Regulation of testicular function in men: implications for male hormonal contraceptive development

In the adult male, the testes produce both sperm and testosterone. The function of the testicles is directed by the central nervous system and pituitary gland. Precise regulation of testicular function is conferred by an elegant feedback loop in which the secretion of pituitary gonadotropins is stimulated by gonadotropin hormone-releasing hormone (GnRH) from the hypothalamus and modulated by testicular hormones. Testosterone and its metabolites estradiol and dihydrotestosterone (DHT) as well as inhibin B inhibit the secretion of the gonadotropins both directly at the pituitary and centrally at the level of the hypothalamus. In the testes, LH stimulates testosterone synthesis and FSH promotes spermatogenesis, but the exact details of gonadotropin action are incompletely understood. A primary goal of research into understanding the hormonal regulation of testicular function is the development of reversible, safe and effective male hormonal contraceptives. The administration of exogenous testosterone suppresses pituitary gonadotropins and hence spermatogenesis in most, but not all, men. The addition of a second agent such as a progestin or a GnRH antagonist yields more complete gonadotropin suppression; such combination regimens effectively suppress spermatogenesis in almost all men and may soon bring the promise of hormonal male contraception to fruition.     

La contraception masculine

Currently available methods of male contraception include condoms and vasectomy, but condoms have a high failure rate and vasectomy is an irreversible method. These methods are also not accepted by all couples. Hormonal methods are based on reversible suppression of gonadotrophin (both LH and FSH) and inhibition of intra-testicular steroid and sperm production. In 1990 and 1996, the WHO published results from two studies using testosterone injections as a method of hormonal contraception. These studies demonstrated, for the first time, that if a hormonal method is able to induce azoospermia or at least severe oligozoospermia, it could constitute an effective method of contraception. Another possible approach consists of using a combination of progestins or other gonadotropin inhibitors together with androgens to ensure more effective suppression of spermatogenesis. The dose of androgens can be lowered to decrease the risk of long-term adverse effects. Ongoing studies are designed to determine the safest and most effective combinations of androgens and progestins. GnRH antagonists interfere with the action of GnRH and suppress gonadotropins and therefore spermatogenesis. Agents acting directly on the testis are often very toxic and frequently induce irreversible effects on spermatogenesis and therefore cannot be used for contraception. Immunocontraception, particularly targeting of antibodies to gamete-specific antigens involved in sperm-egg binding and fertilisation, constitutes a very attractive approach. This is not a new idea, as several immunocontraception trials, using animal model systems, have been reported over recent years. However, the results of these studies have been largely disappointing because immunoneutralisation of a single, gamete-specific antigen appears to be insufficient to induce a significant reduction in fertility and secondly, although systemic immunisation regimes may lead to high serum antibody levels, these levels do not correlate with specific antibody levels in the reproductive tract or with contraceptive efficacy.     

Influence of testosterone substitution on sperm suppression by LHRH agonists

To investigate the effect of LHRH (GnRH) agonists on sperm suppression, we studied the effect of a depot preparation of D-Trp6 LHRH in 10 normal men for 30 weeks. In addition, to determine the role of androgenic substitution on sperm suppression, the volunteers were divided into two groups: group 1 (n = 5) received a low dose T substitution (125 mg of T enanthate every month), while group 2 (n = 5) received a normal T substitution (120 mg of T undecanoate every day). Four men became azoospermic in group 1 and none in group 2. Moreover, administration of additional T injections in 1 volunteer of group 1 resulted in the reappearance of spermatozoa in the ejaculate. Return to the low dose therapy produced azoospermia. These results suggest that testosterone supplementation supports spermatogenesis.     

Male contraception: Another holy grail

The idea that men should participate in family planning by playing an active role in contraception has become more acceptable in recent years. Up to the present the condom and vasectomy have been the main methods of male contraception. There have been and continue to be efforts to develop an acceptable hormonal contraceptive involving testosterone (T) suppression. However the off target affects, delivery of the analogs and the need for T replacement have proven difficult obstacles to this technology. Research into the development of non-hormonal contraception for men is progressing in several laboratories and this will be the subject of the present review. A number of promising targets for the male pill are being investigated. These involve disruption of spermatogenesis by compromising the integrity of the germinal epithelium, interfering with sperm production at the level of meiosis, attacking specific sperm proteins to disrupt fertilizing ability, or interfering with the assembly of seminal fluid components required by ejaculated sperm for acquisition of motility. Blocking contractility of the vas deferens smooth muscle vasculature to prevent ejaculation is a unique approach that prevents sperm from reaching the egg. We shall note the lack of interest by big pharma with most of the support for male contraception provided by the NIH.     

hCG-induced maturation of the seminiferous epithelium in hypogonadotropic men

The effect of long-term hCG administration on sperm output was evaluated in a study in 3 hypogonadal patients with a selective deficiency of gonadotrophins (LH and FSH). The diagnosis of complete hypogonadotropic hypogonadism was based on clinical and hormonal findings as well as testicular histology. Pubertal maturation took place gradually during hCG therapy. 2 out 3 patients, who were azoospermic before treatment, had spermatozoa in their ejaculate after 12 and 24 months of therapy respectively. These effects on spermatogenesis were reversed after hCG withdrawal for 4 months and the patients again became azoospermic. This azoospermia was not reversed by testosterone (T) replacement therapy, or by addition of HMG to T. In vitro, the crude hCG preparation stimulated cAMP accumulation in rat Sertoli cell cultures indicating that this hCG preparation possesses an 'FSH-like' action. The present findings indicate that hCG therapy alone can induce and maintain spermatogenesis in some patients with complete hypogonadotropic hypogonadism.     

Endocrine control of spermatogenesis in primates

Control of primate spermatogenesis is reviewed in terms of endogenous regulatory mechanisms and endocrine approaches to contraception and treatment of infertility. The role of gonadotropins and steroid hormones in maintaining spermatogenesis in primates is incompletely understood because A) hormonal interactions are complex, and B) most studies have used rodents rather than primates. Feedback control, interaction of LH and testosterone, the role of androgen, androgen in secondary sex organs, regulation of receptor proteins, roles of prolactin and growth hormone, and the breakdown and modification of the endocrine control mechanism are reviewed. The treatment of infertility with GnRH, gonadotropins, and androgen is discussed. Information is included on contraception research using the following methods: immunization against GnRH, use of GnRH analogs, immunization against gonadotropins, induced suppression of FSH secretion or action, and steroid suppression of spermatogenesis. The importance of studying testicular steroid metabolism in primates is stressed. Significant advances in the understanding of endocrine control of spermatogenesis have been made in recent years, but no primate species have been thoroughly studied. Variability between species in endocrine control mechanisms is an important factor in selecting primate models, and it is clear that such models can be valuable in the development of male contraceptives.     

Use of testosterone alone as hormonal male contraceptive

The world population continues to grow rapidly while resources for sustainable living dwindle and manmade ecological problems increase proportionally to the overpopulation. Family planning is required to reduce population growth in developing countries and to stabilize populations in developed countries. Contraception makes abortion superfluous and provides the key to family planning. Women increasingly demand that men share the burden and risks of contraception and ?? as opinion polls show ?? men would be willing to use contraceptives if they were available. Research has established the principle of hormonal male contraception based on suppression of gonadotropins and spermatogenesis. All hormonal male contraceptives use testosterone, but in East Asian men, testosterone alone can suppress spermatogenesis to a level compatible with contraceptive protection. In Caucasians additional agents are required of which progestins are favoured.     

Case studies in antelope aggression control using a GnRH agonist

Maintaining surplus captive male antelope in bachelor groups can result in aggression in some species, leading to injury or death. Suppressing endogenous testosterone using gonadotropin‐releasing hormone (GnRH) analogs has been used in primates to control aggressive behavior, but little information is available on the use of GnRH analogs in nondomestic ruminant species. The aim of this study was to investigate the effect of a slow‐release GnRH agonist (deslorelin) on circulating hormone concentrations, semen and sperm characteristics and behavior in male gerenuk, dorcas gazelle, and scimitar horned oryx. Body weight, testicular volume, circulating hormone concentrations, ejaculate traits, and behavior were recorded before and during deslorelin treatment. A GnRH challenge (with serial blood sampling) was administered to gerenuk and dorcas gazelles before and during GnRH analog treatment. Quantitative behavioral data were collected for gerenuk and dorcas gazelles for 30 min three times a week, starting 1 month before deslorelin treatment, and the mean incidence of combined aggressive behaviors (supplanting, foreleg kicking, sparring, marking, and mounting) was compared before and during deslorelin treatment. No statistical difference (P>0.05) in body weight, semen volume, sperm concentration, percent sperm motility, percent sperm plasma membrane integrity, or percent normal sperm morphology was found before or during deslorelin treatment. The characteristic rise in luteinizing hormone (LH), occurring ～10 min following administration of a GnRH challenge in untreated males, was not evident during deslorelin treatment, although tonic LH concentrations were maintained. No differences (P>0.05) in the mean incidence of any aggressive behavioral traits in gerenuk or dorcas gazelle were detected before and during deslorelin. The absence of a GnRH‐induced increase in serum LH in treated males indicated that deslorelin suppressed pituitary responsiveness to endogenous GnRH, but that the continued tonic production of LH was sufficient to maintain testosterone production, aggressive behavior, and subsequent semen production. Zoo Biol 21:435–448, 2002. © 2002 Wiley‐Liss, Inc.     

The evolution of hormonal therapy for prostatic carcinoma

It is well recognized that testosterone has a number of untoward effects on prostatic carcinoma and that castration is associated with significant tumor shrinkage and resolution of symptoms of advanced prostatic carcinoma. Approaches to hormonal therapy have evolved significantly over the last several decades. Initially castration was utilized, which provided effective reduction of testicular androgens, but with adverse psychological factors. The next approach was utilization of diethylstilbestrol, but with significant cardiovascular toxicity in higher doses. The development of the luteinizing hormone-releasing hormone agonists provided an improvement in pharmacologic castration; however, they are associated with a transient testosterone surge and the potential for exacerbation of clinical manifestations of advanced prostate carcinoma (the so-called "testosterone flare"). Recently, gonadotropin-releasing hormone (GnRH) antagonists have been investigated. Abarelix is a pure GnRH antagonist that blocks the anterior pituitary receptor, resulting in prompt and significant reduction not only of luteinizing hormone but also follicle-stimulating hormone. This results in castrate levels of testosterone while avoiding the testosterone surge.     

Pituitary Androgen Receptor Signalling Regulates Prolactin but Not Gonadotrophins in the Male Mouse

Production of the androgen testosterone is controlled by a negative feedback loop within the hypothalamic-pituitary-gonadal (HPG) axis. Stimulation of testicular Leydig cells by pituitary luteinising hormone (LH) is under the control of hypothalamic gonadotrophin releasing hormone (GnRH), while suppression of LH secretion by the pituitary is controlled by circulating testosterone. Exactly how androgens exert their feedback control of gonadotrophin secretion (and whether this is at the level of the pituitary), as well as the role of AR in other pituitary cell types remains unclear. To investigate these questions, we exploited a transgenic mouse line (Foxg1^Cre/+; AR^fl/y) which lacks androgen receptor in the pituitary gland. Both circulating testosterone and gonadotrophins are unchanged in adulthood, demonstrating that AR signalling is dispensable in the male mouse pituitary for testosterone-dependent regulation of LH secretion. In contrast, Foxg1^Cre/+; AR^fl/y males have a significant increase in circulating prolactin, suggesting that, rather than controlling gonadotrophins, AR-signalling in the pituitary acts to suppress aberrant prolactin production in males.     

A simple test for the hormonal assessment of early puberty in boys

The initial hormonal changes in male puberty occur at nighttime, with episodic rises of LH and testosterone (T). Only much later do the daytime levels of these hormones rise. Nocturnal sampling is impractical for routine clinical assessment, so we have examined the relationship between peak nocturnal T levels and those produced in the same subject by a single intravenous injection of gonadotrophin releasing hormone (GnRH, 100 micrograms) in the morning. Nocturnal T profiles and daytime GnRH tests have been conducted in eight boys in early (delayed) puberty, three with pubertal gynaecomastia in later puberty, two normal men, and one man with gynaecomastia. Excellent agreement was obtained between peak nocturnal and post-GnRH T levels. The serum testosterone level 3 hours after 100 micrograms IV GnRH is a simple and useful hormonal marker of pituitary-Leydig cell activity during puberty.     

First ovarian response to gonadotrophin stimulation in rats exposed to neonatal androgen excess

This study analyzes the effects of neonatal androgenization on follicular growth and first ovulation in response to gonadotrophins, using a model of exogenous stimulation or the use of subcutaneous ovary grafts in castrated animals to replace the hypothalamus–pituitary signal. Neonatal rats (days 1–5) were treated with testosterone, dihydrotestosterone or vehicle. At juvenile period, rats were stimulated with PMSG, hCG (alone or combined) or used as ovarian donors to be grafted on castrated adult female rats. Ovulation and ovarian histology were analyzed in both groups. Animals treated with vehicle or dihydrotestosterone stimulated with gonadotrophins (pharmacological or by using an ovary graft) ovulated, showing a normal histological morphology whereas rats exposed to testosterone and injected with the same doses of gonadotrophins did not it. In this group, ovulation was reached using a higher dose of hCG. Ovaries in the testosterone group were characterized by the presence of follicles with atretic appearance and a larger size than those observed in control or dihydrotestosterone groups. A similar appearance was observed in testosterone ovary grafts although luteinization and some corpora lutea were also identified. Our findings suggest that neonatal exposure to aromatizable androgens induces a more drastic signalling on the ovarian tissue that those driven by non-aromatizable androgens in response to gonadotrophins.     

Male contraception: expanding reproductive choice

The development of steroid-based oral contraceptives had revolutionized the availability of contraceptive choice for women. In order to expand the contraceptive options for couples by developing an acceptable, safe and effective male contraceptive, scientists have been experimenting with various steroidal/non-steroidal regimens to suppress testicular sperm production. The non-availability of a long-acting androgen was a limiting factor in the development of a male contraceptive regimen since all currently tested anti-spermatogenic agents also concurrently decrease circulating testosterone levels. A combination regimen of long-acting progestogen and androgen would have advantage over an androgen-alone modality since the dose of androgen required would be much smaller in the combination regimen, thereby decreasing the adverse effects of high steroid load. The progestogen in the combination regimen would act as the primary anti-spermatogenic agent. Currently, a number of combination regimens using progestogen or GnRH analogues combined with androgen are undergoing trials. The side effects of long-term use of androgens and progestogens have also undergone evaluation in primate models and the results of these studies need to be kept in view, while considering steroidal regimens for contraceptive use in men. Efforts are also being made to popularize non-scalpel vasectomy and to develop condoms of greater acceptability. The development of contraceptive vaccines for men, using sperm surface epitopes not expressed in female reproductive tract as source, still requires considerable research efforts.     

Regulation of primate testicular function by GnRH analogues

The potential of GnRH analogues for regulating testicular function is reviewed. Our experiments showed that constant infusion of GnRH agonists effectively suppressed testicular function in monkeys. In men, however, spermatogenesis could not be suppressed to achieve azoospermia uniformly. GnRH antagonists, although at much higher dosages than agonists, caused a more rapid and uniform inhibition of testis function. Spermatogenesis was reversibly disrupted at the spermatogonial level. Concomitant testosterone supplementation, used to maintain libido and potency, attenuated the antitesticular effects of GnRH analogues. In monkeys testosterone appears to stimulate spermatogenesis directly on the testicular level, while evidence has been obtained that in rats testosterone can also stimulate the release and synthesis of FSH under antagonist mediated blockage of pituitary GnRH receptors. When extrapolating to human studies special care has to be exerted in the selection of testosterone substitution regimens. Although the agonistic and antagonistic analogues of GnRH ultimately exert their antireproductive effects via inhibition of gonadotropin secretion the antagonists may have the greater potential for male fertility regulation due to quicker pituitary and testicular suppression.     

Gonadotropin releasing hormone (GnRH) agonists in male contraception

A potent gonadotropin releasing hormone (GnRH) agonist, D(Nal2)6 GnRH (Nafarelin) has been administered to two groups of normal men for 16 weeks by two routes in order to assess its effectiveness in suppressing spermatogenesis. In this report 400 micrograms of the GnRH agonist was given daily by constant subcutaneous infusion and the results compared to an earlier study in which 200 micrograms of the same agonist was given as a single daily subcutaneous injection. All subjects in both groups received an intramuscular injection of testosterone enanthate (200 mg) every two weeks to prevent symptoms of androgen deficiency. The higher dose infusion regimen was much more effective in suppressing spermatogenesis than the single daily injection. With infusion treatment, 3 of 7 subjects were azoospermic, a fourth subject had less than 1 million sperm per ml of semen and 5 of 7 subjects had sperm counts less than 5 million per ml. Because of the differences in GnRH dose it is unclear if the enhanced effect seen in the infusion group is the result of the route or dose of drug. Data from experimental animals and short term comparative studies with two routes and two doses suggest that both mechanisms may be operative. In either case, the results are the most promising to date and raise the possibility that constant delivery of a higher dosage of agonist could produce azoospermia in most or all subjects.     

Effect of injection of gonadotrophin-releasing hormone on testicular steroidogenesis in the hypogonadal (hpg) mouse

Hypogonadal (hpg) mice were injected once daily with 10 ng, 50 ng or 1 microgram GnRH for 5, 10 or 20 days or 12 times daily with 4.2 ng GnRH for 5 days. Basal and hCG-stimulated production in vitro of androstenedione, testosterone and 5 alpha-androstane-3 alpha,17 beta-diol (androstanediol) were measured by radioimmunoassay. All doses of GnRH increased testicular weight and in-vitro androgen production although seminal vesicle weights were unchanged and serum testosterone concentrations remained undetectable. After 5 days' treatment androstenedione and androstanediol were the dominant androgens produced, the latter indicating the presence of high levels of 5 alpha-reductase. By 20 days testosterone production was predominant after treatment with higher doses of GnRH. Total androgen production (androstenedione + testosterone + androstanediol) after 5 and 10 days was similar at all concentrations of GnRH used. After 20 days' treatment total androgen production was significantly greater with 50 ng GnRH/day than with 10 or 1000 ng/day. Multiple daily injections of 4.2 ng GnRH (total dose 50 ng/day) had no greater effect on androgen production in vitro compared to single daily injections of 50 ng. This suggests that under the conditions used in this study the testis does not require pulsatile release of the gonadotrophins. The pattern of [3H]pregnenolone metabolism was measured after 5 days injection of 50 ng GnRH/day. Compared to control hpg animals there was a significant increase in formation of C19 steroids, synthesis being solely through the 4-ene pathway. These results show that GnRH treatment of hpg mice will induce testicular steroidogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)     

L'andropause

In men, aging is associated with progressive impairment of testicular function. Decrease in total testosterone levels with aging has been reported in many studies in normal healthy men. This decrease has a primarily testicular origin, as shown by decreased number of Leydig cells in histological studies, increased basal gonadotropin levels and decreased response to hCG. A greater decrease in bioavailable testosterone rather in than total testosterone concentrations is explained by the age-dependent increase in the SHBG concentration. Although immunoreactive gonadotropin levels are higher than in young men, a relative alteration of bioactive gonadotropin secretion by the pituitatry occurs in ederly men. Althought the definitive demonstration of an alteration of GnRH secretion by the hypothalamus cannot be established in healthy ederly men, such an alteration might be responsible for a decompensation of the testicular function in case of intercurrent illness. Increased FSH and decreased inhibin plasma levels are indicating a similar alteration in seminiferous tubules as directly demonstrated by histological data showing a decrease of Sertoli cell number and daily sperm production with aging. Although the incidence of sexual dysfunction increases with aging, the relationship between sexual behaviour and testicular endocrine function remained a mater of controversy. A threshold of testosterone action on sexual behavior might be responsible for the difficulty in establishing this relationship. Although some controled studies are available, the risk-to-benefit balance of androgen substitution in older male remained a controversial issue. A positive effect on sense of well-being and/or libido has been and the lack of adverse effect on lipid and carbohydrate metabolism had been demonstrated in short term studies, however, the role of androgens in the benign hypertrophy of the prostate and in stimulating the growth of latent prostate adenocarcinoma remained to be more clearly established by longterm controlled studies.     

Androgens in the demography of male life course--a review

While the basics of testosterone production, effects and metabolism have been known for decades, there has been a flow of novel insights in the genomics of testosterone action on a molecular and cellular level, as well as in the clinical effects from modern clinical trials, improving the understanding of the role of testosterone in male life course. Androgens are produced under the control of an endocrine cascade from GnRH via gonadotropins to the testicular Leydig cells. In some organs, testosterone is reduced to 5alpha-dihydrotestosterone prior to the receptor binding by the 5alpha reductase. The androgen receptor gene is located on the X chromosome in the q11-12 region, each mutation in the gene will induce phenotypic manisfestations. In the first stage of the male life course, testosterone moderates the male embryonic development under the control of a complex molecular genetic network. The next important phase of male maturation is the puberty, in which testosterone levels increase and induce the development of somatic and psychological characteristics of male sexuality. In the adult male, testosterone maintains sexual functions and fertility. In aging men, testosterone levels decrease slowly. Testosterone supplementation in the aging male is able to restore the function of androgen target organs only in part.     

Maternal dietary carotenoids mitigate detrimental effects of maternal GnRH on offspring immune function in Japanese quail Coturnix japonica

Maternal resources deposited in eggs can affect the development of several offspring phenotypic traits and result in trade‐offs among them. For example, maternal androgens in eggs may be beneficial to offspring growth and competitive ability, but detrimental to immunocompetence and oxidative stress. In contrast, maternal antioxidants in eggs may be beneficial if they mitigate oxidative stress and immunosuppressive effects of androgens. We investigated possible interactive effects of maternal steroids and carotenoids on aspects of offspring physiology and phenotype, by simultaneously manipulating levels of androgens (via gonadotropin‐releasing hormone, GnRH‐challenges) and carotenoids (via diet supplementation) in captive female Japanese quail Coturnix japonica during egg laying. Carotenoid supplementation of hens, which elevates yolk concentrations of carotenoid and vitamins A and E, enhanced egg hatching success, offspring survival to age 15 d, and size of the bursa of Fabricius in offspring. In contrast, repeated maternal GnRH challenges, which elevated yolk testosterone concentrations, enhanced offspring neonatal size, but negatively affected bursa size. However, interaction among the treatments suggests that the positive effect of maternal carotenoid supplementation on plasma bactericidal capacity was mediated by maternal GnRH challenges. Chicks originating from carotenoid‐supplemented hens were less immunosuppressed than those originating from carotenoid‐supplemented + GnRH‐challenged hens, which were less immunosuppressed than chicks from GnRH‐challenged females not supplemented with carotenoids. Females availability of carotenoid enriched diets allows them to enhance the development of offspring immune system via carotenoids and vitamins deposited in egg yolks and offset detrimental effects of androgens deposited by GnRH‐challenged females.