Thyroid gland, previously supposed not tohave any impact on spermatogenesis andmale fertility, are now being recognized ashaving important role in male reproduc-tive functions. Most of the studies on theeffectof thyroidhormonesonmalefertilitywereconductedbetweentheyears1970and2000 (1). The effects of thyroid hormonealterationsonthereproductivesystemhavebeen studied extensively in human sub-jects and animal models that have gener-ally shown that changes from normal thy-roid function resulted in decreased sexualactivity and fertility (2,3). The underly-ing mechanisms,however,are not constantthroughout all species, and results fromdifferent studies disagree (4).In rats rendered thyrotoxic by T4resulted in decreased serum gonadotropinlevels (5), decrease in total lipids, cho-lesterol, and phospholipids in testes, andsynthesize increased amounts of testos-terone(6).Inimmaturemalemiceagedlessthan 4weeks,the administration of slightlysupra-physiological T4 doses resulted ina tendency toward early maturation andshortening of development period. Con-versely, larger TH doses resulted indecreased testes weights and seminal vesi-cles, both in mice and rabbits (3). Directeffects of T4 resulted in minimal oxygenconsumption changes in testes when T4was present in testicular slice incubations(7). Finally, the effects of T4 on spermato-genesis are conflicting (8), but it wouldappear that T4 does not exert a direct effecton spermatogenesis in mature rats or rams(9). In rats, T3 affects testis maturation,and thyroid receptor (TR) type-1 (TR-1)expression in rats’ testes (10,11). Maxi-mal Sertoli cell proliferation coincides withmaximal T3 binding capacity in testis, sug-gesting that the main target of T3 action istheSertolicell.However,T3alsoplaysasig-nificant role in differentiation of the semi-niferous epithelium,and studies in rodentshave shown that T3 is an important factorin maturation of Leydig cells. The presenceof T3 is necessary to initiate differentiationof mesenchymal cells into Leydig progeni-torcells,andT3worksinconcertwithotherhormones [luteinizing hormone (LH) andIGF-I] to promote Leydig cell development(12). Data from other animal species (suchas deer, sheep, cattle, birds, and mink) alsosuggest that T3 is a component of the neu-roendocrine system that regulates seasonalcycles of reproductive activity (13). Theunderlying mechanisms postulate that T3triggers cessation of reproduction at theend of the reproduction season becausecirculating T3 levels in deer rise at thetime of seasonal transition to the non-breeding state and thyroidectomy resultsin the absence of seasonal regression ofthetestis(14,15).Hypothyroidisminducedor occurring soon after birth was associ-ated with marked sexual maturation anddevelopment delays in animals (16). Ratsmade hypothyroid transiently by propy-lthiouracil (PTU) administration showeda decrease in testicular size, retardation inSertoli cell differentiation, and prolonga-tion of Sertoli cell proliferation time (17).When the rats became older and returnedto a euthyroid status, there was an increaseintestissize,Sertolicellnumber,andspermproduction (18). In other studies whereexperimental hypothyroidism in rats andrams was left untreated for more than1month, there was an arrest of sexualmaturity, decreased testosterone concen-tration as well as an absence of libido andejaculate (6,19). It would therefore appearthat hypothyroidism affects the immature,but not the mature, testis. Pekary and Sat-tin (20) showed that both hypothyroidismand castration reduced TRH levels (20).The two most common types of thyroiddiseases are hypothyroidism and hyper-thyroidism. Studies assessing the role ofhypo- and hyperthyroidism in male infer-tility have also been conducted in humansubjects. Hypothyroidism may result ina decrease in the sex hormone bindingglobulin (SHBG) levels and a decreasein total serum testosterone levels, as wellas a decrease in the LH and the folliclestimulating hormone (FSH) levels (21). Incases of prolonged pre-pubertal hypothy-roidism due to drop in LH and FSH lev-els, the Leydig and Sertoli cells, respec-tively are less stimulated to differentiateinto mature cells, negatively affecting sper-matogenesis. This increases the number ofcells in the testes but decreases the num-ber of mature cells. Thus, in patients withhypothyroidism, increased testicular size isobserved along with a significant drop inmature germ cells within the seminifer-ous tubules (22,23). Fortunately, hypothy-roidism is very rare in males with anoccurrence rate of only 0.1% in the gen-eral population (21). Among the studieson human subjects, Corrales Hernandezet al. (24) analyzed blood and semen sam-ples of patients with primary hypothy-roidism (24). The study concluded thathypothyroidism adversely affected semenquality by compromising semen volumeand progressive sperm motility. Krassas
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