Androgenic status in patients with lepromatous leprosy.

OBJECTIVE: To assess the incidence of testicular atrophy by evaluation of hormonal status, testicular histology and sperm production in chronic lepromatous patients. PATIENTS AND METHODS: Forty-one male patients with a mean age of 39.5 years (range 16-57) were studied at the Leprosy Hospital, Istanbul, Turkey, and were compared with 15 age-matched controls with proven fertility. RESULTS: Reduced testicular size was observed in 51% and gynaecomastia in 27%. Of the 31 patients who were married, 15 were primarily or secondarily infertile. Twelve of 16 patients had oligospermia or azoospermia. The mean basal luteinizing hormone (LH), follicle stimulating hormone (FSH) and oestradiol levels were significantly elevated and the level of testosterone significantly reduced when compared with the control group. CONCLUSION: Whenever leprosy is diagnosed patients should be informed of the need for treatment of an acute attack and the need for routine assessment of FSH, LH, testosterone and oestradiol levels to detect hypogonadism and potential infertility.

Gynaecomastia in leprosy in three districts of Tamil Nadu.

The prevalence of Gynaecomastia (GM), a well known complication of leprosy in adult male patients was studied in 790 cases of whom 641 were the inmates of five leprosy hospitals and the remaining 149 mostly from the clinics of field area attached to the Central Leprosy Teaching and Research Institute, Chengalpattu during 1982-83. The overall prevalence rate was found to be 19.24%. Among the hospitalised patients, it was 22.15% against 6.71% among the patients attending the clinics in the field area. The youngest and the oldest patient in this study was 16 years and 83 years respectively. The highest rate of 32.89% was in the 36-45 age group. Only 152 GM cases were detected; the rates in the lepromatous, borderline lepromatous, borderline tuberculoid were 29.21%, 9.64% and 3.68% respectively. Those who gave a history of frequent ENL reactions had a higher rate of GM i.e. 34.55 as against 21.52 without or with very infrequent ENL reaction. Early treatment had a remarkable effect in the reduction of GM. Only 14% developed GM when the treatment was started within 2 years after the onset of leprosy as against 46.9% when the same was started after 16 years. In the latter group, the longer duration of the disease could also play a contributory role. Sterility rate was more than double in those with GM i.e. 34.14% against 14% without it.

Pathologic changes in testis and epididymis of infertile leprotic males.

Thirty-two cases of male infertility in patients having leprosy were studied. One case was oligospermic and the remaining 31 cases were azoospermic. Pathologic changes in the testis and epididymis are described and illustrated. An important observation was the presence of obstruction in the tail of the epididymis in five cases and this obstruction was undoubtedly the cause of sterility in these five cases as the head of the epididymis was full of sperm and testicular biopsy was more or less normal. In the remaining 27 cases, the cause of sterility was testicular affection with fibrosis and hyalinization of the seminiferous tubules in most of the cases.

Evaluation of male gonadal function in leprosy

Impotency, sterility, loss of libido, loss of sexual hair and gynecomastia are well documented in patients suffering from leprosy. They occur with greater frequency in lepromatous leprosy as compared to dimorphous and tuberculois types.

Testicular and epididymal involvement in leprosy patients, with special reference to gynecomastia

Sixty-six male patients with leprosy were studied. Only those with the lepromatous type developed testicular and epididymal changes. Nine of the 38 patients showed decreased sexual function, and 7 developed gynecomastia. These changes were believed to be due to the altered gonadal state.

Testicular and epididymal involvement in leprosy patients, with special reference to gynecomastia.

Sixty-six male patients with leprosy were studied. Only those with the lepromatous type developed testicular and epididymal changes. Nine of the 38 patients showed decreased sexual function, and 7 developed gynecomastia. These changes were believed to be due to the altered gonadal state.