An understanding of the hypothalamic-pituitary-gonadal axis is vital for the management of men with infertility and erectile dysfunction (ED). The commonly encountered hormones include—

• LHRH—luteinizing hormone releasing factor

• LH—luteinizing hormone

• FSH—follicle-stimulating hormone

• Testosterone

Pulses of LHRH from the hypothalamus stimulate LH and FSH release from the anterior pituitary.

• LH stimulates testosterone production from Leydig cells of the testis

• FSH stimulates Sertoli cells in the seminiferous tubules to produce mature sperm

• Production of inhibin is increased by FSH release, and this effects a negative feedback to the pituitary to decrease FSH release

Testosterone acts—

• Locally (within the testis to aid spermatogenesis)

• Systemically (to produce male secondary sexual characteristics, anabolism, and libido)

• To have a negative feedback on the hypothalamus/pituitary to inhibit LHRH secretion.

Prolactin (produced by the anterior pituitary)—

• Role in men not completely understood

• Thought to increase concentration of LH receptors in Leydig cells (and therefore increase testosterone levels)

• Enhances the effects of testosterone and helps maintain libido

Table 2.8 highlights some of the common features related to sex hormones in males.

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