Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
J Urol. 2020 Sep;204(3):551-556. doi: 10.1097/JU.0000000000001016. Epub 2020 Mar 13.
Intratesticular testosterone is essential for spermatogenesis and can only be reliably measured with invasive testicular sampling. Previous studies have demonstrated good correlation between intratesticular testosterone and serum 17-hydroxyprogesterone (17-OHP) in men treated with human chorionic gonadotropin. Based on this observation we hypothesized that we can use serum 17-OHP as a serum biomarker for evaluating intratesticular testosterone in men receiving medications that alter serum testosterone.
Initially, we conducted a cross-sectional analysis of men with a single serum 17-OHP evaluation from July 2018 to March 2019. We followed this with a prospective analysis from July 2018 to October 2019 with evaluation of 140 men including fertile controls, and those receiving treatments that alter serum testosterone at baseline and after 3 months of therapy. According to the data distribution, we reported the median and interquartile ranges, and used the Mann Whitney U or Wilcoxon tests.
In the initial cross-sectional analysis of 93 men, a total of 30 men received treatments that increase or maintain intratesticular testosterone concentrations, such as clomiphene citrate and/or human chorionic gonadotropin; 21 men received treatments that suppress intratesticular testosterone concentrations (various exogenous testosterone replacement therapy formulations) and 42 fertile men with normal serum testosterone (greater than 300 ng/dl) were used as control. We demonstrated that serum testosterone levels were within normal range among men receiving the various therapies. In contrast, we found that serum 17-OHP was undetectable in men who received exogenous testosterone replacement therapy, as opposed to men receiving human chorionic gonadotropin and/or clomiphene citrate or fertile controls (p <0.05). In the prospective evaluation that ensued, 17-OHP values decreased in the 21 men who received testosterone replacement therapy (47.5 [21-70] to 13.5 [10-23] ng/dl, p <0.05). Conversely, 17-OHP increased in the 55 men who received human chorionic gonadotropin and/or clomiphene citrate when compared to their baseline levels (42 [24-72] to 88 [61-135] ng/dl, p <0.05).
Serum 17-OHP appears to be a reliable serum marker for intratesticular testosterone levels and could potentially be used to titrate or change medications that alter intratesticular testosterone.
睾丸内的睾酮对于精子发生至关重要，只能通过侵入性睾丸采样可靠地测量。先前的研究表明，在接受人绒毛膜促性腺激素治疗的男性中，睾丸内睾酮与血清 17-羟孕酮（17-OHP）之间存在良好的相关性。基于这一观察结果，我们假设我们可以使用血清 17-OHP 作为评估接受改变血清睾酮药物治疗的男性睾丸内睾酮的血清生物标志物。
最初，我们对 2018 年 7 月至 2019 年 3 月期间接受单次血清 17-OHP 评估的男性进行了横断面分析。随后，我们进行了前瞻性分析，纳入了 140 名男性，包括生育控制组和基线及治疗 3 个月后接受改变血清睾酮治疗的男性。根据数据分布，我们报告了中位数和四分位间距，并使用了 Mann-Whitney U 或 Wilcoxon 检验。
在最初的 93 名男性横断面分析中，共有 30 名男性接受了增加或维持睾丸内睾酮浓度的治疗，如克罗米芬和/或人绒毛膜促性腺激素；21 名男性接受了降低睾丸内睾酮浓度的治疗（各种外源性睾酮替代疗法制剂），42 名生育控制组男性的血清睾酮水平正常（大于 300ng/dl）作为对照。我们表明，接受各种治疗的男性的血清睾酮水平均在正常范围内。相比之下，我们发现接受外源性睾酮替代治疗的男性的血清 17-OHP 无法检测到，而接受人绒毛膜促性腺激素和/或克罗米芬或生育控制组的男性则可以检测到（p<0.05）。在随后的前瞻性评估中，21 名接受睾酮替代治疗的男性的 17-OHP 值下降（47.5[21-70]至 13.5[10-23]ng/dl，p<0.05）。相反，与基线相比，接受人绒毛膜促性腺激素和/或克罗米芬的 55 名男性的 17-OHP 增加（42[24-72]至 88[61-135]ng/dl，p<0.05）。
血清 17-OHP 似乎是睾丸内睾酮水平的可靠血清标志物，可能可用于滴定或改变改变睾丸内睾酮的药物。
