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Presenter R1 洪士鈞 Supervisor VS 張宏江

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).

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Presenter R1 洪士鈞 Supervisor VS 張宏江

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  1. Presenter R1 洪士鈞 Supervisor VS 張宏江

  2. Outline • Case • Literature review • Anabolic-androgenic steroids • BCS • Use • Physiology • Clinical: Infertility

  3. Basic Data • 33 M • American • Married • Underlying (-) • A/B/C (-) • Family hx(-) • Op hx: abd penetration trauma (gun shot)

  4. History & Treatment course • Chief complaint • Infertility since last year • Ever fertile in 17 y/o • No vasectomy or testicular trauma

  5. History & Treatment course • GYN OPD • Semen analysis: Azoospermia • FSH: 0.146 • LH: <0.1 • Testosterone: 3.37 • Prolactin: 8.72 • Chromosome: 46,XY • AZF(Azoospermia Factor): no abnormality  Urology OPD

  6. 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

  7. History & Treatment course • PE: • BH/BW: 172 cm / 105 kg • Pubic hair (+) • Scrotum:

  8. History & Treatment course • Lab

  9. History & Treatment course • Imp: • Secondary infertility, exogenous hormone related hypogonadotropic hypogonadism • Treatment: • Gonal-F 150IU SC TIW x 3 months • Response • sperm(+) • FSH: 6.63 • LH: 5.03 • Testosterone: 3.43

  10. Anabolic steroids and male infertility: a comprehensive review Guilherme Leme de Souza and Jorge Hallak BJUI 2011

  11. Anabolic-androgenic steroids(AAS) • Testosterone & synthetic derivatives • 3 million users in USA • 2/3 out layers • 15-25% dietary supplement

  12. Testosterone • Androgenic effect • Secondary characteristic • Hair • Sebaceous • Spermatogenesis • Libido • 300-1000 ng/dL (3-10 ng/mL)

  13. Anabolism • Nitrogen retained in lean body mass • Synthesis ↑ • Breakdown ↓ • Myotrophic-androgenic index • Dose dependent

  14. Classification • Route • Oral • Alkyl substitution  hepatic problem • Parenteral • Effect • Testosterone-like • DHT-like • Nandrolone-like

  15. How to Use AAS • Stacking • Multiple agents with small dosage • Cycling • Mass-building cycle • Testosterone + Nandrolone • Cutting cycle • Low-estrogenic androgen • Post cycle therapy • Anti-estrogen or hCG

  16. Physiology • Direct • Erythropoiesis • Lipolysis • Protein synthesis • Hair & Sebum • Indirect • Anti-glucorticoid

  17. Side effect • Acne, Alopecia • LUTS • Gynecomastia • CV • Liver • Psychiatric • Mortality: 4.6 times higher • Discontinuation: ED, Libido loss

  18. AAS abuse & Infertility Laydig / Sertoli

  19. AAS abuse & infertility • After discontinue AAS • Quantity recover in 4-12 months • Quality persist longer • Mostly became fertile • Conservative vs. Active treat? • hCG • Human menopausal gonadotropin (hMG) • Recombinant FSH

  20. Take home massage • AAS • Anabolic and androgenic effect • Infertility: Sperm quantity & quality • Other side effect, mortality • May spontaneous recover in 4-12 months • May treat with gonadotropic agent

  21. Thanks for your attention!

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