to alter the metabolism of estradiol, leading to enhanced formation of the inactive catechol estrogens.

Nicotine and cotinine inhibit steroidogenesis in mouse Leydig cells

Cigarette smoking alters plasma testosterone concentrations in men. The objectives of this study were to determine if nicotine and cotinine, two alkaloid products of cigarettes, affect luteinizing hormone(LH)-stimulated steroidogenesis in isolated adult mouse Leydig cells. Leydig cells from adult Swiss-Webster mice were isolated by linear density gradient and incubated (95% O2, 5% CO2) in minimum essential medium at 37 C for 3 hours with LH (10 ng) and with or without nicotine or cotinine (10(-5)-10(-7) M). Both nicotine and cotinine produced dose response inhibition (P less than 0.05) of LH-stimulated testosterone production (50-70%). The addition of 8-bromo-3',5'-cyclic monophosphate (cAMP, 500 uM) stimulated steroidogenesis comparable to LH in the absence of the alkaloids, but both nicotine and cotinine significantly (P less than 0.05) reduced testosterone production in response to cAMP, suggesting that the alkaloids inhibit testosterone production in response to LH distal to the formation of cAMP. In MEM without calcium, LH-stimulated testosterone synthesis was decreased, and neither nicotine nor cotinine significantly affected steroidogenesis. The addition of a calcium ionophore in MEM with normal calcium content enhanced (P less than 0.05) the inhibitory effects of nicotine and cotinine on LH-responsive steroidogenesis. A calcium channel blocking agent, verapamil, at 10uM significantly (P less than 0.05) reversed the inhibition of LH-stimulated testosterone production produced by both alkaloids when incubated in the medium with a normal calcium concentration. These results suggest that nicotine and cotinine either affect intracellular calcium content or block the effects of calcium on steroidogenesis in mouse Leydig cells.