Chapter 21: Gonadal Function
By Marissa Grotzke
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes
Paired, ovoid organs
Dual functions
1. Production of sperm
2. Production of reproductive steroid hormones
Testosterone
In embryonic stage, aids in development & differentiation of
primordial gonads
After puberty, helps with sperm production & maintains
secondary sexual characteristics
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Functional Anatomy of the Male Reproductive Tract
Testes are located outside body, encased by a muscular sac.
Blood flow & contraction of dartos muscle regulate temperature of
testicles to 2C below core body temperature, which is vital to sperm
production.
Spermatic cord can retract testicles into inguinal canal when injury is
threatened.
Composed of 2 anatomic units:
Seminiferous tubules: contain germ & Sertoli cells (sperm
production)
Interstitium
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Physiology of the Testicles
Spermatogenesis
Spermatogonia: stem cells that form sperm
Spermatogonia undergo mitosis & miosis; haploid cells
transform to form mature sperm.
Mature sperm has head, body, & tail so it can swim.
Hormonogenesis
Testosterone: controlled by FSH & LH, which are produced
by gonadotrophs
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Physiology of the Testicles
Hormonal control of testicular function
Hypothalamus generates GnRH in pulsatile manner.
Testosterone is principal androgen hormone in blood.
Testosterone concentration fluctuates in a circadian fashion.
Cellular mechanism of testosterone action
Testosterone enters cell & converts to DHT.
DHT complexes with intracellular receptor protein, & this complex
binds to nuclear receptor, effecting protein synthesis & cell
growth.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Physiology of the Testicles
Physiologic actions of testosterone
Prenatal development: differentiation of male genital tract
Postnatal development: secondary sex hair, linear skeletal
growth, internal & external genitalia, muscles, voice deepens
Effect on spermatogenesis: paracrine effects (acting with
FSH) on seminiferous & Sertoli cells inducing spermatogenesis
Effect on secondary sexual effects: promotes growth of
various target tissues
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Disorders of Sexual Development and Testicular
Hypofunction
Hypergonadotropic hypogonadism
Klinefelters syndrome
Testicular feminization syndrome
5-alpha-reductase deficiency
Myotonic dystrophy
Testicular injury and infection
Sertoli-cell-only syndrome
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Disorders of Sexual Development and Testicular
Hypofunction
Hypogonadotropic hypogonadism
Kallmanns syndrome
Hyperprolactinemia
Age
Pituitary disease
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Diagnosis of Hypogonadism
Both clinical & biochemical features must be met.
Timing of sample must be considered (circadian rhythm).
Multiple estimation of free & bound levels done on different days
FSH and/or LH levels elevated in primary etiologies, but
inappropriately normal or low with secondary etiologies
Pituitary MRI should be done in secondary cases in young people.
Older people often have secondary or tertiary dysfunction.
Clinical signs & symptoms should be corroborated with low
testosterone levels.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Clinical diagnostic evaluation of male hypogonadism
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Testosterone Replacement Therapy
Parenteral testosterone
Intramuscular injection; most widely available & cost-effective
Transdermal testosterone therapy
Absorption from patch through skin; provides more physiologic levels
Testosterone gel
Gel applied to nongenital skin; risk of transmission to others
Buccal testosterone
Plastic tablet placed along gum line; local discomfort
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Testes (contd)
Monitoring Testosterone Replacement Therapy
Prostate-specific antigen (PSA), blood counts, & lipid levels
should be checked 36 months after initiation & yearly
thereafter.
Routine clinical evaluation for leg edema, sleep apnea, & prostate
enlargement
Pharmacologic use of testosterone may reduce sperm count.
If PSA is elevated, prostate evaluation with possible biopsy is
recommended.
Active prostate cancer is contraindication to testosterone
replacement.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary
Paired organs with dual functions
1. Gamete (ovum) production
2. Steroid hormone production
Primordial reproductive cells in female typically produce
solitary gamete.
Hormones from hypothalamus, pituitary, & ovaries
prepare uterus for implantation of embryo.
In absence of implantation, uterine lining is shed
(menses).
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary (contd)
Functional Anatomy of the Ovary
Oval-shaped organs that lie in pelvic fossa
Positioned near fimbrial end of fallopian tubes
Adult ovary measures 25 cm in length, weighs 14 g.
Contain 24 million primordial follicles, present at birth
Follicular phase: All but 1 recruited follicles in a cycle atrophy.
Graafian follicle: Remaining follicle contains maturing ovum.
Luteal phase: Graafian follicle releases ovum in response to LH.
Luteinization: Graafian follicle develops into corpus luteum.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary (contd)
Hormonal Production by the Ovaries
Estrogen: promotes breast, uterine, & vaginal development
Progesterone: induces secretory activity of endometrial glands
Androgens: in excess, lead to hirsutism, loss of female
characteristics, development of male secondary sexual features
Others
Inhibins A & B inhibit FSH production; activin enhances FSH
secretion & induces steroidogenesis.
Folliculostatin, relaxin, follicle regulatory protein, oocyte
maturation factor, meiosis-inducing substance
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary (contd)
The Menstrual Cycle
Starts on first day of menses (day 1)
Consists of two phases of parallel events occurring at ovaries &
endometrium
Follicular phase
Begins with onset of menses & ends on day of LH surge
A rise in FSH stimulates estrogen production.
Luteal phase
Starts with extrusion of ovum, about 36 hours after LH surge
Ends with onset of menses
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary (contd)
Hormonal Control of Ovulation
Central control of FSH & LH secretion resides in gonadotropinreleasing hormone (GnRH) pulse generator of arcuate nuclei &
medial preoptic nuclei of hypothalamus.
Positive & negative feedback responses exist among estrogen,
progesterone, LH, & FSH production.
A midcycle surge in LH production stimulates a series of events that
culminates in ovulation, with FSH levels falling thereafter.
Pubertal Development in the Female
Development of breast tissue (1st), pubic hair (2nd), menses (3rd);
measured by Tanner staging system
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary (contd)
Menstrual Cycle Abnormalities
Amenorrhea: absence of menses
Oligomenorrhea: infrequent or irregular menstrual bleeding
Hypogonadotropic hypogonadism
Deficiency of FSH & LH; can cause secondary amenorrhea
Hypergonadotropic hypogonadism
Ovarian failure with elevation of FSH concentrations
Polycystic ovary syndrome
Infertility, hirsutism, chronic anovulation, glucose intolerance,
hyperlipidemia or dyslipidemia, & hypertension
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The Ovary (contd)
Diagnostic approach to secondary amenorrhea
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Ovary (contd)
Hirsutism
Abnormal, abundant, androgen-sensitive terminal hair growth
Cause is most commonly idiopathic (60%) or PCOS (35%).
Should only be considered in context of womans ethnic origin
Measured using Ferriman-Gallwey scale
Nine areas: lip, chin, sideburn region, neck, chest, abdomen,
upper & lower back, & thigh
Allots points on a scale of 14 based on hair thickness &
pigmentation
Score of >8 is consistent with diagnosis of hirsutism.
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The Ovary (contd)
Estrogen Replacement Therapy
Remains a contentious issue
Womens Health Initiative study found the following in 16,608
postmenopausal women who underwent estrogen replacement
therapy:
Increased incidence of invasive breast cancer & venous clot
formation
No benefit in cognitive decline or coronary artery disease
Reduction in bone loss, colon polyp formation, & menopausal
symptoms (hot flashes, vaginal dryness)
Remains a treatment option in select women after risk counseling
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins