presenter r1 洪士鈞 supervisor vs 張宏江
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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). - PowerPoint PPT PresentationTRANSCRIPT
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!