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Novaes LF, Flores JM, Benfante N, Schofield E, Katz DJ, Nelson CJ, Mulhall JP. Analysis of diurnal variation in serum testosterone levels in men with symptoms of testosterone deficiency. J Sex Med 2024; 21:408-413. [PMID: 38481019 DOI: 10.1093/jsxmed/qdae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Testosterone (T) plays a crucial role in various physiological functions in men, and understanding the variations in T levels during the day is essential for diagnosing and treating testosterone deficiency (TD). AIM We sought to evaluate the reduction in serum total T (TT) levels throughout the day in men with symptoms of testosterone deficiency and to determine the variables having an impact on the extent of this decline. METHODS The study population consisted of a group of men who within 3 months of each other had all undergone both early morning and afternoon TT level measurements. We did not include patients with a history of a prior orchiectomy, testosterone levels below 100 ng/dL or above 1000 ng/dL, a history of androgen deprivation therapy, or patients on T therapy. Statistical analyses were conducted using descriptive statistics, t-tests, chi-square tests, and correlation calculations. Liquid chromatography-tandem mass spectrometry was used to measure TT, and a change in TT levels greater than 100 ng/dL was considered significant. Using multivariable and univariable analysis, we attempted to define predictors of a decrease in afternoon TT levels. OUTCOMES The majority of men showed no significant difference in T levels between morning and afternoon. RESULTS In total, 506 men with a median age of 65 years were analyzed. The most common comorbidities were hypertension and hyperlipidemia. Levels of TT were measured in the morning and afternoon, and no significant differences in mean T levels based on the time of the test were found. Age was not significantly associated with T levels. CLINICAL IMPLICATIONS There was a weak negative correlation between age and the difference between morning and afternoon T levels, with younger men showing more significant variations in T levels. The most considerable differences in T levels were observed in men younger than 30 years. There were no predictors of the magnitude of the T decrease in the afternoon. STRENGTHS AND LIMITATIONS Strengths of the study include the number of subjects and the use of liquid chromatography-tandem mass spectrometry for T measurement. Limitations include failure to measure morning and afternoon T levels on the same day, the retrospective nature of the study, and a smaller sample size of patients younger than 30 years. CONCLUSION In this study we found no strong link between age and daily T fluctuation, but we observed a decrease in the magnitude of variation with aging. The group experiencing the most significant decline in daily T had higher morning and consistently normal afternoon T levels.
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Affiliation(s)
- Luis F Novaes
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Jose M Flores
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Nicole Benfante
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, United States
| | - Darren J Katz
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
| | - Chris J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, United States
| | - John P Mulhall
- Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, NewYork, NY 10022, United States
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2
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Markouli M, Michala L. Fertility potential in 5α-reductase type 2 deficient males. J Pediatr Urol 2023; 19:108-114. [PMID: 36153242 DOI: 10.1016/j.jpurol.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Males with 5α-reductase deficiency experience oligospermia or azoospermia, resulting in fertility problems. OBJECTIVE The aim of the present systemic review was to assess the fertility status of males with 5α-reductase type 2 deficiency and explore how reproduction can be achieved in these patients. STUDY DESIGN An extensive search of two databases (Pubmed and SCOPUS) was performed. Studies with original clinical data in patients with 5α-reductase deficiency evaluating the impact of the disease on semen quality and quantity and pregnancy outcomes through assisted or natural conception methods were eligible to be included in this systematic review. RESULTS A total of nine cases were identified based on the eligibility criteria, all of which included reports of successful reproduction in males with 5α-reductase type 2 deficiency. DISCUSSION In five individuals, assisted reproduction technology was used to achieve conception, highlighting its importance in solving the fertility problems that males with 5α-reductase deficiency are facing. Potential future fertility is a further indication for assigning the male gender in diagnosed newborns. CONCLUSION In order to achieve this, the development of a management plan starting at birth is crucial for these patients, so that spermatogenesis and potential fertility can be preserved. In adulthood, semen analysis and mutation screening may also help in guiding these patients to select the correct fertilization method for their individual genetic and phenotypic characteristics.
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Affiliation(s)
- Mariam Markouli
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas Sofias Avenue, Athens, Greece.
| | - Lina Michala
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas Sofias Avenue, Athens, Greece
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3
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Batista RL, Mendonca BB. The Molecular Basis of 5α-Reductase Type 2 Deficiency. Sex Dev 2022; 16:171-183. [PMID: 35793650 DOI: 10.1159/000525119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/13/2022] [Indexed: 11/19/2022] Open
Abstract
The 5α-reductase type 2 enzyme catalyzes the conversion of testosterone into dihydrotestosterone, playing a crucial role in male development. This enzyme is encoded by the SRD5A2 gene, which maps to chromosome 2 (2p23), consists of 5 exons and 4 introns, and encodes a 254 amino acid protein. Disruptions in this gene are the molecular etiology of a subgroup of differences of sex development (DSD) in 46,XY patients. Affected individuals present a large range of external genitalia undervirilization, ranging from almost typically female external genitalia to predominantly typically male external genitalia with minimal undervirilization, including isolated micropenis. This is an updated review of the implication of the SRD5A2 gene in 5α-reductase type 2 enzyme deficiency. For that, we identified 451 cases from 48 countries of this particular 46,XY DSD from the literature with reported variants in the SRD5A2 gene. Herein, we present the SRD5A2 mutational profile, the SRD5A2 polymorphisms, and the functional studies related to SRD5A2 variants to detail the molecular etiology of this condition.
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Affiliation(s)
- Rafael L Batista
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, do Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Endocrine Oncology Unit, Instituto do Câncer do Estado de São Paulo, ICESP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Berenice B Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular/LIM42, Hospital das Clínicas, Disciplina de Endocrinologia, do Departamento de Clínica Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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4
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Cavadias I, Touraine P, Ahmed SF. DSD in Boys: Impact on Fertility. ANNALES D'ENDOCRINOLOGIE 2022; 83:177-180. [DOI: 10.1016/j.ando.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Wada T, Ichikawa C, Takeuchi M, Matsui F, Matsumoto F, Ida S, Etani Y, Kawai M. Histological analysis of testes in patients with 5 alpha-reductase deficiency type 2: comparison with cryptorchid testes in patients without endocrinological abnormalities and a review of the literature. Clin Pediatr Endocrinol 2022; 31:144-151. [PMID: 35928389 PMCID: PMC9297171 DOI: 10.1297/cpe.2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/07/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Tamaki Wada
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Chihiro Ichikawa
- Department of Pathology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Makoto Takeuchi
- Department of Pathology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Futoshi Matsui
- Department of Urology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Fumi Matsumoto
- Department of Urology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Shinobu Ida
- Department of Clinical Laboratory, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Yuri Etani
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Masanobu Kawai
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women’s and Children’s Hospital, Osaka, Japan
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Hosseinirad H, Yadegari P, Mohanazadeh Falahieh F, Nouraei S, Paktinat S, Afsharzadeh N, Sadeghi Y. Disorders of sex development and female reproductive capacity: A literature review. Syst Biol Reprod Med 2021; 67:323-336. [PMID: 34196232 DOI: 10.1080/19396368.2021.1937376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Disorders of sex development (DSD) are a wide-ranging group of complex conditions that influence chromosomal, gonadal, and phenotypic sex. The prevalence of DSD is very low, but affected patients deserve individualized management to improve psychological, sexual, and reproductive outcomes. This review aims to clarify the fertility potential of DSD patients who can be reared as females and their chance of becoming pregnant, especially using assisted reproductive techniques (ART). Due to the effects of DSD on internal and external genital organs, these conditions result in varying degrees of fertility potential. Fertility rate depends on the phenotype and is inversely related to the severity of the disorder. Reproductive endocrinologists and infertility specialists must be considered active partners of the interdisciplinary treatment team. With current advances in ART, pregnancy is more achievable in patients who were considered infertile at first glance. Due to the complexity of the medical management in DSD patients, more studies should be conducted to conclusively suggest the best choice for improving their fertility potential.Abbreviations: AIS: Androgen Insensitivity Syndrome; AMH: Anti-Müllerian Hormone; ART: Assisted Reproductive Technology; ASRM: American Society for Reproductive Medicine; CAH: Congenital Adrenal Hyperplasia; CAIS: Complete Androgen Insensitivity Syndrome; DHT: Dihydrotestosterone; DSD: Disorders of Sexual Development; FSH: Follicle Stimulating Hormone; GD: Gonadal Dysgenesis; ICSI: Intracytoplasmic Sperm Injection; IUGR: Intrauterine Growth Restriction; IVF: In Vitro Fertilization; IVF-ET: IVF and Embryo Transfer; LH: Luteinizing Hormone; MGD: Mixed Gonadal Dysgenesis; MRI: Magnetic Resonance Imaging; MRKH: Mayer-Rokitansky-Kuster-Hauser; US: Ultrasonography; HSG: Hysterosalpingography; PAIS: Partial Androgen Insensitivity Syndrome; PGD: Preimplantation Genetic Diagnosis; POR: P450 Oxidoreductase; PROM: Premature Rupture of Membranes; TS: Turner Syndrome; 17β-HSD III: 17β-Hydroxysteroid Dehydrogenase III; 21-OHD: 21-hydroxylase deficiency; 5α-RD-2: 5α-reductase-2.
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Affiliation(s)
- Hossein Hosseinirad
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pouya Yadegari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Soheila Nouraei
- Department of Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrokh Paktinat
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Yousef Sadeghi
- Department of Anatomy and Physiology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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7
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Traish AM. Post-finasteride syndrome: a surmountable challenge for clinicians. Fertil Steril 2020; 113:21-50. [PMID: 32033719 DOI: 10.1016/j.fertnstert.2019.11.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
Post-finasteride syndrome (PFS) is a constellation of serious adverse side effects manifested in clinical symptoms that develop and persist in patients during and/or after discontinuing finasteride treatment in men with pattern hair loss (androgenetic alopecia) or benign prostatic hyperplasia. These serious adverse side effects include persistent or irreversible sexual, neurological, physical and mental side effects. To date, there are no evidence-based effective treatments for PFS. Although increasing number of men report persistent side effects, the medical community has yet to recognize this syndrome nor are there any specific measures to address this serious and debilitating symptoms. Here we evaluate the scientific and clinical evidence in the contemporary medical literature to address the very fundamental question: Is PFS a real clinical condition caused by finasteride use or are the reported symptoms only incidentally associated with but not caused by finasteride use? One key indisputable clinical evidence noted in all reported studies with finasteride and dutasteride was that use of these drugs is associated with development of sexual dysfunction, which may persist in a subset of men, irrespective of age, drug dose or duration of study. Also, increased depression, anxiety and suicidal ideation in a subset of men treated with these drugs were commonly reported in a number of studies. It is important to note that many clinical studies suffer from incomplete or inadequate assessment of adverse events and often limited or inaccurate data reporting regarding harm. Based on the existing body of evidence in the contemporary clinical literature, the author believes that finasteride and dutasteride induce a constellation of persistent sexual, neurological and physical adverse side effects, in a subset of men. These constellations of symptoms constitute the basis for PFS in individuals predisposed to epigenetic susceptibility. Indeed, delineating the pathophysiological mechanisms underlying PFS will be of paramount importance to the understanding of this syndrome and to development of potential novel therapeutic modalities.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts.
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8
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Disorders of Sex Development-Novel Regulators, Impacts on Fertility, and Options for Fertility Preservation. Int J Mol Sci 2020; 21:ijms21072282. [PMID: 32224856 PMCID: PMC7178030 DOI: 10.3390/ijms21072282] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
Disorders (or differences) of sex development (DSD) are a heterogeneous group of congenital conditions with variations in chromosomal, gonadal, or anatomical sex. Impaired gonadal development is central to the pathogenesis of the majority of DSDs and therefore a clear understanding of gonadal development is essential to comprehend the impacts of these disorders on the individual, including impacts on future fertility. Gonadal development was traditionally considered to involve a primary 'male' pathway leading to testicular development as a result of expression of a small number of key testis-determining genes. However, it is increasingly recognized that there are several gene networks involved in the development of the bipotential gonad towards either a testicular or ovarian fate. This includes genes that act antagonistically to regulate gonadal development. This review will highlight some of the novel regulators of gonadal development and how the identification of these has enhanced understanding of gonadal development and the pathogenesis of DSD. We will also describe the impact of DSDs on fertility and options for fertility preservation in this context.
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9
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Sasaki G, Ishii T, Hori N, Amano N, Homma K, Sato S, Hasegawa T. Effects of pre- and post-pubertal dihydrotestosterone treatment on penile length in 5α-reductase type 2 deficiency. Endocr J 2019; 66:837-842. [PMID: 31178538 DOI: 10.1507/endocrj.ej19-0111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Steroid 5α-reductase type 2 deficiency (5αRD2) is a congenital disorder of sex development caused by impairment of conversion from testosterone (T) to 5α-dihydrotestosterone (DHT). DHT deficiency leads to various degrees of undervirilized external genitalia including micropenis, primarily correlated with mutations of the SRD5A2 gene that encodes 5α-reductase type 2. Four Japanese boys with isolated micropenis were diagnosed as 5αRD2 by elevated ratios of serum T/DHT, and decreased ratios of urinary 5α/5β-reduced steroid metabolites. Genetic analyses for SRD5A2 identified that the four patients shared a hypomorphic mutation R227Q that has a residual activity related to the mild-form of 5αRD2. For prepubertal micropenis, DHT was transdermally applied to the four patients at the ages of 4-11 year, increasing a median of stretched penile lengths (SPLs) from 2.6 cm (-2.5 SD) to 4.4 cm (-0.2 SD). Nevertheless, the post-pubertal penile growth was apparently retarded, despite normal levels of T secreted from well-developed testes. The second course of DHT treatment underwent at ages of 12-18 year, but unable to normalize SPLs at a range of 6.0 to 7.0 cm (-3.4 to -2.4 SD). The prostate volumes of two patients were variable at 8.1 and 21 cm3, and a sperm cell count of one patient was normal as young adult. DHT treatment contributes to development of the penis and prostate, which are favorable for the potential fertility of 5αRD2 adults. Meanwhile, the retarded penile growth and a risk of prostate overgrowth may complicate the post-pubertal management with DHT for 5αRD2 males.
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MESH Headings
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/blood
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/deficiency
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics
- Child
- Child, Preschool
- Dihydrotestosterone/administration & dosage
- Disorder of Sex Development, 46,XY/blood
- Disorder of Sex Development, 46,XY/drug therapy
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/pathology
- Drug Administration Schedule
- Genital Diseases, Male/blood
- Genital Diseases, Male/drug therapy
- Genital Diseases, Male/genetics
- Humans
- Hypospadias/blood
- Hypospadias/drug therapy
- Hypospadias/genetics
- Hypospadias/pathology
- Longitudinal Studies
- Male
- Membrane Proteins/deficiency
- Membrane Proteins/genetics
- Mutation
- Penis/abnormalities
- Penis/drug effects
- Penis/growth & development
- Penis/pathology
- Puberty/drug effects
- Puberty/physiology
- Sexual Maturation/drug effects
- Steroid Metabolism, Inborn Errors/blood
- Steroid Metabolism, Inborn Errors/drug therapy
- Steroid Metabolism, Inborn Errors/genetics
- Steroid Metabolism, Inborn Errors/pathology
- Testosterone/blood
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Goro Sasaki
- Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba 272-8513, Japan
| | - Tomohiro Ishii
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naoaki Hori
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Naoko Amano
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Keiko Homma
- Clinical Laboratory, Keio University Hospital, Tokyo 160-8582, Japan
| | - Seiji Sato
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan
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10
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Islam R, Lane S, Williams SA, Becker CM, Conway GS, Creighton SM. Establishing reproductive potential and advances in fertility preservation techniques for XY individuals with differences in sex development. Clin Endocrinol (Oxf) 2019; 91:237-244. [PMID: 31004515 DOI: 10.1111/cen.13994] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/07/2019] [Accepted: 04/15/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Discordance between gonadal type and gender identity has often led to an assumption of infertility in patients with differences in sex development (DSD). However, there is now greater recognition of fertility being an important issue for this group of patients. Currently, gonadal tissue that may have fertility potential is not being stored for individuals with DSD and, where gonadectomy forms part of management, is often discarded. The area of fertility preservation has been predominantly driven by oncofertility which is a field dedicated to preserving the fertility of patients undergoing gonadotoxic cancer treatment. The use of fertility preservation techniques could be expanded to include individuals with DSD where functioning gonads are present. METHODS This is a systematic literature review evaluating original research articles and relevant reviews between 1974 and 2018 addressing DSD and fertility, in vitro maturation of sperm, and histological/ultrastructural assessment of gonadal tissue in complete and partial androgen insensitivity syndrome, 17β-hydroxysteroid dehydrogenase type 3 and 5α-reductase deficiency. CONCLUSION Successful clinical outcomes of ovarian tissue cryopreservation are paving the way for similar research being conducted using testicular tissue and sperm. There have been promising results from both animal and human studies leading to cryopreservation of testicular tissue now being offered to boys prior to cancer treatment. Although data are limited, there is evidence to suggest the presence of reproductive potential in the gonads of some individuals with DSD. Larger, more detailed studies are required, but if these continue to be encouraging, individuals with DSD should be given the same information, opportunities and access to fertility preservation as other patient groups.
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Affiliation(s)
- Rumana Islam
- Department of Reproductive Medicine, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Sheila Lane
- Department of Paediatric Oncology and Haematology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Suzannah A Williams
- Nuffield Department of Women's and Reproductive Health, Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, Oxford Endometriosis CaRe Centre, Women's Centre, John Radcliffe Hospital University of Oxford, Oxford, UK
| | - Gerard S Conway
- Department of Endocrinology, University College London Hospitals, London, UK
| | - Sarah M Creighton
- Elizabeth Garrett Anderson UCL Institute of Women's Health, University College London Hospitals, London, UK
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11
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Giudice MG, Del Vento F, Wyns C. Male fertility preservation in DSD, XXY, pre-gonadotoxic treatments - Update, methods, ethical issues, current outcomes, future directions. Best Pract Res Clin Endocrinol Metab 2019; 33:101261. [PMID: 30718080 DOI: 10.1016/j.beem.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper aims at reviewing the fertility preservation strategies that could be considered in several conditions at risk of spermatogonial depletion such as 46,XY disorders of sexual development, Klinefelter syndrome and after gonadotoxic treatment in males highlighting current knowledge on diseases and processes involved in infertility as well as future directions along with their specific ethical issues. While sperm cryopreservation after puberty is the only validated technique for fertility preservation, for prepubertal boys facing gonadotoxic therapies or at risk of testicular tissue degeneration where testicular sperm is not present, cryopreservation of spermatogonial cells may be an option to ensure future parenthood. Promising results with transplantation and in vitro maturation of spermatogonial cells were achieved in animals but so far none of the techniques was applied in humans.
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Affiliation(s)
- Maria Grazia Giudice
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium
| | - Federico Del Vento
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium
| | - Christine Wyns
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium.
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12
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Bertelloni S, Baldinotti F, Baroncelli GI, Caligo MA, Peroni D. Paternity in 5α-Reductase-2 Deficiency: Report of Two Brothers with Spontaneous or Assisted Fertility and Literature Review. Sex Dev 2019; 13:55-59. [PMID: 30889611 DOI: 10.1159/000497400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/14/2022] Open
Abstract
Fertility remains a challenge for men with 5α-reductase-2 deficiency. Such a diagnosis was made in 2 adult brothers who are compound heterozygous for the 5α-reductase type 2 gene (SRD5A2; c.308G>C; c.689A>C). They were born with ambiguous genitalia and the male sex was assigned. Both brothers underwent reconstructive genital surgery during pediatric age and had spontaneous virilization at puberty. The older brother experienced natural conception, while the younger had a son by assisted reproductive technology. Other family members were demonstrated to be compound heterozygous or heterozygous for the same genetic variants. The older brother is the third man with 5α-reductase-2 deficiency and spontaneous paternity. The little series of men with 5α-reductase-2 deficiency and documented spontaneous or assisted paternity is reviewed. In conclusion, the possibility of fatherhood is a main indication for male sex assignment in patients with 5α-reductase-2 deficiency.
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13
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Mendonca BB, Batista RL, Domenice S, Costa EMF, Arnhold IJP, Russell DW, Wilson JD. Reprint of "Steroid 5α-reductase 2 deficiency". J Steroid Biochem Mol Biol 2017; 165:95-100. [PMID: 27842977 DOI: 10.1016/j.jsbmb.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 01/05/2023]
Abstract
Dihydrotestosterone is a potent androgen metabolite formed from testosterone by action of 5α-reductase isoenzymes. Mutations in the type 2 isoenzyme cause a disorder of 46,XY sex development, termed 5α-reductase type 2 deficiency and that was described forty years ago. Many mutations in the encoding gene have been reported in different ethnic groups. In affected 46,XY individuals, female external genitalia are common, but Mullerian ducts regress, and the internal urogenital tract is male. Most affected males are raised as females, but virilization occurs at puberty, and male social sex develops thereafter with high frequency. Fertility can be achieved in some affected males with assisted reproduction techniques, and adults with male social sex report a more satisfactory sex life and quality of life as compared to affected individuals with female social sex.
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Affiliation(s)
- Berenice B Mendonca
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil.
| | - Rafael Loch Batista
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Sorahia Domenice
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Elaine M F Costa
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Ivo J P Arnhold
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - David W Russell
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8857, USA
| | - Jean D Wilson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8857, USA
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Van Batavia JP, Kolon TF. Fertility in disorders of sex development: A review. J Pediatr Urol 2016; 12:418-425. [PMID: 27856173 DOI: 10.1016/j.jpurol.2016.09.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/24/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Disorders of sex development (DSD) are a heterogeneous group of complex conditions that can affect chromosomal, gonadal, and/or phenotypical sex. In addition to impacts on internal and external genitalia,these conditions can affect fertility potentialto various degrees. In this review we discuss fertility issues including gonadalpreservation and reproductive outcomes based on specific DSD conditions. METHODS AND MATERIALS A systematic literature review was performed on Embase™, PubMed®, and Google Scholar™ for disordersof sex development and infertility. Original research articles and relevant reviews were examinedand a synopsis of these data was generated for a comprehensive review of fertility potential in disorders of sex development. RESULTS While patients with some DSDs may have functioning gonads with viable germ cells but an inability to achieve natural fertility secondary to incongruent internal or external genitalia, other patients may have phenotypically normal genitalia but infertility due to abnormal gonad development. Fertility rates in females with congenital adrenal hyperplasia (CAH) depend on phenotype and are inversely proportionalto the severity of the disease. Men with classic CAH have reduced fertility and due to the presence of testicular adrenal rest tumors and to suppression of the hypothalamic-pituitary-gonadal axis by high systemic levels of androgens. Infertility is seen in complete androgen insensitivity and subfertility is common in partial cases. Fertility is rare in pure or mixed gonadal dysgenesis, ovotesticular disorder, Klinefelter syndrome, and XX males. CONCLUSION Fertility potential appears to be the highest in patientswith XX or XY CAH, especially non-classic forms. Advancements in assisted reproduction techniques has in rare cases produced offspring in some diagnoses thought to be universally infertile. Discussion of fertility issues with the patient and family is essential to the optimal treatment of each patient and an important part of the multi-disciplinary approach to evaluating and counseling these families.
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Affiliation(s)
- J P Van Batavia
- Department of Urology (Surgery), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - T F Kolon
- Department of Urology (Surgery), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Mendonca BB, Batista RL, Domenice S, Costa EMF, Arnhold IJP, Russell DW, Wilson JD. Steroid 5α-reductase 2 deficiency. J Steroid Biochem Mol Biol 2016; 163:206-11. [PMID: 27224879 DOI: 10.1016/j.jsbmb.2016.05.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 01/03/2023]
Abstract
Dihydrotestosterone is a potent androgen metabolite formed from testosterone by action of 5α-reductase isoenzymes. Mutations in the type 2 isoenzyme cause a disorder of 46,XY sex development, termed 5α-reductase type 2 deficiency and that was described forty years ago. Many mutations in the encoding gene have been reported in different ethnic groups. In affected 46,XY individuals, female external genitalia are common, but Mullerian ducts regress, and the internal urogenital tract is male. Most affected males are raised as females, but virilization occurs at puberty, and male social sex develops thereafter with high frequency. Fertility can be achieved in some affected males with assisted reproduction techniques, and adults with male social sex report a more satisfactory sex life and quality of life as compared to affected individuals with female social sex.
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MESH Headings
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/deficiency
- 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics
- Adult
- Dihydrotestosterone/metabolism
- Disorder of Sex Development, 46,XY/enzymology
- Disorder of Sex Development, 46,XY/genetics
- Disorder of Sex Development, 46,XY/pathology
- Disorder of Sex Development, 46,XY/psychology
- Female
- Gender Identity
- Gene Expression
- Genitalia, Female/abnormalities
- Genitalia, Female/enzymology
- Genitalia, Female/growth & development
- Genitalia, Male/abnormalities
- Genitalia, Male/enzymology
- Genitalia, Male/growth & development
- Humans
- Male
- Membrane Proteins/deficiency
- Membrane Proteins/genetics
- Phenotype
- Quality of Life
- Sex Differentiation
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Affiliation(s)
- Berenice B Mendonca
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil.
| | - Rafael Loch Batista
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Sorahia Domenice
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Elaine M F Costa
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - Ivo J P Arnhold
- Developmental Endocrinology Unit, Hormone and Molecular Genetics Laboratory (LIM/42), Endocrinology Division, Internal Medicine Department, Medical School, University of São Paulo, Brazil
| | - David W Russell
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8857, USA
| | - Jean D Wilson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8857, USA
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Higuchi T, Holmdahl G, Kaefer M, Koyle M, Wood H, Woodhouse C, Wood D. International Consultation on Urological Diseases: Congenital Anomalies of the Genitalia in Adolescence. Urology 2016; 94:288-310. [DOI: 10.1016/j.urology.2016.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Trost LW, Mulhall JP. Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials. J Sex Med 2016; 13:1029-46. [PMID: 27209182 PMCID: PMC5516925 DOI: 10.1016/j.jsxm.2016.04.068] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Male hypogonadism is a common condition, with an increasing body of literature on diagnosis, implications, and management. Given the significant variability in testosterone (T) from a physiologic and assay perspective, a thorough understanding of factors affecting T values and study methodology is essential to interpret reported study outcomes appropriately. However, despite the large number of publications on T, there are no reference materials consolidating all relevant and potentially confounding factors necessary to interpret T studies appropriately. AIMS To create a resource document that reviews sources of T variability, free vs total T, assay techniques and questionnaires, and study methodology relevant to interpreting outcomes. METHODS A PubMed search was performed of all the T literature published on T variability, assay techniques, and T-specific questionnaires. Results were summarized in the context of their impact on interpreting T literature outcomes and methodology. MAIN OUTCOME MEASURES Effect of various factors on T variability and their relevance to study methodology and outcomes. RESULTS Several factors affect measured T levels, including aging, circadian rhythms, geography, genetics, lifestyle choices, comorbid conditions, and intraindividual daily variability. The utility of free T over total T is debatable and must be compared using appropriate threshold levels. Among various assay techniques, mass spectrometry and equilibrium dialysis are gold standards. Calculated empirical estimates of free T also are commonly used and accepted. Hypogonadism-specific questionnaires have limited utility in screening for hypogonadism, and their role as objective end points for quantifying symptoms remains unclear. Numerous aspects of study methodology can directly or indirectly affect reported outcomes, including design (randomized, prospective, retrospective), duration, populations studied (age, comorbid conditions), low T threshold, therapeutic agent used, objective measurements and end points selected, and statistical interpretation. CONCLUSION Critical appraisal of the T literature requires an understanding of numerous factors resulting in T variability, study design and methodology, and limitations of assay techniques and objective measurement scales.
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Affiliation(s)
- Landon W Trost
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - John P Mulhall
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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18
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Bertelloni S, Baldinotti F, Russo G, Ghirri P, Dati E, Michelucci A, Moscuzza F, Meroni S, Colombo I, Sessa MR, Baroncelli GI. 5α-Reductase-2 Deficiency: Clinical Findings, Endocrine Pitfalls, and Genetic Features in a Large Italian Cohort. Sex Dev 2016; 10:28-36. [PMID: 27070133 DOI: 10.1159/000445090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/19/2022] Open
Abstract
Clinical records (n = 24) with an established diagnosis of 5α-reductase-2 deficiency were reviewed. A previous misdiagnosis was present in about 70% (period from first observation to definitive diagnosis: 9.1 ± 10.8 years), and in 8 children gonadal removal was performed before certain diagnosis. Initial sex assignment was female in 16/24 (67%) and male in 8/24 (33%) cases. After diagnosis, sex re-assignment was performed in 5 babies (4 girls to male sex; 1 boy to female sex). Baseline testosterone/DHT ratio was diagnostic in 6/12 subjects (first months of life n = 4; puberty n = 2), while post-hCG testosterone/DHT ratio was diagnostic in all tested individuals (choosing both the cut-off value 15 or 10). Eighteen different mutations in the steroid-5α-reductase-2 (SRD5A2) gene were identified, 5 of which have never been reported. In conclusion, a time lag exists before the diagnosis of 5α-reductase-2 deficiency is established; sex assignment and gonadal removal may be performed before certain diagnosis. Sex re-assignment is usually female to male, but the contrary may occur. A large variability in clinical phenotypes and genetic mutations was present in this cohort. Accurate endocrine evaluation is recommended in babies possibly affected by 5α-reductase-2 deficiency, since the use of appropriate cut-off values of testosterone/DHT ratio after hCG stimulation may permit to select individuals for SRD5A2 gene analysis. A genotype-phenotype correlation was not found in this study.
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Affiliation(s)
- Silvano Bertelloni
- Adolescent Medicine, Pediatric Division, Azienda Ospedaliero-Universitaria Pisana (AOUP), Pisa, Italy
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Guercio G, Costanzo M, Grinspon RP, Rey RA. Fertility Issues in Disorders of Sex Development. Endocrinol Metab Clin North Am 2015; 44:867-81. [PMID: 26568498 DOI: 10.1016/j.ecl.2015.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fertility potential should be considered by the multidisciplinary team when addressing gender assignment, surgical management, and patient and family counselling of individuals with disorders of sex development. In 46,XY individuals, defects of gonadal differentiation or androgen or anti-Müllerian hormone synthesis or action result in incomplete or absent masculinization. In severe forms, raised as females, motherhood is possible with oocyte donation if Müllerian ducts have developed. In milder forms, raised as males, azoospermia or oligospermia are frequently found, however paternity has been reported. Most 46,XX patients with normal ovarian organogenesis are raised as females, and fertility might be possible after treatment.
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Affiliation(s)
- Gabriela Guercio
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, Buenos Aires C1245AAM, Argentina
| | - Mariana Costanzo
- Servicio de Endocrinología, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, Buenos Aires C1245AAM, Argentina
| | - Romina P Grinspon
- CONICET - FEI - División de Endocrinología, Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina
| | - Rodolfo A Rey
- CONICET - FEI - División de Endocrinología, Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Hospital de Niños Ricardo Gutiérrez, Gallo 1330, Buenos Aires C1425EFD, Argentina; Departamento de Histología, Biología Celular, Embriología y Genética, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Buenos Aires C1121ABG, Argentina.
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20
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Trost L, Saitz TR, Hellstrom WJG. Side Effects of 5-Alpha Reductase Inhibitors: A Comprehensive Review. Sex Med Rev 2015; 1:24-41. [PMID: 27784557 DOI: 10.1002/smrj.3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION 5α-reductase inhibitors (5ARI) include finasteride and dutasteride, and are commonly prescribed in the treatment of benign prostatic hyperplasia and androgenic alopecia. 5ARIs are associated with several known adverse effects (AEs), with varying reported prevalence rates. AIM The aim was to review and summarize findings from published literature detailing AEs associated with 5ARI use. A secondary aim was to review potential mechanisms of action, which may account for these observed and reported AEs. METHODS A PubMed search was conducted on articles published from 1992 to 2012, which reported AEs with 5ARIs. Priority was given to randomized, placebo-controlled trials. Studies investigating potential mechanisms of action for 5ARIs were included for review. MAIN OUTCOME MEASURES AE data reported from available trials were summarized and reviewed. RESULTS Reported AEs with 5ARIs include sexual dysfunction, infertility, mood disorders, gynecomastia, high-grade prostate cancer, breast cancer, and cardiovascular morbidity/risk factors, although their true association, prevalence, causality, and clinical significance remain unclear. A pooled summary of all randomized, placebo-controlled trials evaluating 5ARIs (N = 62,827) revealed slightly increased rates over placebo for decreased libido (1.5%), erectile dysfunction (ED) (1.6%), ejaculatory dysfunction (EjD) (3.4%), and gynecomastia (1.3%). The limited data available on the impact of 5ARIs on mood disorders demonstrate statistically significant (although clinically minimal) differences in rates of depression and/or anxiety. Similarly, there are limited reports of reversible, diminished fertility among susceptible individuals. Post-marketing surveillance reports have questioned the actual prevalence of AEs associated with 5ARI use and suggest the possibility of persistent symptoms after drug discontinuation. Well-designed studies evaluating these reports are needed. CONCLUSIONS 5ARIs are associated with slightly increased rates of decreased libido, ED, EjD, gynecomastia, depression, and/or anxiety. Further studies directed at identifying prevalence rates and persistence of symptoms beyond drug discontinuation are required to assess causality. Trost L, Saitz TR, and Hellstrom WJG. Side effects of 5-alpha reductase inhibitors: A comprehensive review. Sex Med Rev 2013;1:24-41.
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Affiliation(s)
| | - Theodore R Saitz
- Department of Urology, Section of Andrology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Section of Andrology, Tulane University School of Medicine, New Orleans, LA, USA.
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21
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Traish AM, Melcangi RC, Bortolato M, Garcia-Segura LM, Zitzmann M. Adverse effects of 5α-reductase inhibitors: What do we know, don't know, and need to know? Rev Endocr Metab Disord 2015; 16:177-98. [PMID: 26296373 DOI: 10.1007/s11154-015-9319-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Steroids are important physiological orchestrators of endocrine as well as peripheral and central nervous system functions. One of the key processes for regulation of these molecules lies in their enzymatic processing by a family of 5α-reductase (5α-Rs) isozymes. By catalyzing a key rate-limiting step in steroidogenesis, this family of enzymes exerts a crucial role not only in the physiological control but also in pathological events. Indeed, both 5α-R inhibition and supplementation of 5α-reduced metabolites are currently used or have been proposed as therapeutic strategies for a wide array of pathological conditions. In particular, the potent 5α-R inhibitors finasteride and dutasteride are used in the treatments of benign prostatic hyperplasia (BPH), as well as in male pattern hair loss (MPHL) known as androgenetic alopecia (AGA). Recent preclinical and clinical findings indicate that 5α-R inhibitors evoke not only beneficial, but also adverse effects. Future studies should investigate the biochemical and physiological mechanisms that underlie the persistence of the adverse sexual side effects to determine why a subset of patients is afflicted with such persistence or irreversible adverse effects. Also a better focus of clinical research is urgently needed to better define those subjects who are likely to be adversely affected by such agents. Furthermore, research on the non-sexual adverse effects such as diabetes, psychosis, depression, and cognitive function are needed to better understand the broad spectrum of the effects these drugs may elicit during their use in treatment of AGA or BPH. In this review, we will summarize the state of art on this topic, overview the key unresolved questions that have emerged on the pharmacological targeting of these enzymes and their products, and highlight the need for further studies to ascertain the severity and duration of the adverse effects of 5α-R inhibitors, as well as their biological underpinnings.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Biochemistry and Department of Urology, Boston University School of Medicine, 715 Albany Street, A502, Boston, MA, 02118, USA.
| | - Roberto Cosimo Melcangi
- Department of Pharmacological and Biomolecular Sciences- Center of Excellence on Neurodegenerative Diseases, Iniversità degli Studi di Milano, Milan, Italy
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, University of Kansas, Lawrence, KS, USA
| | | | - Michael Zitzmann
- Centre for Reproductive Medicine and Andrology, University Clinics Muenster, Domagkstrasse 11, D-48149, Muenster, Germany
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22
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Vija L, Ferlicot S, Paun D, Bry-Gauillard H, Berdan G, Abd-Alsamad I, Lombès M, Young J. Testicular histological and immunohistochemical aspects in a post-pubertal patient with 5 alpha-reductase type 2 deficiency: case report and review of the literature in a perspective of evaluation of potential fertility of these patients. BMC Endocr Disord 2014; 14:43. [PMID: 24885102 PMCID: PMC4041634 DOI: 10.1186/1472-6823-14-43] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/06/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Testicular morphology and immunohistochemical studies have never been reported in genetically documented adult patients with 5 alpha-reductase type 2 deficiency (5α-R2 deficiency). CASE PRESENTATION We describe the testicular histopathology of a 17-year-old XY subject with 5α-R2 deficiency caused by the recurrent homozygous Gly115Asp loss of function mutation of the SRD5A2 gene.We also performed an immunohistochemical analysis in order to further study the relationship between seminiferous tubules structure, Sertoli cell differentiation and androgenic signaling impairment in this case. We thus evaluated the testicular expression of the anti-Müllerian hormone (AMH), androgen receptor (AR) and 3β-hydroxysteroid dehydrogenase (3βHSD). Histological analysis revealed a heterogeneous aspect with a majority (92%) of seminiferous tubules (ST) presenting a mature aspect but containing only Sertoli cells and devoid of germ cells and spermatogenesis. Focal areas of immature ST (8%) were also found. Testicular AR and 3βHSD expression were detected in adult male control, 5α-R2 deficiency and CAIS subjects. However, AMH expression was heterogeneous (detectable only in few AR negative prepubertal ST, but otherwise repressed) in the 5α-R2 deficiency, conversely to normal adult testis in which AMH was uniformly repressed and to an adult CAIS testis in which AMH was uniformly and strongly expressed. CONCLUSION Intratesticular testosterone can repress AMH by itself, independently of its metabolism into dihydrotestosterone. We also compare our results to the few post pubertal cases of 5α-R2 deficiency with available histological testicular description, reported in the literature. We will discuss these histological findings, in the more general context of evaluating the fertility potential of these patients if they were raised as males and were azoospermic.
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Affiliation(s)
- Lavinia Vija
- Faculté de Médecine Paris-Sud, Univ Paris-Sud, UMR-S693, Le Kremlin-Bicêtre F-94276, France
- Inserm, U693, Le Kremlin-Bicêtre F-94276, France
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Service de Biophysique et Médecine Nucleaire, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin-Bicêtre F-94275, France
| | - Sophie Ferlicot
- Univ Paris-Sud, Assistance Publique-Hôpitaux de Paris, Service d’Anatomo-Pathologie, Hôpital Bicêtre, Le Kremlin-Bicêtre F-94276, France
| | - Diana Paun
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Hélène Bry-Gauillard
- Service d’Endocrinologie et maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94275, France
| | - Gabriela Berdan
- Department of Pathology,” Burghele” Hospital, Bucharest, Romania
| | - Issam Abd-Alsamad
- Service d’Anatomo-Pathologie, Centre Hospitalier Intercommunal de Creteil, Creteil F-94276, France
| | - Marc Lombès
- Faculté de Médecine Paris-Sud, Univ Paris-Sud, UMR-S693, Le Kremlin-Bicêtre F-94276, France
- Inserm, U693, Le Kremlin-Bicêtre F-94276, France
- Service d’Endocrinologie et maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94275, France
| | - Jacques Young
- Faculté de Médecine Paris-Sud, Univ Paris-Sud, UMR-S693, Le Kremlin-Bicêtre F-94276, France
- Inserm, U693, Le Kremlin-Bicêtre F-94276, France
- Service d’Endocrinologie et maladies de la Reproduction, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, 78, rue du Général Leclerc, Le Kremlin-Bicêtre F-94275, France
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Kang HJ, Imperato-McGinley J, Zhu YS, Rosenwaks Z. The effect of 5α-reductase-2 deficiency on human fertility. Fertil Steril 2014; 101:310-6. [PMID: 24412121 PMCID: PMC4031759 DOI: 10.1016/j.fertnstert.2013.11.128] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 11/27/2022]
Abstract
A most interesting and intriguing male disorder of sexual differentiation is due to 5α-reductase-2 isoenzyme deficiency. These male infants are born with ambiguous external genitalia due to a deficiency in their ability to catalyze the conversion of T to dihydrotestosterone. Dihydrotestosterone is a potent androgen responsible for differentiation of the urogenital sinus and genital tubercle into the external genitalia, urethra, and prostate. Affected males are born with a clitoral-like phallus, bifid scrotum, hypospadias, blind shallow vaginal pouch from incomplete closure of the urogenital sinus, and a rudimentary prostate. At puberty, the surge in mainly T production prompts virilization, causing most boys to choose gender reassignment to male. Fertility is a challenge for affected men for several reasons. Uncorrected cryptorchidism is associated with low sperm production, and there is evidence of defective transformation of spermatogonia into spermatocytes. The underdeveloped prostate and consequent low semen volumes affect sperm transport. In addition, semen may not liquefy due to a lack of prostate-specific antigen. In the present review, we discuss the 5α-reductase-2 deficiency syndrome and its impact on human fertility.
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Affiliation(s)
- Hey-Joo Kang
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
| | | | - Yuan-Shan Zhu
- Division of Endocrinology, Diabetes & Metabolism, Weill Cornell Medical Center, New York, New York
| | - Zev Rosenwaks
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York.
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Abstract
OBJECTIVE 5α-reductases are a family of isozymes expressed in a wide host of tissues including the central nervous system (CNS) and play a pivotal role in male sexual differentiation, development and physiology. METHODS A comprehensive literature search from 1970 to 2011 was made through PubMed and the relevant information was summarized. RESULTS 5α reductases convert testosterone, progesterone, deoxycorticosterone, aldosterone and corticosterone into their respective 5α-dihydro-derivatives, which serve as substrates for 3α-hydroxysteroid dehydrogenase enzymes. The latter transforms these 5α-reduced metabolites into a subclass of neuroactive steroid hormones with distinct physiological functions. The neuroactive steroid hormones modulate a multitude of functions in human physiology encompassing regulation of sexual differentiation, neuroprotection, memory enhancement, anxiety, sleep and stress, among others. In addition, 5α -reductase type 3 is also implicated in the N-glycosylation of proteins via formation of dolichol phosphate. The family of 5α-reductases was targeted for drug development to treat pathophysiological conditions, such as benign prostatic hyperplasia and androgenetic alopecia. While the clinical use of 5α-reductase inhibitors was well established, the scope and the magnitude of the adverse side effects of such drugs, especially on the CNS, is still unrecognized due to lack of knowledge of the various physiological functions of this family of enzymes, especially in the CNS. CONCLUSION There is an urgent need to better understand the function of 5α-reductases and the role of neuroactive steroids in human physiology in order to minimize the potential adverse side effects of inhibitors targeting 5α-reductases to treat benign prostatic hyperplasia and androgenic alopecia.
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Affiliation(s)
- Abdulmaged M Traish
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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25
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Palmer BW, Wisniewski AB, Schaeffer TL, Mallappa A, Tryggestad JB, Krishnan S, Chalmers LJ, Copeland K, Chernausek SD, Reiner WG, Kropp BP. A model of delivering multi-disciplinary care to people with 46 XY DSD. J Pediatr Urol 2012; 8:7-16. [PMID: 22078657 DOI: 10.1016/j.jpurol.2011.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 08/31/2011] [Indexed: 11/17/2022]
Abstract
In 2006, a consensus statement was jointly produced by the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society of Paediatric Endocrinology (ESPE) concerning the management of disorders of sex development (DSD) [1]. A recommendation provided by this consensus was that evaluation and long-term care for people affected by DSD should be performed at medical centers with multi-disciplinary teams experienced in such conditions. Here we provide our team's interpretation of the 2006 consensus statement recommendations and its translation into a clinical protocol for individuals affected by 46 XY DSD with either female, or ambiguous, genitalia at birth. Options for medical and surgical management, transitioning of care, and the use of mental health services and peer support groups are discussed. Finally, we provide preliminary data to support the application of our model for delivering multi-disciplinary care and support to patients and their families.
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Affiliation(s)
- Blake W Palmer
- Pediatric Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Analyse d’articles. Basic Clin Androl 2011. [DOI: 10.1007/s12610-011-0138-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kang HJ, Imperato-McGinley J, Zhu YS, Cai LQ, Schlegel P, Palermo G, Rosenwaks Z. The first successful paternity through in vitro fertilization-intracytoplasmic sperm injection with a man homozygous for the 5α-reductase-2 gene mutation. Fertil Steril 2011; 95:2125.e5-8. [PMID: 21334614 DOI: 10.1016/j.fertnstert.2011.01.121] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 01/03/2011] [Accepted: 01/15/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report a case of successful paternity from a male homozygous for 5α-reductase-2 deficiency. DESIGN Case report. SETTING Academic center, division of reproductive endocrinology. PATIENT(S) A 45-year-old Dominican man and his 32-year-old wife. INTERVENTION(S) In vitro fertilization and intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Pregnancy. RESULT(S) Viable twin gestation. CONCLUSION(S) Men homozygous for 5α-reductase-2 deficiency can achieve biologic paternity through in vitro fertilization with intracytoplasmic sperm injection despite severely abnormal semen parameters.
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Affiliation(s)
- Hey-Joo Kang
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Department of Medicine/Endocrinology, Weill Medical College of Cornell University, New York, New York 10021, USA
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Finasteride-associated male infertility. Fertil Steril 2010; 95:1786.e9-11. [PMID: 21193189 DOI: 10.1016/j.fertnstert.2010.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/01/2010] [Accepted: 12/01/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe a male patient with finasteride-associated infertility. DESIGN Case report. SETTING Tertiary-care clinic for male infertility. PATIENT(S) A patient with azoospermia who had been taking finasteride (1-mg dose) for 1 year for androgenic alopecia. He had been diagnosed with oligospermia 5 years before. INTERVENTION(S) Discontinuation of finasteride. MAIN OUTCOME MEASURE(S) Improvement of semen parameters. RESULT(S) After cessation of finasteride, the patient's semen volume increased immediately, and sperm concentration was up to more than 10 × 10(6)/mL 16 weeks after stopping finasteride. He is now trying to achieve pregnancy by intrauterine insemination. CONCLUSION(S) Cessation of finasteride improved spermatogenesis and allowed the couple to attempt less-invasive fertility therapy. In this case, the patient had impaired spermatogenesis before he started the drug. In such patients, the drug may further decrease spermatogenesis. We suggest that drug cessation could be taken into consideration for infertile male patients with impaired semen parameters who are taking finasteride at a 1-mg dose.
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Matsubara K, Iwamoto H, Yoshida A, Ogata T. Semen analysis and successful paternity by intracytoplasmic sperm injection in a man with steroid 5α-reductase-2 deficiency. Fertil Steril 2010; 94:2770.e7-10. [PMID: 20493473 DOI: 10.1016/j.fertnstert.2010.04.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/02/2010] [Accepted: 04/07/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report semen parameters and successful paternity by intracytoplasmic sperm injection (ICSI) in a male patient with molecularly confirmed steroid 5α-reductase-2 deficiency. DESIGN Case report. SETTING National research institute and an infertility clinic. PATIENT(S) A 29-year-old Japanese man with 5α-reductase-2 deficiency who had failed to have a child despite an ordinary conjugal life for 2 years with his wife. INTERVENTION(S) Mutation analysis, semen analysis, and execution of ICSI. MAIN OUTCOME MEASURE(S) Mutation detection, semen assessment, and production of a child. RESULT(S) Mutation analysis revealed a homozygous p.R246Q missense mutation on exon 5 of SRD5A2. Semem analysis showed oligozoospermia (semen volume 0.3 mL, sperm count 15 × 10(6)/mL, total sperm count 4.5 × 10(6), motile cells 17%, and normal morphologic sperm 8%). ICSI resulted in a production of a healthy male infant. CONCLUSION(S) The results, in conjunction with those of previously reported patients who received semen analysis and/or achieved paternity, suggest that male patients with 5α-reductase-2 deficiency, especially those with hypomorphic mutations including p.R246Q, could retain some degree of spermatogenic function and achieve paternity with and without assisted reproductive technology.
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Affiliation(s)
- Keiko Matsubara
- Department of Endocrinology and Metabolism, National Research Institute for Child Health and Development, Tokyo, Japan
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46,XY DSD with Female or Ambiguous External Genitalia at Birth due to Androgen Insensitivity Syndrome, 5alpha-Reductase-2 Deficiency, or 17beta-Hydroxysteroid Dehydrogenase Deficiency: A Review of Quality of Life Outcomes. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2009; 2009:567430. [PMID: 19956704 PMCID: PMC2777017 DOI: 10.1155/2009/567430] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 07/29/2009] [Indexed: 11/17/2022]
Abstract
Disorders of sex development refer to a collection of congenital conditions in which atypical development of chromosomal, gonadal, or anatomic sex occurs. Studies of 46,XY DSD have focused largely on gender identity, gender role, and sexual orientation. Few studies have focused on other domains, such as physical and mental health, that may contribute to a person's quality of life. The current review focuses on information published since 1955 pertaining to psychological well-being, cognition, general health, fertility, and sexual function in people affected by androgen insensitivity syndromes, 5-α reductase-2 deficiency, or 17β-hydroxysteroid dehydrogenase-3 deficiency—reared male or female. The complete form of androgen insensitivity syndrome has been the focus of the largest number of investigations in domains other than gender. Despite this, all of the conditions included in the current review are under-studied. Realms identified for further study include psychological well-being, cognitive abilities, general health, fertility, and sexual function. Such investigations would not only improve the quality of life for those affected by DSD but may also provide information for improving physical and mental health in the general population.
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Abstract
The term disorders of sex development (DSD) includes congenital conditions in which development of chromosomal, gonadal or anatomical sex is atypical. Mutations in genes present in X, Y or autosomal chromosomes can cause abnormalities of testis determination or disorders of sex differentiation leading to 46,XY DSD. Detailed clinical phenotypes allow the identification of new factors that can alter the expression or function of mutated proteins helping to understand new undisclosed biochemical pathways. In this review we present an update on 46,XY DSD aetiology, diagnosis and treatment based on extensive review of the literature and our three decades of experience with these patients.
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MESH Headings
- Chromosomes, Human, X/genetics
- Chromosomes, Human, Y/genetics
- Disorders of Sex Development/diagnosis
- Disorders of Sex Development/genetics
- Disorders of Sex Development/therapy
- Female
- Gonadal Dysgenesis, 46,XY/diagnosis
- Gonadal Dysgenesis, 46,XY/genetics
- Gonadal Dysgenesis, 46,XY/therapy
- Humans
- Male
- Mutation/genetics
- Testis/abnormalities
- Testosterone/metabolism
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Affiliation(s)
- Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular, LIM 42, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.
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Wisniewski A, Mazur T. 46,XY DSD with Female or Ambiguous External Genitalia at Birth due to Androgen Insensitivity Syndrome, 5-Reductase-2 Deficiency, or 17-Hydroxysteroid Dehydrogenase Deficiency: A Review of Quality of Life Outcomes. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2009. [DOI: 10.1186/1687-9856-2009-567430] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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LIU K, BINSALEH S, LO K, JARVI K. Propecia-induced spermatogenic failure: a report of two cases. Fertil Steril 2008; 90:849.e17-9. [DOI: 10.1016/j.fertnstert.2007.08.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 08/08/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
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Hadziselimovic F, Dessouky N. Differences in testicular development between 5alpha-reductase 2 deficiency and isolated bilateral cryptorchidism. J Urol 2008; 180:1116-20. [PMID: 18639287 DOI: 10.1016/j.juro.2008.05.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We demonstrated that infertility develops in most patients with steroid 5alpha-reductase 2 deficiency. MATERIALS AND METHODS We compared the testicular histopathology of boys with steroid 5alpha-reductase 2 deficiency to that of boys with isolated bilateral cryptorchidism. RESULTS Testes with steroid 5alpha-reductase 2 deficiency lacked spermatocytes but had Ad spermatogonia and a normal germ cell count. In contrast, bilateral cryptorchid testes had severe germ cell depletion and the majority lacked Ad spermatogonia. CONCLUSIONS In patients with steroid 5alpha-reductase 2 deficiency the impaired second step of germ cell maturation results in defective transformation of spermatogonia into spermatocytes. The position of the undescended testis appears to have no major pathological impact on the development of germ cells in patients with steroid 5alpha-reductase 2 deficiency.
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Elzanaty S, Giwercman YL, Giwercman A. Significant impact of 5alpha-reductase type 2 polymorphisms on sperm concentration and motility. INTERNATIONAL JOURNAL OF ANDROLOGY 2006; 29:414-20. [PMID: 16487406 DOI: 10.1111/j.1365-2605.2005.00625.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Androgens, including 5alpha-dihydrotestosterone (DHT), are known to play a role for spermatogenesis and accessory sex gland function. The enzyme 5alpha-reductase (SRD5A) catalyses the conversion of testosterone to DHT. Our objective was to investigate whether polymorphisms in the SRD5A2 gene influence semen parameters in the general population. DNA from 182 Swedish military conscripts was examined for the A49T, V89L, and R227Q polymorphisms in the SRD5A type 2 gene. Ejaculates were analysed according to WHO guidelines. In addition, sperm motility was assessed using computer-aided sperm analysis (CASA). Seminal markers of epididymal (neutral alpha-glucosidase), prostatic (prostate specific-antigen and zinc), and seminal vesicles function (fructose) were measured. The A49TT-allele was associated with significantly higher sperm concentration compared with the wild type A-allele (mean: 102 x 10(6)/mL vs. 57 x 10(6)/mL, p = 0.02). The V89LV-genotype was correlated with significantly higher proportion progressive motile spermatozoa compared with the L-variant (mean: 55% vs. 48%, p = 0.04). The same trend was found regarding the CASA motile spermatozoa (mean: 52% vs. 41%, p = 0.02). No association between any of the polymorphisms and biochemical markers was found. SRD5A2 gene variants were associated with sperm concentration and motility, but not with epididymal and accessory sex gland markers. This effect on sperm parameters might therefore be exerted via a direct effect of DHT on spermatogenesis.
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Affiliation(s)
- S Elzanaty
- Scanian Andrology Centre, Fertility Centre, Malmö University Hospital, Lund University, Malmö, Sweden.
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37
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Potential determinant factors of sexual identity in ambiguous genitalia. J Pediatr Urol 2005; 1:383-8. [PMID: 18947576 DOI: 10.1016/j.jpurol.2005.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/06/2005] [Indexed: 01/13/2023]
Abstract
This is a review of literature scanning the potential factors which may affect Sexual Identity (S.I.) and Gender Identity (G.I.) in patients with ambiguous genitalia. Definitions of these concepts are outlined. Genetic, gonadal, hormonal, social and cultural pressures are reviewed as well as lessons to learn from clinical experiences and outcomes. Current criteriae used to assign gender in a child with ambiguous genitalia are discussed including medical and surgical criteriae as well as cultural disruptors. At the dawn of the third millennium, it is remarkable how little we know about the establishment of our individual and social identities.
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Nicoletti A, Baldazzi L, Balsamo A, Barp L, Pirazzoli P, Gennari M, Radetti G, Cacciari E, Cicognani A. SRD5A2 gene analysis in an Italian population of under-masculinized 46,XY subjects. Clin Endocrinol (Oxf) 2005; 63:375-80. [PMID: 16181229 DOI: 10.1111/j.1365-2265.2005.02348.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The differential diagnosis of male under-masculinization, including a wide spectrum of phenotypes and a heterogeneous genetic basis, is crucial for the correct management of the patients. To characterize an Italian population of under-masculinized males, we performed the molecular analysis of the SRD5A2 gene (2p23), encoding the 5alpha-reductase-2 enzyme that converts testosterone (T) to dihydrotestosterone (DHT), and is required for full masculinization of the male foetus. DESIGN AND PATIENTS Twenty-six Italian patients with 46,XY kariotype and various degrees of ambiguous genitalia were retrospectively selected for this study. Twelve of these patients, 10 of whom were referred for partial androgen insensitivity syndrome (PAIS), were raised as females; 15 were raised as males and all had a severe hypospadias. For most of the patients, the case histories and hormonal findings were incomplete but all could be included in the clinical characteristics of under-masculinization. MEASUREMENT For hormonal evaluation, T and DHT were measured by means of radioimmunoassay (RIA) and high-performance liquid chromatography (HPLC)-RIA methods, respectively. Genomic DNA of all patients and relatives was extracted from peripheral blood, the five exons of the SRD5A2 gene were amplified by polymerase chain reaction (PCR) and submitted to automatic sequencing. RESULTS Five known mutations affecting the NADPH binding function and one new mutation affecting the enzyme C-terminus were identified in a total of eight patients (two of whom were sisters). Five families were characterized, and in two patients only one affected allele was observed. The extension of the analysis to the regions flanking exons allowed the identification of a new polymorphism in intron 2, whose frequency was determined. CONCLUSION This first report of an Italian population underlines the importance of differential diagnoses in patients with under-masculinization. The lack of precise genotype-phenotype correlation in some of the mutations highlights the necessity to improve knowledge about the biochemical aspects of steroid 5alpha-reductase action and about the interactions of genetic and environmental factors.
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Affiliation(s)
- Yuan-Shan Zhu
- Associate Professor of Medicine, Department of Medicine/Endocrinology, Weill Medical College of Cornell University, 1300 York Avenue, Box 149, New York, New York 10021
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Abstract
The following syndromes of XY intersexuality are reviewed: 5alpha-reductase-2 deficiency, 17beta-hydroxysteroid dehydrogenase-3 deficiency, and complete and partial androgen insensitivity with attention focused on issues of gender identity. Each syndrome, with its unique presentation, provides an opportunity to explore the relative effects of nature (androgens) versus nurture (sex of rearing) in gender identity development. The phenomenon of gender role reversal in these conditions is described and theories on the determinants of gender identity formation are proposed. Issues of importance to psychiatrists in treating patients who have these conditions also are discussed.
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Affiliation(s)
- Vivian Sobel
- Department of Medicine/Endocrinology, Weill Medical College of Cornell University, 1300 York Avenue, New York, NY 10021, USA
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Fernández-Cancio M, Nistal M, Gracia R, Molina MA, Tovar JA, Esteban C, Carrascosa A, Audí L. Compound heterozygous mutations in the SRD5A2 gene exon 4 in a male pseudohermaphrodite patient of Chinese origin. JOURNAL OF ANDROLOGY 2004; 25:412-6. [PMID: 15064320 DOI: 10.1002/j.1939-4640.2004.tb02808.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The goal of this study was to perform 5-alpha-reductase type 2 gene (SRD5A2) analysis in a male pseudohermaphrodite (MPH) patient with normal testosterone (T) production and normal androgen receptor (AR) gene coding sequences. A patient of Chinese origin with ambiguous genitalia at 14 months, a 46,XY karyotype, and normal T secretion under human chorionic gonadotropin (hCG) stimulation underwent a gonadectomy at 20 months. Exons 1-8 of the AR gene and exons 1-5 of the SRD5A2 gene were sequenced from peripheral blood DNA. AR gene coding sequences were normal. SRD5A2 gene analysis revealed 2 consecutive mutations in exon 4, each located in a different allele: 1) a T nucleotide deletion, which predicts a frameshift mutation from codon 219, and 2) a missense mutation at codon 227, where the substitution of guanine (CGA) by adenine (CAA) predicts a glutamine replacement of arginine (R227Q). Testes located in the inguinal canal showed a normal morphology for age. The patient was a compound heterozygote for SRD5A2 mutations, carrying 2 mutations in exon 4. The patient showed an R227Q mutation that has been described in an Asian population and MPH patients, along with a novel frameshift mutation, Tdel219. Testis morphology showed that, during early infancy, the 5-alpha-reductase enzyme deficiency may not have affected interstitial or tubular development.
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Affiliation(s)
- Mónica Fernández-Cancio
- Unidad Investigación Endocrinología y Nutrición Pediátricas, Hospital Vall d'Hebron, Barcelona, Spain
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Affiliation(s)
- S M Creighton
- Middlesex Clinic, Elizabeth Garrett Anderson and Obstetric Hospital, University College London Hospitals, London, UK.
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Imperato-McGinley J. 5alpha-reductase-2 deficiency and complete androgen insensitivity: lessons from nature. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 511:121-31; discussion 131-4. [PMID: 12575759 DOI: 10.1007/978-1-4615-0621-8_8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Dihydrotestosterone (DHT), a potent androgen, is converted from testosterone by 5alpha-reductase isozymes. There are two 5alpha-reductase isozymes, type 1 and type 2 in humans and animals. These two isozymes have differential biochemical and molecular features. Mutations in type 2 isozyme cause male pseudohermaphroditism, and many mutations have been reported from various ethnic groups. The affected 46XY individuals have high normal to elevated plasma testosterone levels with decreased DHT levels and elevated testosterone/DHT ratios. They have ambiguous external genitalia at birth so that they are believed to be girls and are often raised as such. However, Wolffian differentiation occurs normally and they have epididymides, vas deferens and seminal vesicles. Virilization occurs at puberty frequently with a gender role change. The prostate in adulthood is small and rudimentary, and facial and body hair is absent or decreased. Balding has not been reported. Spermatogenesis is normal if the testes are descended. The clinical, biochemical and molecular genetic analyses of 5alpha-reductase-2 deficiency highlight the significance of DHT in male sexual differentiation and male pathophysiology.
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Affiliation(s)
- J Imperato-McGinley
- Division of Endocrinology, Diabetes and Metabolisms, Department of Medicine, Weill Medical College, Cornell University, 1300 York Avenue, Box 149, Room F-260, New York, NY 10021, USA.
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Abstract
Although much of male infertility is currently unexplained, it is likely that underlying defects in critical genes or entire gene pathways are responsible. Because powerful technologies exist to bypass severe male-factor infertility, improving the diagnosis of genetic infertility is important for the infertile couple, not only to explain the problem but also to inform them of conditions potentially transmissible to offspring.
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Affiliation(s)
- Paul J Turek
- Department of Urology, University of California San Francisco, 2330 Post Street, San Francisco, California 94115-1695, USA.
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Migeon CJ, Wisniewski AB, Brown TR, Rock JA, Meyer-Bahlburg HFL, Money J, Berkovitz GD. 46,XY intersex individuals: phenotypic and etiologic classification, knowledge of condition, and satisfaction with knowledge in adulthood. Pediatrics 2002; 110:e32. [PMID: 12205282 DOI: 10.1542/peds.110.3.e32] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objective of this study was to identify and study adults who have a 46,XY karyotype and presented as infants or children with variable degrees of undermasculinization of their genitalia (female genitalia, ambiguous genitalia, or micropenis). Participants' knowledge of their condition, satisfaction with their knowledge, and desire for additional education about their intersex condition were assessed. METHODS Participants were classified according to the cause underlying their intersex condition based on review of medical and surgical records. Knowledge of medical condition, satisfaction with that knowledge, and desire for additional education were assessed with a written questionnaire and a semistructured interview. RESULTS Patients were ineligible for recruitment because of death (9%), because of developmental delay (12%), or because they were not located (27%). Among the 96 eligible patients, 78% participated. Approximately half of the men (53%) and women (54%) exhibited a good understanding of their history. Fewer women who have a 46,XY chromosome complement and were born with female genitalia were informed about their intersex condition (36% with complete androgen insensitivity syndrome) than were women who were born with masculinized genitalia such as micropenis (80%) or ambiguous genitalia (72%). More women (66%) than men (38%) were satisfied with their knowledge of their medical and surgical history. CONCLUSIONS Almost half of the patients, reared male or female, were neither well informed about their medical and surgical history nor satisfied with their knowledge.
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Affiliation(s)
- Claude J Migeon
- Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Foresta C, Ferlin A, Gianaroli L, Dallapiccola B. Guidelines for the appropriate use of genetic tests in infertile couples. Eur J Hum Genet 2002; 10:303-12. [PMID: 12082505 DOI: 10.1038/sj.ejhg.5200805] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2001] [Revised: 03/06/2002] [Accepted: 03/15/2002] [Indexed: 11/09/2022] Open
Abstract
Research on genetic causes of male and female infertility rapidly expanded in the last years, following the development of in vitro fertilising techniques. Genetic tests are now available to explore the cause of the infertility and assess the risk of a given couple to transmit its genetic characteristics. This allows at-risk couples to take an informed decision when electing for a medically assisted reproduction. It also allows the professionals to offer a prenatal diagnosis when appropriate. Thus, the genetic work-up of the infertile couple has become good practice for an appropriate diagnosis, treatment and prognostic assessment. The lack of national or international rules for the genetic approach to the infertile couple, prompted the Italian community of professionals in the field of reproductive medicine to join and set up guidelines for the genetic diagnosis of male and female infertility. The group of clinical and research experts is representative of 12 national scientific societies and was supported by external experts from four international societies. We examine the clinically relevant genetic causes of male and female infertility and suggest the category of patients for which each genetic test is recommended or optional, both for an accurate diagnosis and prior to ART.
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Affiliation(s)
- Carlo Foresta
- University of Padova, Department of Medical and Surgical Sciences, Clinica Medica 3, Via Ospedale 105, 35128 Padova, Italy.
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CHRONIC TREATMENT WITH FINASTERIDE DAILY DOES NOT AFFECT SPERMATOGENESIS OR SEMEN PRODUCTION IN YOUNG MEN. J Urol 1999. [DOI: 10.1097/00005392-199910000-00014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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OVERSTREET JAMESW, FUH VIVIANL, GOULD JOHN, HOWARDS STUARTS, LIEBER MICHAELM, HELLSTROM WAYNE, SHAPIRO SANDER, CARROLL PETER, CORFMAN RANDLES, PETROU STEVEN, LEWIS RONALD, TOTH PHILLIP, SHOWN TOM, ROY JOHNNY, JAROW JONATHANP, BONILLA JAIME, JACOBSEN CAROLA, WANG DANIELZ, KAUFMAN KEITHD. CHRONIC TREATMENT WITH FINASTERIDE DAILY DOES NOT AFFECT SPERMATOGENESIS OR SEMEN PRODUCTION IN YOUNG MEN. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68270-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- JAMES W. OVERSTREET
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - VIVIAN L. FUH
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - JOHN GOULD
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - STUART S. HOWARDS
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - MICHAEL M. LIEBER
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - WAYNE HELLSTROM
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - SANDER SHAPIRO
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - PETER CARROLL
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - RANDLE S. CORFMAN
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - STEVEN PETROU
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - RONALD LEWIS
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - PHILLIP TOTH
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - TOM SHOWN
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - JOHNNY ROY
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - JONATHAN P. JAROW
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - JAIME BONILLA
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - CAROL A. JACOBSEN
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - DANIEL Z. WANG
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
| | - KEITH D. KAUFMAN
- From the Departments of Obstetrics and Gynecology, and Urology, University of California, Davis and Department of Urology, University of California, San Francisco, California, Merck Research Laboratories, Rahway, New Jersey, Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia, Department of Urology, Mayo Clinic, Rochester and Midwest Center for Reproductive Health, Minneapolis, Minnesota, Department of Urology, Tulane University Medical School, New Orleans
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