Pituitary Gland Abnormalties
Case: 33 year old male with a history of unproven fertility, an unremarkable medical history, a semen analysis revealing oligospermia (a reduction in the concentration of sperm), and a hormone evaluation revealing an elevated concentration of both LH and testosterone (with a normal FSH concentration).
Question: What should be considered given this information?
The cause of oligospermia often remains unclear. However, a basic male factor evaluation should be completed, including a medical history, reproductive history, formal semen analyses on at least 2 different occasions, physical examination (usually by a Urologist), and hormone evaluation (including FSH, LH, Testosterone, and Prolactin).
If there is an elevation in both the LH and Testosterone concentrations, one should suspect and rule out the possibility of a pituitary LH secreting tumor. Pituitary LH and FSH secreting tumors are not common, but have been found more often in men than in women. If there was an elevation in the LH concentration due to testicular failure (the more common cause for elevated concentrations of LH) then one would also expect to find a suppressed concentration of testosterone and an elevated concentration of FSH.
Radiologic testing is appropriate in this context, with MRI having outstanding resolution when imaging the brain.
Case: 38 year old male with a history of unproven fertility, an unremarkable medical history, a normal semen analysis, impotence, and a hormone evaluation revealing an elevated concentration of prolactin.
What should be considered given this information?
The cause of the impotence may be the excess circulating prolactin. Prolactin appears to reduce libido (sex drive) and cause impotence by suppressing GnRH, FSH, LH and androgenic hormone concentrations. Supplementation of testosterone (an androgenic hormone) most often does not restore libido or normal erectile function unless the prolactin concentrations are also (concurrently) brought down into the normal range.
Erectile or ejaculatory problems most often are thought to have a psychological basis (cause). However, they can also be due to hormone imbalances, nervous system abnormalities, or vascular disorders. Also, some medications can result in impotence.
Poor quality erections may not be able to deposit the semen completely within the vaginal canal. Long term impotence may result in abnormal androgenic hormone concentrations and this may subsequently impair the production of normal sperm.