Abstract
Introduction: Evaluation of the hypothalamic-pituitary-testicular axis and sperm analyses are not a standard examination of patients with Relapsing-Remitting Multiple Sclerosis (RRMS).Methods: This is a prospective-case-controlled study. Patients, aged 18–55, with a confirmed diagnosis of RRMS, naïve to any DMT were enrolled. Controls were men with normal evaluation who acceded to the Andrology Center of Catania in a contemporary matched randomized fashion to the group of RRMS patients. The aim of the study is to evaluate gonadal steroids and sperm quality in men at the time of RRMS diagnosis and 12 months following the first disease modifying treatment (DMT).Results: Out of 41 patients with RRMS, 38 were included in the study (age 40.3 ± 12.3) to be compared with matched controls. Patients with RRMS showed no differences in gonadal steroids or sperm parameters, except for free testosterone (fT) plasma levels, which were lower in RRMS patients than controls (median 0.09 vs. 1.4, p < 0.0001). The correlation analyses, corrected for age and Body Mass Index, did not reveal any correlation between hormonal/sperm parameters and level of disability or disease activity at onset. Additionally, 12 months following the start of DMT, there were no differences in gonadal steroids and sperm quality compared to baseline.Conclusions: Results suggest that RRMS may not have an impact on fertility status but prospective long-term studies are needed.
Highlights
Evaluation of the hypothalamic-pituitary-testicular axis and sperm analyses are not a standard examination of patients with Relapsing-Remitting Multiple Sclerosis (RRMS)
98% of plasmatic testosterone (T) is irreversibly converted to the active metabolite 5α-dihydrotestosterone (5α-DHT), which binds the androgen receptor with a higher affinity than T. 5α-DHT is a DNA-binding ligand-activated transcription factor that regulates the expression of the target gene in many cell lines, including leukocytes [3, 4]
Controls were men with normal evaluation screened for gonadal steroids and sperm parameters who acceded to the Andrology Center of Catania in a contemporary matched randomized fashion to the group of RRMS patients
Summary
Evaluation of the hypothalamic-pituitary-testicular axis and sperm analyses are not a standard examination of patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Relapsing-remitting multiple sclerosis (RRMS) is a severe inflammatory degenerative disease of the central nervous system (CNS), with typical onset occurring in the third to fourth decade of life [1]. It has been suggested that the gender dimorphism may be linked to the effects of sex hormones on the immune system and parenchymal CNS cells. 5α-DHT is a DNA-binding ligand-activated transcription factor that regulates the expression of the target gene in many cell lines, including leukocytes [3, 4]. There are several important effects of T on immune function, such as the shift from the Th1 to Th2 phenotype, leading to an increased production of interleukin-5 (IL-5) and interleukin (IL-10) and decreased pro-inflammatory cytokines such as interferon-(IFL- γ), tumor necrosis factor-α (TNF-α), and interleukin-17 (IL-17), with a consequent impact on lymphocyte proliferation and differentiation. Several studies have described the neuroprotective effect of T, given its ability to cross the blood–brain barrier and directly act on neuronal cells [5, 6]
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