Spermaturia in two normal boys without other signs of puberty

Mini review shows that a testicular volume of 3 mL was the most reliable clinical sign of pubertal onset in males

AIM

We aimed to evaluate aspects of pubertal development to identify the most reliable clinical sign of pubertal onset in males.

METHODS

We performed a mini review of the literature.

RESULTS

In 1951 Reynolds and Wines categorised pubic hair growth and genital development in five stages by visual inspection. Today the Tanner scale is used to assess the five stages of pubertal development, The second genital stage, characterised by enlargement of the scrotum defines pubertal onset in males. Testicular volume may be evaluated by using a calliper or by ultrasound scan. The Prader orchidometer, described in 1966, offers a method for evaluating testicular growth by palpation. Pubertal onset is commonly defined as testicular volume >3 or ≥4 mL. The development of sensitive laboratory methods has enabled studies analysing hormonal activity in the hypothalamus-pituitary-gonadal axis. We review the relationships between physical and hormonal signs of puberty. We also discuss the results of studies assessing different aspects of pubertal development with a focus on identifying the most reliable clinical sign of pubertal onset in males.

CONCLUSION

A substantial amount of evidence supports testicular volume of 3 mL as the most reliable clinical sign of male pubertal onset.

Assessing puberty in ex situ male cheetahs (Acinonyx jubatus) via fecal hormone metabolites and body weights

Cheetahs are one of the most heavily studied felid species, with numerous publications on health, disease, and reproductive physiology produced over the last 30 years. Despite this relatively long history of research, there is a paucity of crucial biological data, such as pubertal onset, which has direct and significant applications to improved management of ex situ cheetah populations. This study aimed to determine age of pubertal onset in ex situ male cheetahs using non-invasive fecal steroid hormone monitoring and body weights. Fecal samples from 12 male cheetahs from four institutions were collected 2-3 times weekly from 1 to 42 months of age. Fecal androgen and glucocorticoid metabolites were analyzed using enzyme immunoassays previously validated for use with cheetah feces. Animal body weights were recorded monthly. Fecal hormone and body weight data were analyzed using generalized linear mixed models. Androgen concentrations exhibited an increase to levels similar to those observed in adult males by 18-24 months of age, and males attained adult body weights by 21 months of age. Based on these weight data and the initial increase in androgens toward adult concentrations, males were considered pubertal from 18 to 24 months of age. Glucocorticoid concentrations and amplitude of concentration over baseline were also increased during this period. Knowledge about the physiological changes associated with puberty is useful for management and improving reproductive success of cheetah populations under human care, particularly for determining timing of litter separation from dam, littermate dispersal and when to introduce potential breeding pairs.

The past, present and future of fertility preservation in cancer patients

Fertility preservation strategies have been developed for men and women whose fertility is compromised for medical reasons, especially in case of cancer therapy. At present, many reliable options for preserving fertility are available. However, a part of these fertility preservation methods, despite being promising, are still considered experimental. Nevertheless, there are still situations where no methods can be offered. Remarkable scientific progress is currently underway to improve available techniques and to develop new technologies to solve problems with current fertility strategies. These new options may drastically change reproductive options for young patients facing germ cell loss and hence sterility. Therefore, oncofertility counseling by a specialist is recommended for all young cancer patients having to undergo treatment that may reduce fertility potential.

Fertility preservation in men with cancer

During the past decade, advances in cancer treatment have increased survival rates of both boys and men. However, cancer treatment itself can compromise fertility, especially exposure to alkylating agents and whole body irradiation, which cause substantial germ cell loss. Children and adolescents with testicular cancer, leukaemia, and Ewing sarcomas are at the highest risk of developing permanent sterility from cancer treatment. Consequently, various strategies to preserve fertility are necessary. Sperm cryopreservation is an effective but underused method to safeguard spermatozoa. In the past few years, large advances have been made in prepubertal germ cell storage aimed at subsequent transplantation of testicular tissue and associated stem cells. Although still experimental, these approaches offer hope to many men in whom germ cell loss is associated with sterility. The derivation of male gametes from stem cells also holds much promise; however, data are only available in animals, and the use of this method in human beings is probably many years away.

A cross Canada survey of sperm banking practices in pediatric oncology centers

BACKGROUND

Childhood cancer survivors have identified fertility preservation as a major concern. Sperm banking is an established fertility preservation option in pubertal males. We sought to describe current practices in Canadian pediatric oncology programs, and to identify perceived barriers to sperm banking for male adolescents.

PROCEDURE

A questionnaire was developed to (1) describe current sperm banking practices and facilities; (2) report on the utilization of sperm banking; and (3) identify barriers to sperm banking and possible solutions to improve current practices. A healthcare professional with an interest in fertility preservation within each institution was approached to participate in the study.

RESULTS

Fifteen of 16 institutions participated, 2 have fertility preservation teams. Only one has written guidelines or adolescent focused educational material. Over 2 years, 50/262 (19%) adolescents in 12 institutions successfully banked a specimen. In 11 of these, additional information was available: of 85/172 (49%) adolescents offered the option to bank, 38/85 (45%) subsequently attempted. Reported barriers to sperm banking included the pressure to start therapy and restricted banking hours. Formal education of healthcare providers in fertility preservation practices, provision of financial support for families, and an adolescent focused approach were identified as important initiatives to improve sperm banking.

CONCLUSIONS

There is a disparity in current sperm banking practices in Canada and at present, <25% of eligible male adolescents attempt to bank sperm. The development of a fertility preservation team, adolescent-specific guidelines, adolescent friendly sperm banking units, financial support, and improving knowledge translation among professionals and patients may improve the rates of banking.

Age at spermarche and comparison of growth and performance of pre- and post-spermarcheal Chinese boys

The prevalence of first ejaculation emission (spermarche) in Chinese Han boys in 1995 was considered. The subjects were 86,744 Han boys 9 through 18 years randomly selected from 28 provinces. Median spermarcheal ages (MSAs) were 14.4 and 14.6 years for urban and rural boys, respectively, and 14.3, 14.6, and 14.7 years for the boys of 1st, 2nd, and 3rd socioeconomic classes, respectively. Two environmental factors, ecological and socioeconomic, had strong influence upon MSAs. Eight indicators of somatic growth and motor ability were compared between pre- and post-spermarcheal boys of the same age. Post-spermarcheal boys were advanced in body size, shape, and physiological function during early and middle puberty, but most of the difference disappeared by 16 years. Pre-spermarcheal boys in a given age group were more linear and had more potential for increasing leg length into late adolescence. Within an age group, post-spermarcheal boys had advanced performances in several tasks requiring endurance, strength, and power around the age of maximum growth, 13-15 years. At older ages, the groups did not differ.

High dose testosterone therapy for reduction of final height in constitutionally tall boys: does it influence testicular function in adulthood?

OBJECTIVE

We have studied the effect of treatment with high doses of androgens during puberty on testicular function in adult men with constitutionally tall stature, taking into account confounding factors interfering with sperm quality, since existing published data do not include whether testicular function is impaired by such treatment.

DESIGN

Historical cohort study.

PATIENTS

Forty-three previously androgen treated tall men (cases) and 30 non-treated tall men (controls).

MEASUREMENTS

Physical examination, semen analysis and plasma levels of LH, FSH, testosterone (T), sex hormone binding globulin (SHBG) and inhibin.

RESULTS

Sperm quality and testis volume were comparable between cases and controls. Mean sperm concentration was 66.4 x 10(6)/ml in cases and 66.2 x 10(6)/ml in controls. A left-sided varicocele was found in 45% of the cases and 37% of the controls. In cases we observed a significant effect of the age at start of androgen therapy on sperm motility (regr. coeff. (SE): 4.92 (2.41)%, P = 0.048). In addition, testicular size at start of therapy had a significant effect on sperm concentration (regr. coeff. (SE): 5.57 (1.54) x 10(6)/ml, P = 0.0012) and on total sperm count (regr. coeff. (SE): 43.1 (7.73) x 10(6), P = 0.0001). Plasma levels of T, SHBG and inhibin were not statistically different between the groups. Cases had significantly higher FSH levels (mean (SD) 3.3 (2.2) vs 2.1 (0.8) IU/I, P = 0.004) and significantly lower LH levels (mean (SD) 2.3 (0.9) vs 3.1 (1.4) IU/I, P = 0.019). We found a significant effect of age at start of therapy on plasma FSH level in the treated men (regr. coeff. (SE): -0.73 (0.18) IU/I, P = 0.0003).

CONCLUSIONS

Treatment with high doses of androgens for reduction of final height in constitutionally tall stature has no long-term side-effect on sperm quality, testicular volume or plasma testosterone levels. However, treated men had significantly higher plasma levels of FSH compared with controls. The meaning of this difference remains to be established. Varicocele was present in 42% of the adult tall men.