What Are the Signs of Elevated Testosterone?

The testis is the main sex organ of the male, and its function is to produce sperm, which combines with the eggs to form new individuals, thereby ensuring the continuation of the human race. another

Testis-free: detailed plan view of testis

No testis

There is no testicular disease, and the disease is caused by complete atrophy of the testicles due to infection, trauma, vascular embolism or testicular torsion during the embryonic stage. Adolescent men do not develop secondary sexual characteristics, and the external genitalia remain immature, without testicles. If androgen treatment is not given early, eunuchs will appear. If there are residual and ectopic mesenchymal cells that secrete androgens, moderate secondary sexual characteristics can occur. Blood testosterone levels are low and gonadotropins are significantly increased. Testosterone does not increase after HCG stimulation.

Testosterone-free overview

The testis is the main sex organ of the male, and its function is to produce sperm, which combines with the eggs to form new individuals, thereby ensuring the continuation of the human race. another

Testis-free: detailed plan view of testis

In addition, it also secretes androgens, which can stimulate spermatogenesis and the development of male accessory organs and parasexual characteristics. Therefore, whether it is congenital developmental disorders or acquired testicular lesions caused by many factors, can cause infertility.

Causes of no testicular disease

1. During the development of the embryo, some factors interfere with the development of gonads. Lobacarro et al. Believe that the abnormality of the SRY gene on the sex-determining region of the Y chromosome may cause testicular arrhythmia.

2. Testicular torsion of spermatic cord blood vessels during pregnancy or shortly before or after birth may cause testicular atrophy due to blocked testicular blood flow supply.

Early symptoms of no testis

1) In the absence of unilateral testicles, the penis and scrotum develop normally. Due to the compensatory hyperplasia of the healthy testicles, the testosterone levels in the blood are normal, and the secondary sexual characteristics in puberty are normal. In the absence of bilateral testis, the patient has no developmental ability and develops in the form of eunuchs, showing subcutaneous fat plumpness, delicate skin, and sharp tone. Physical examination revealed scrotal dysplasia and empty testicles in the scrotum. The penis is small with no pubic hair growth.

2) Testicular defect is usually diagnosed during cryptorchidral surgery, which is about 3.3% of cryptorchidral surgery. About 20% of patients who cannot reach the testes before surgery cannot find the testes.

3) If the diagnosis of congenital testicular defect is difficult, the existence of cryptorchidism or ectopic testicles must be ruled out. In particular, it should be distinguished from inaccessible bilateral cryptorchidism.

Testicular characteristics

Patients often come for diagnosis due to primary amenorrhea and infertility;

Female form and female fat distribution, with female habits;

Has normal female breasts, but less breast tissue, slightly smaller or normal nipples;

Sparse or absent armpit hair and pubic hair;

There are female external genitalia, labia minora is underdeveloped, clitoris is normal or small, and the vagina is blind capsule;

Female genitalia is absent or underdeveloped;

The genital glands are undescended testes, and the tissue morphology is similar to testes.

Testis-free pathogenesis

At 8 weeks of gestation, testicular tissues begin to develop and secrete anti-Müllerian hormone (AMH). Testosterone is secreted if testicular tissue is lost before secreting testosterone. Müller's canal has been degraded butrogen-dependent Wolff tube differentiation and genitourinary sinus and external genitalia The virilization has not yet begun. If the testicular tissue originally exists and secretes testosterone for a period of time, the androgen-dependent urogenital target organs will develop more or less toward men.

Patients with congenital bilateral asymptomatic disease with AMH secretion and no testosterone secretion appear as male pseudohermaphroditism. Female patients with external genitalia have not only Müller tube-derived gonads (fallopian tube uterus and upper vagina) nor Wolff tube-derived gonads. Organs (epididymal vas deferens and seminal vesicles) If the testicular tissue secretes testosterone during embryonic development, then the external genitalia are male-type Wolff tube-derived gonadal organs that can develop small penis, to a certain extent, it reflects that embryonic development is a testosterone-dependent organ Developmental stagnation If there is no treatment for patients with congenital bilateral testicular disease, pubertal development will stagnate and present a typical testicular-like appearance. Because unilateral testicles can meet the needs of physiological functions, patients with unilateral congenital testicular disease will not. The appearance of adolescent gender developmental abnormalities but the possibility of unilateral Müller tube remnants depends of course on the timing of testicular tissue loss.

Testicular disease classification

(1) Absence of testicles.

(2) Deficiency of part of testis, epididymis and vas deferens.

(3) Deficiency of testis, epididymis and vas deferens. Its etiology is unknown, and testicular atrophy may be caused by toxin damage during embryonic stage or secondary to occlusion and trauma of blood vessels. Unilateral anesthesia mostly occurs on the right side and is often accompanied by the contralateral cryptorchidism. Due to lack of mesenchymal cells that secrete male hormones, bilateral testes often lead to abnormal gender and comorbid eunuchia. There are also individuals who do not have esophageal-like disease, and may have ectopic mesenchymal cells.

No testicular diagnosis

1) The sex hormone test has certain guiding significance in judging the presence or absence of testes and deciding whether to conduct surgical exploration. The bilateral testes cannot be touched in time if LHFSH is elevated. Intramuscular injection of chorionic gonadotropin (HCG) 1000-1500U once every other day for a total of 3 A second follow-up review of serum testosterone elevation may confirm the diagnosis of congenital testicular deficiency. Surgical exploration is not required.

2) Invasive tests, such as testicular arteries or venography, have low accuracy and have certain complications. Non-invasive tests such as B-mode CTMRI are not specific and can only be used as a reference. Currently, laparoscopic techniques can be used as a reference. Safe and accurate diagnosis of abdomen cryptorchidism and testicular absence to avoid blind investigation.

3) If serum testosterone levels increase after injection of HCG or LHFSH does not increase although there is no change in serum testosterone, at least one testis is required for surgical exploration.

4) Patients with congenital bilateral testicular not only can't find testicular tissue histologically and can't find testicular function from endocrine function. Children's serum follicle stimulating hormone (FSH) and plasma luteinizing hormone (LH) have been found in children. When it reaches puberty, it rises to the level of castration while the level of testosterone is very low. ^[1]

Testicular Treatment

Unilateral testis deficiency. Because the contralateral testis is normal and no other malformations are needed, no treatment is needed. From a patient's psychological perspective, artificial testicles can be implanted into the scrotum as prostheses. The shape and feel of the prosthesis are satisfactory except for the non-function.

Insufficient bilateral testicles, infants and young children can be considered for transsexual surgery, clitoroplasty for puberty, and vaginoplasty for early determination of gender. Raising girls can reduce the anxiety of their parents. If denial surgery is rejected, sex hormone therapy should be applied early. Testosterone promotes penile and scrotal development.

Insufficient bilateral testicles. Adolescent availability of hormone replacement therapy. Intramuscular injection of testosterone to promote virilization. Bilateral testicular infertility cannot be treated. To meet the patient's psychological needs, artificial testicles can be implanted in the scrotum as a prosthesis. Allogeneic testicular transplantation Allogeneic testicular transplantation is the same as other organ transplants. Preoperative tissue matching excludes testicular epididymis and vas deferens.

Testosterone-free preventive care

1. Loose boxer briefs better prevent testicular abnormalities. Loose draping is the best way to keep the natural shape of the eggs, so boxers are better than skinny briefs and a good way to prevent abnormal testicles.

2, testicular abnormalities should pay attention to "sit" class to strengthen physical exercise. Sitting more than 10 hours a day is more likely to get testicular cancer, which is a testicular abnormality that requires special attention.

3. Check the testicles by yourself. It should feel like a solid boiled egg, smooth and strong, but not hard. You must pay attention to any lumps and hard areas, and you can't ignore them if you have abnormal testicles.

4, to reduce testicular abnormalities to reduce fat foods. A high-fat diet can interfere with testosterone production. Related to the appearance of testicular abnormalities. Therefore, it can be said that it is not that men who eat large pieces of meat and drink in large bowls are more masculine. They are likely to be useless, but those who have a light diet, a regular life, exercise regularly, and seem to be more restrained in their lives. Sexual ability, so it is important to prevent testicular abnormalities. ^[2]

Testes without diagnosis

The diagnosis of testicular arrhythmia should be mainly differentiated from cryptorchidism, especially those without bilateral testis. Testicular bilateral lack of general sexual function, while cryptorchidism can still maintain male sexual function. Determination of blood testosterone levels can assist in differential diagnosis. The method is that after a single injection of chorionic gonadotropin 5000U, testosterone in patients with cryptorchidism significantly increases. If there is a chromosomal abnormality, it should be considered as a gender abnormality.

When the testis is absent, there is no fertility because the interstitial cells that do not secrete androgens do not have germ cells. If the diagnosis is clear, the main treatment is to supplement the androgen reasonably and timely, so that the patient's external genitalia can develop better. However, if androgen is used prematurely, it can close the epiphysis and affect the development of the body. Testosterone levels should be measured regularly during medication to adjust the dose of the drug. "Artificial testicle" implantation can to a certain extent soothe the patient's psychological inferiority and reduce mental trauma. ^[3]