Case Study for Chapter

Steroid Abuse

A 30-year-old man and his 29-year-old wife have been trying to have a baby. She has been having regular menstrual cycles. They have intercourse 2 to 3 times a week, with no physical problems, and try to time intercourse around the time of her ovulation.

Physical examination and history for the wife are normal. The husband's physical examination reveals a muscular man with an excellent physique who works out regularly to build his body. His testes are small and soft. Laboratory results indicate that his plasma testosterone is 1850 ng/dL (normal, 300 to 100 ng/dL) and LH < 2 |U/mL (normal, 3 to 18 |U/mL). His semen analysis reveals a sperm count of 1.2 X 106/mL (normal, >20 X 106/mL)

Questions

1. What is the major reason for the failure of the wife to get pregnant?

2. What is a reasonable explanation for the abnormal hormone levels?

Answers to Case Study Questions for Chapter 37

1. He has an extremely low sperm count.

2. Since he is a body builder with small, soft testes, high testosterone levels, and low LH levels, the physician should suspect androgen abuse or possibly androgen-producing tumor (extremely rare). The high androgen levels would suppress LH secretion and reduce intratesticular testosterone levels. The low LH and intratesticular testosterone would correlate well with small testes and low sperm count, respectively.

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