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Thread: Low Testostorone and SCI?

  1. #1

    Low Testostorone and SCI?

    Just wondering if low levels of Testostorone is common in males with SCI's. Anyone have any information on this?

    Thanks,

  2. #2
    Senior Member dogger's Avatar
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    i've been told definitely not !

    chimera , i asked my then specialist [Dr. Vernon Hill ] a similar question . this was pre viagra days and i asked my specialist if a shot or two of testosterone might help in sexual function . my thinking being it gives neutered animals the desire so could give some beneficial results in SCI patients. his reply was something along the lines of '' most of the blokes i know with SCI have plenty of testosterone , their desire is high , it is just the mechanics that let them down .'' this specialist was very involved with sexuality in SCI patients and programs whereby they could become parents .
    hope this helps .
    dogger

  3. #3
    According to the published literature, low testosterone levels are common in men with spinal cord injury, but I don't think that it is such a common cause of infertility and I agree with Dogger's doctor that the most common reason for failure of erection and ejaculation is not due to testorone levels but due to either medication or loss of neural input/output and excitability of the lower spinal cord. The cause of the lower testosterone levels is uncertain but recent data suggest that it may be related to exercise or lack of exercise.

    • Safarinejad MR (2001). Level of injury and hormone profiles in spinal cord-injured men. Urology. 58 (5): 671-6. Summary: OBJECTIVES: To evaluate the level of injury and endocrine profiles in men with spinal cord injury (SCI). METHODS: Seventy-six men with SCI at different levels were studied, using uninjured normal and infertile subjects as controls. RESULTS: Compared with normal controls, the subjects with SCI (50%) had lower serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone. Subjects with T8-T11 and T12-L5 injury had the highest and lowest incidence of hormonal abnormalities, respectively. All subjects with hyperprolactinemia (n = 5) had T8-T11 injuries. CONCLUSIONS: The results of our study indicate that subjects with SCI have an altered central neurotransmitter tone, and the likelihood of these abnormalities (hypogonadotropism) are higher in men with low thoracic SCI. Department of Urology, Division of Urology and Renal Transplantation, Military University of Medical Sciences, Air Force Hospital, Tehran, Iran.

    • Bauman WA, Spungen AM, Adkins RH and Kemp BJ (1999). Metabolic and endocrine changes in persons aging with spinal cord injury. Assist Technol. 11 (2): 88-96. Summary: Persons with spinal cord injury (SCI) have secondary medical disabilities that impair their ability to function. With paralysis, dramatic deleterious changes in body composition occur acutely with further adverse changes ensuing with increasing duration of injury. Lean mass, composed of skeletal muscle and bone, is lost and adiposity is relatively increased. The body composition changes may be further exacerbated by associated reductions in anabolic hormones, testosterone, and growth hormone. Individuals with SCI also have decreased levels of activity. These body composition and activity changes are associated with insulin resistance, disorders in carbohydrate and lipid metabolism, and may be associated with premature cardiovascular disease. Although limited information is available, upper body exercise and cycle ergometry of the lower extremities by functional electrical stimulation (FES) have been reported to have a salutary effect on these body composition and metabolic sequelae of paralysis. Perhaps other innovative, externally mediated forms of active exercise of the paralyzed extremities will result in an increased functional capacity, metabolic improvement, and reduction of atherosclerotic vascular disease. Department of Medicine, Mount Sinai Medical Center, New York, New York, USA.

    • Elliott SP, Orejuela F, Hirsch IH, Lipshultz LI, Lamb DJ and Kim ED (2000). Testis biopsy findings in the spinal cord injured patient. J Urol. 163 (3): 792-5. Summary: PURPOSE: Azoospermia after electroejaculation in spinal cord injured men may be due to testicular failure or obstruction. These men can initiate pregnancy with assisted reproductive techniques, such as intracytoplasmic sperm injection, but only if sperm are present in the testis biopsy. We analyzed the histopathology of testis biopsies from spinal cord injured men and assessed whether patient factors were predictive of testis biopsy pathology. MATERIALS AND METHODS: A total of 50 paraplegic men undergoing testis biopsy were divided into 2 groups based on normal or abnormal testis histopathology. Patient age, post-injury years, level of lesion, hormonal status and semen analysis results were compared. RESULTS: Spermatogenesis was normal in 28 of the 50 patients. Hypospermatogenesis was exhibited in 15, maturation arrest at the spermatid stage in 6 and maturation arrest at the spermatocyte stage in 1 of the 22 abnormal cases. Nevertheless, mature sperm were identified in 43 of 50 biopsies (normal spermatogenesis and hypospermatogenesis). Men with normal spermatogenesis had better forward progression of sperm and a higher testosterone-to-luteinizing hormone ratio. Otherwise, there was no statistically significant correlation between study variables and testis biopsy results. No factors were predictive of testis biopsy histopathology. CONCLUSIONS: The documentation of mature sperm in 43 of 50 biopsies from spinal cord injured patients suggests that a high rate of sperm retrieval is possible using testicular sperm extraction if sperm cannot be retrieved from the ejaculate. With intracytoplasmic sperm injection techniques the majority of spinal cord injured men retain fertility potential, even if azoospermic following electroejaculation. Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.

    • Bauman WA and Spungen AM (2000). Metabolic changes in persons after spinal cord injury. Phys Med Rehabil Clin N Am. 11 (1): 109-40. Summary: Persons with chronic SCI have several metabolic disturbances. As a consequence of inactivity and the body compositional changes of decreased skeletal muscle with a relative increase in adiposity, a state of insulin resistance and hyperinsulinemia has been demonstrated to exist, associated with abnormalities in oral carbohydrate handling. Elevated plasma insulin levels in persons with SCI probably contribute to the cause of frequent dyslipidemia and hypertension. This constellation of metabolic changes represents an atherogenic pattern of CHD risk factors with many of the distinctive features of a cardiovascular dysmetabolic syndrome that is called syndrome X. Reduction in modifiable risk factors for CHD should decrease the occurrence of catastrophic cardiovascular events. There is evidence to suggest that endogenous anabolic hormone levels are depressed in a proportion of individuals with SCI. Depression of serum testosterone and growth hormone/IGF-I levels may exacerbate the adverse lipid and body compositional changes, reduce exercise tolerance, and have deleterious effects on quality of life. Because of immobilization, individuals with paraplegia have osteoporosis of the pelvis and lower extremities, and those with tetraplegia also have osteoporosis of the upper extremities. In addition, there is evidence to suggest that bone loss progresses with time in persons with chronic SCI. This may be caused by chronic immobilization per se or may be a consequence of adverse hormonal changes, including deficiency of anabolic hormones or deficiency of vitamin D and calcium with secondary hyperparathyroidism. Serum thyroid function abnormalities resembling the euthyroid sick "low T3 syndrome" have been reported in those with acute and chronic spinal cord injury. Depressed serum T3 and elevated rT3 in chronic SCI may be caused by associated illness. Current practice has been hesitant to treat abnormal serum thyroid chemistries associated with nonthyroidal illness. Recognition of metabolic abnormalities in individuals with SCI is vital as a first step in improving clinical care. The application of appropriate interventions to correct or ameliorate these abnormalities promises to improve longevity and quality of life in persons with SCI. Department of Medicine, Mount Sinai Medical Center, New York, USA. Bauman.W@Bronx.VA.GOV.

    • Huang TS, Wang YH, Lee SH and Lai JS (1998). Impaired hypothalamus-pituitary-adrenal axis in men with spinal cord injuries. Am J Phys Med Rehabil. 77 (2): 108-12. Summary: Twenty-five men with spinal cord injuries were studied for evaluation of the hypothalamus-pituitary-adrenal axis, using corticotropin-releasing hormone and insulin-induced hypoglycemia. Twenty-five age-matched healthy male volunteers served as controls. Three spinal cord-injured subjects had hyperprolactinemia, three had elevated basal follicle-stimulating hormone levels, one had an elevated basal luteinizing hormone level, and four had hypotestosteronemia. The mean plasma adrenocorticotropin response to corticotropin-releasing hormone of spinal cord-injured subjects was smaller than that of the healthy controls but did not reach a statistical significance. The cortisol response to corticotropin-releasing hormone of the spinal cord-injured subjects was significantly lower than that of healthy controls. However, the difference disappeared if a correction was made for baseline values. Six spinal cord-injured subjects did not have a cortisol response to insulin-induced hypoglycemia, and they had either a minimal or no adrenocorticotropin response. Another 11 spinal cord-injured subjects had a maximal cortisol response to insulin-induced hypoglycemia below the lowest limit of normal, i.e., 0.5 micromol/l. Among these spinal cord-injured subjects, three had a less than 50% increase of plasma adrenocorticotropin after insulin-induced hypoglycemia. These findings are consistent with the notion that spinal cord-injured subjects have an altered central neurotransmitter tone and substantiate the hypothesis that an afferent neural pathway exists between the adrenal and hypothalamus and may modulate stress-induced secretion of adrenocorticotropin. Long-term abnormal adrenocorticotropin secretion may cause mild adrenocortical atrophy and, thereby, a reduced cortisol response. Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Republic of China.

    • Wheeler GD, Ashley EA, Harber V, Laskin JJ, Olenik LM, Sloley D, Burnham R, Steadward RD and Cumming DC (1996). Hormonal responses to graded-resistance, FES-assisted strength training in spinal cord-injured. Spinal Cord. 34 (5): 264-7. Summary: Functional electrical stimulation (FES) assisted resistance training has been effective in increasing muscular strength and endurance in spinal cord injured men and women in preparation for FES-assisted cycle programs and for FES-assisted standing and walking. Increases in blood pressure and a concomitant bradycardia suggestive of autonomic dysreflexia have been reported during FES-assisted resistance training. Self-induced autonomic dysreflexia in athletes who use wheelchairs suppressed the normal exercise induced serum testosterone increase. We, therefore, examined the changes in hematocrit and circulating levels of testosterone, sex hormone binding globulin (SHBG), cortisol, prolactin, norepinephrine and epinephrine during FES assisted resistance exercise in five high spinal cord injured men (SCI) and comparable maximal exercise in five able bodied controls (AB). Mean serum testosterone levels significantly increased with FES-assisted resistance training in SCI and maximal resistance exercise in AB with no significant change in hematocrit or SHBG. Prolactin, cortisol and epinephrine levels were unchanged while norepinephrine levels were significantly increased in SCI and AB. These findings suggest that there is no concern over inadequate physiological androgen response to an exercise stimulus in SCI. The data do not support the previous findings that elevated levels of norepinephrine in autonomic dysreflexia suppress testosterone response to exercise. Rick Hansen Centre, University of Alberta, Edmonton, Canada.

    • Tsitouras PD, Zhong YG, Spungen AM and Bauman WA (1995). Serum testosterone and growth hormone/insulin-like growth factor-I in adults with spinal cord injury. Horm Metab Res. 27 (6): 287-92. Summary: Aging is associated with relative growth hormone and/or testosterone (T) hormone deficiency, and those with SCI may have a premature deficiency of these two hormones. The effects of SCI, duration of injury (DOI), and advancing age with that of human growth hormone (hGH) and insulin-like growth factor I (IGF-I), as well as potential associations between them, were studied. Data were obtained from 20 male subjects with SCI and 16 gender- and age-matched controls. Serum total and free T were lower in subjects with SCI compared with controls (mean +/- SEM, 3.12 +/- 0.29 versus 4.68 +/- 0.28 ng/ml, p < 0.001 and 1.89 +/- 0.18 versus 2.46 +/- 0.22 ng/ml, p < 0.05, respectively). Nine of the 20 subjects with SCI, but none of the controls, had abnormally low serum total T. Arginine-stimulated values for hGH were lower in the group with SCI compared with controls [198 +/- 18 versus 267 +/- 27 ng/ml, p < 0.05). Serum luteinizing hormone and follicular stimulating hormone, as well as body mass index, were not significantly different between the groups. Serum total and free T were correlated with advancing age in controls [r = 0.62, p < 0.01 and r = 0.51, < 0.05, respectively) but not in SCI [r = 0.19, p > 0.43 and r = 0.39, p = 0.09). However, serum total and free T declined with increasing DOI in SCI (r = 0.56, p < 0.01 and r = 0.44, p = 0.05, respectively).[ABSTRACT TRUNCATED AT 250 WORDS). Spinal Cord Damage Research Center, Mount Sinai Medical Center, New York, USA.

    • Brackett NL, Lynne CM, Weizman MS, Bloch WE and Abae M (1994). Endocrine profiles and semen quality of spinal cord injured men. J Urol. 151 (1): 114-9. Summary: We characterized endocrine profiles and semen quality in spinal cord injury subjects using noninjured normal and infertile subjects as controls. Compared to normal controls, spinal cord injury subjects had lower serum levels of luteinizing hormone and follicle-stimulating hormone. Subjects with spinal cord injuries between the T8 and T10 levels had a higher incidence of hormone outliers compared to subjects with injuries at other levels. Sperm motility and per cent normal sperm morphology were lower in spinal cord injury subjects compared to normal controls but not to infertile control subjects. Spinal cord injury subjects with elevated follicle-stimulating hormone levels were azoospermic. We conclude that endocrine abnormalities are likely to accompany spinal cord injury but may not be the sole mechanism contributing to impairments in semen quality. Department of Urology, University of Miami School of Medicine, Florida.

    • Huang TS, Wang YH, Chiang HS and Lien YN (1993). Pituitary-testicular and pituitary-thyroid axes in spinal cord-injured males. Metabolism. 42 (4): 516-21. Summary: Thirty spinal cord-injured (SCI) males were studied for evaluation of their pituitary-testicular and pituitary-thyroid axes using combined luteinizing hormone-releasing hormone (LHRH) and thyrotropin-releasing hormone (TRH) tests and electroejaculated semen analyses. Thirty age-matched normal male volunteers served as controls. There were four subjects with low serum triiodothyronine (T3) levels, one with elevated serum follicle-stimulating hormone (FSH) level, eight with elevated serum testosterone levels, and 11 with elevated serum prolactin levels. There were significantly elevated luteinizing hormone (LH) responses to LHRH in SCI subjects when compared with normal controls. There were 16 (53.3%) SCI subjects who had exaggerated and/or prolonged LH responses. Among them, six subjects also had elevated FSH responses. There were eight and four subjects whose thyrotropin (TSH) and prolactin responses to TRH were exaggerated, respectively. Marked impaired motility was observed in 56 electroejaculated semen samples from 16 SCI subjects. There was a significant correlation between LH and total sperm count. Our data suggest that there is a reduced central dopaminergic tone in SCI subjects. Department of Internal Medicine, National Taiwan University Hospital, Republic of China.

    • Wang YH, Huang TS and Lien IN (1992). Hormone changes in men with spinal cord injuries. Am J Phys Med Rehabil. 71 (6): 328-32. Summary: The steady state profiles of 63 men with traumatic spinal cord injuries (24 quadriplegics and 39 paraplegics; average age of 31.2 +/- 6.8 yr; 18-44 yr) were studied. The average length of post-traumatic period was 6.2 +/- 5.0 yr, ranging from 8 months to 20 yr. It was found that all the subjects had normal serum thyroxine, thyrotropin, cortisol, growth hormone and plasma adrenocorticotropic hormone. Seven cases (11.1%) had low serum triiodothyronine and eight cases (12.7%) had low serum testosterone. On the other hand, 17 cases (27.0%) had hyperprolactinemia; 9 cases (14.3%) had elevated serum testosterone level; 6 cases (9.5%) had elevated serum follicle-stimulating hormone; and 4 cases (6.3%) had elevated serum luteinizing hormone. The level of spinal cord injury, injury period and patient age had no correlation with other serum hormone changes except that quadriplegic subjects had lower serum triiodothyronine than the paraplegic, with a mean of 1.42 +/- 0.30 v 1.70 +/- 0.36 nmol/liter (P < 0.005). Of the eight subjects who had low serum testosterone, none had elevated gonadotropin. There were also eight subjects with elevated follicle-stimulating hormone and/or luteinizing hormone, six of them had normal serum testosterone and two had elevated serum testosterone. This suggested their hypogonadism did not result primarily from classic primary gonadal failure. It could be speculated that other testicular paracrine factors and/or alteration of hypothalamus-pituitary-testicular axis are involved in the pathogenesis of hypogonadism. Further studies in this field will provide information regarding male reproductive physiology and may have impact on fertility enhancement options for men with spinal cord injuries. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Republic of China.

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