The most frequently reported cause of subfertility in males with CAH is the presence of adrenal rest tumors in the testes (5,6,9). These tumors may interfere directly (mechanically or paracrine) or indirectly (endocrine) with testicular function (10,11). Subfertility can also be caused by gonadotropin deficiency resulting from suppression of the hypothalamic-pituitary-gonadal axis by adrenal androgens (both directly and after conversion to estrogens) (12-14). Other testicular abnormalities and psychological problems may also be important (2). The next sections focus on these topics separately, although in practice, these factors may not be separated easily.
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