Assessment of the androgen environment within the human testis: minimally invasive method to obtain intratesticular fluid.

Previous studies of the rat have shown that testosterone concentrations within the interstitial and seminiferous tubularfluids of the testes are significantly higher than normal serum levels, and further, that although intratesticular testosterone concentration can be substantially reduced without an effect on spermatogenesis, the concentration that is minimally required to maintain spermatogenesis is also substantially higher than serum levels. The purpose of the present study was to adapt a minimally invasive technique to sample human intratesticular fluid to enable parallel observations in man. To this end, aspiration methods were first developed for the rat testis and then adapted to the human. The testosterone concentration in fluid obtained by unilateral aspiration of rat testes was approximately 50 ng/mL, similar to the known concentration in seminiferous tubular fluid. These aspiration methods were then adapted to obtain intratesticular fluid from human testes. Studies of 12 fertile human subjects demonstrated that percutaneous testicular aspiration could be performed safely and successfully using a 19-gauge needle. Nine additional human subjects had bilateral testicular aspiration and simultaneous measurement of peripheral blood testosterone levels. Testicular aspirations yielded 8 to 117 microL of fluid from each testicle. The mean concentration of testosterone in aspirates obtained from the 21 patients was 609 +/- 50 ng/mL. Dihydrotestosterone and 3alpha-androstanediol concentrations were quite low, below the limits of detection of our assay. The SHBG/ABP concentration in the aspirates was 8.5 +/- 1.1 nM. These results define testosterone as the major androgenic steroid in the human testis, as in the rat testis, and indicate that the testosterone concentration within the human testis is approximately 200-fold greater than that of SHBG/ABP, and more than 100-fold greater than the concentration of testosterone found in normal human serum.

Is routine endocrine testing of impotent men necessary?

Endocrine screening of impotent men is performed in an effort to identify a treatable cause of impotence. However, the prevalence of endocrinopathy in this patient population is low. We determined whether any historical or physical findings obtained during the initial office visit would identify a subgroup of patients at risk for endocrinopathy to decrease the cost of endocrine screening. The results of routine endocrine screening of 330 consecutive impotent patients formed the basis of this study. A total of 7 patients (2.1%) had endocrinopathy. Testicular atrophy was observed in 5 of these 7 patients and 6 reported decreased libido. All of the patients with endocrinopathy had either decreased libido or bilateral testicular atrophy. Our results indicate that the cost of impotence evaluation can be decreased by screening only those patients with clinical signs of hypogonadism, that is either decreased libido or bilateral testicular atrophy.