Presenter R1 洪士鈞Supervisor VS 張宏江

Outline

Case Literature review

Anabolic-androgenic steroids○ BCS○ Use○ Physiology○ Clinical: Infertility

Basic Data

33 M American Married Underlying (-) A/B/C (-) Family hx(-) Op hx: abd penetration trauma (gun

shot)

History & Treatment course Chief complaint

Infertility since last year

Ever fertile in 17 y/o No vasectomy or testicular trauma

History & Treatment course GYN OPD

Semen analysis: AzoospermiaFSH: 0.146 LH: <0.1Testosterone: 3.37Prolactin: 8.72Chromosome: 46,XYAZF(Azoospermia Factor): no abnormality

Urology OPD

History & Treatment course Urology OPD

Over-the-counter medication○ Anastrozole: aromatase inhibitor○ DHEA○ Testosterone ○ Adrenal rebuilder : porcine adrenal abstract

without hormone○ Ortho biotic○ Omega-3○ Multi-vitamin (B-complex+ Niacin + Vitamin D)○ Glucosamine

History & Treatment course PE:

BH/BW: 172 cm / 105 kgPubic hair (+)Scrotum:

Left Right

Size, consistence 12 mL, soft 15 mL, soft

Vas present present

Epididymis n.p. n.p.

History & Treatment course Lab

Semen No sperm

FSH 0.274

LH <0.1

β-hCG 15.7

Prolactin 7.54

Testosterone 4.84

α-FP 4.39

History & Treatment course Imp:

Secondary infertility, exogenous hormone related hypogonadotropic hypogonadism

Treatment: Gonal-F 150IU SC TIW x 3 months

Response sperm(+)FSH: 6.63LH: 5.03Testosterone: 3.43

Anabolic steroids and male infertility: a comprehensive review

Guilherme Leme de Souza and Jorge Hallak

BJUI 2011

Anabolic-androgenic steroids(AAS) Testosterone & synthetic derivatives 3 million users in USA

2/3 out layers

15-25% dietary supplement

Testosterone

Androgenic effectSecondary characteristicHairSebaceousSpermatogenesisLibido

300-1000 ng/dL (3-10 ng/mL)

Anabolism

Nitrogen retained in lean body massSynthesis ↑Breakdown ↓

Myotrophic-androgenic index Dose dependent

Classification

RouteOral

○ Alkyl substitution hepatic problemParenteral

EffectTestosterone-like DHT-like Nandrolone-like

How to Use AAS

StackingMultiple agents with small dosage

CyclingMass-building cycle

○ Testosterone + NandroloneCutting cycle

○ Low-estrogenic androgenPost cycle therapy

○ Anti-estrogen or hCG

Physiology

DirectErythropoiesisLipolysisProtein synthesisHair & Sebum

IndirectAnti-glucorticoid

Side effect

Acne, Alopecia LUTS Gynecomastia CV Liver Psychiatric Mortality: 4.6 times higher

Discontinuation: ED, Libido loss

AAS abuse & Infertility

Laydig / Sertoli

AAS abuse & infertility

After discontinue AASQuantity recover in 4-12 monthsQuality persist longerMostly became fertile

Conservative vs. Active treat?hCGHuman menopausal gonadotropin (hMG)Recombinant FSH

Take home massage

AAS Anabolic and androgenic effect Infertility: Sperm quantity & qualityOther side effect, mortality

May spontaneous recover in 4-12 months

May treat with gonadotropic agent

Thanks for your attention!