Disorders of sperm production can be classified quantitatively as oligospermia (low sperm count) or azoospermia (no sperm during ejaculation). Numerous genes have been implicated in spermatogenesis. We describe a case of two identical twins who presented with different reproductive capabilities. One brother was infertile due to azoospermia, and the other, although oligospermic, previously naturally fathered a child. They were found to have differential gene expression based on RNA sequencing analysis. In the man with azoospermia, we found elevated E2F1 and HOXB9 gene expressions when compared with his brother, suggesting that the increased RNA expression of these genes could influence sperm production.

OBJECTIVE:Seasonal variations in testosterone levels have been reported in some studies, but the results are inconsistent. In this study, we aimed to determine if clinically relevant seasonal variability in testosterone levels exists using a large cohort of men from 2 different institutions, 1 located in an area with seasons (Pittsburgh, Pa) and 1 without seasons (Miami, Fla). METHODS:Using 2 institutional databases, testosterone levels were obtained for men ages 18-99 from 2010 to 2021 who had at least 2 morning testosterone levels drawn within a 2-year period. All samples were analyzed with liquid chromatography with tandem mass spectrometry. To avoid potential confounding by testosterone altering medications patients who were currently or previously on exogenous testosterone, endogenous testosterone-stimulating medications, testosterone-suppressing medications, and aromatase inhibitors were excluded from the study. RESULTS:There were 9495 and 16171 total testosterone levels measured from Miami and Pittsburgh, respectively, with all men having 2 or more levels. There was no statistically significant variation in testosterone levels for the overall cohort in Pittsburgh or Miami, respectively. Additionally, when stratified by age group, no individual groups were found to have significant seasonal variability. CONCLUSION:Our findings suggest that although there is differing total testosterone levels between men who reside in 2 different climates, there is no significant variability in testosterone levels between seasons. Therefore, testosterone levels can be checked and interpreted without the need to account for the season during which they were drawn.

In this chapter, the authors explain the role of mitochondrial DNA content to determine oocyte quality and implantation potential to increase the pregnancy success rate in couples undergoing infertility treatment. Currently, three companies offer mitochondrial DNA content testing: Igenomix (MitoScore), Progenesis (MitoSure), and Reprogenetics (MitoGrade). This method of genetic testing is on its way to being implemented for infertility workups. Oocytes of higher quality should contain an optimal number of mitochondria that allow for normal fertilization and development of the embryo. Studies have found that once fertilization has occurred, embryos with lower levels of mtDNA have higher rates of implantation. In conclusion, higher mtDNA levels in embryos have been associated with implantation failure, and optimal levels of mitochondria in oocyte are needed for successful fertilization and preimplantation embryo development.

Background: Testosterone (T) plays an important role in male reproductive function and tissue development. Normal serum T levels vary between 300 and 1000 ng/dl. It is not known, however, if varying serum T levels alter androgen receptor (AR) signaling in tissue.Objective: To measure AR signaling levels in human corpus cavernosal tissue in males with different serum T levels.Design, setting, and participants: Participants were selected from a group of males undergoing surgical management for erectile dysfunction (ED; penile prosthesis place-ment). T levels were measured 1 week before surgery and a sample of corpus cavernosal tissue was procured during surgery. The tissue was homogenized, measured for protein concentration, and used for western blot analysis. VEGF was selected as an AR marker and actin was used for protein normalization.Outcome measurements and statistical analysis: VEGF and actin expression levels were analyzed using western blot analysis and ImageJ was used for quantification of antibody expression.Results and limitations: AR signaling was measured in terms of VEGF expression. Above a T level of 200 ng/dl, there was no significant difference found in VEGF expression. Only one patient had a T level less than 200 ng/dl, limiting the generalizability of these results. In addition, all patients had a history of ED, and controls (patients without ED) were not included in the study.Conclusions: Above a serum T level of 200 ng/dl, there was no significant difference in AR signaling. This finding suggests that there could be a saturation level present in corpus cavernosal tissue that is approximately 200 ng/dl.Patient summary: Serum testosterone levels above a certain threshold may not be nec-essary for biological functions. Instead, it is most likely that there is an approximate serum testosterone level that fully saturates tissue androgen receptors and results in peak function in men.(c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

INTRODUCTION:Increased hematocrit (HCT) is a common adverse effect in men on testosterone therapy (TTh). We aimed to uncover differences in HCT changes among men receiving different forms of TTh. METHODS:We conducted a single-center, retrospective, matched-cohort study of patients treated for testosterone deficiency (TD) to investigate the effect of three TTh regimens on HCT. We included men who received intranasal testosterone (NT), intramuscular testosterone (TC), or subcutaneous testosterone pellet (TP) regimens between January 2011 and December 2020. We matched treatment cohorts 1:1:1 for age, body mass index (BMI), and history of obstructive sleep apnea (OSA). Those taking TTh for <16 weeks were excluded. Comparison between groups was performed with Mann-Whitney U test, Student's t-test, ANOVA, or Kruskal-Wallis test as appropriate. RESULTS:Seventy-eight matched-cohort individuals with TD received either NT, TC, or TP. The most common TD symptoms prior to initiation of TTh were erectile dysfunction (38%), low libido (22%), and lack of energy (17%). Baseline serum testosterone and HCT were higher in NT recipients (p<0.05). As expected, all men receiving TTh were found to have increased serum testosterone levels at followup (p<0.001). Relative to their respective baselines, men receiving TC experienced the greatest increase in serum testosterone (240.8 ng/dL to 585.5 ng/dL), followed by NT (230.3 ng/dL to 493.5 ng/dL) and TP (210.8 ng/dL to 360.5 ng/dL) (all p<0.001). TC and TP were associated with significant increases in HCT (4.4% and 1.7%) while NT was associated with a decrease in HCT (-0.8%) at 16-week followup. CONCLUSIONS:When controlled for age, BMI, and OSA, men receiving NT experienced decreased HCT compared to TC or TP at 16-week followup. Intranasal testosterone, while able to increase serum testosterone levels to reference range, does not appear to have a significant impact on HCT compared to the longer-acting forms of TTh.

Peyronie's disease (PD) is defined by penile plaque formation and curvature causing sexual dysfunction. The only FDA-approved intralesional treatment is Collagenase Clostridium histolyticum (CCh). CCh contains two collagenases, AUX1 and AUXII, that break down the type I and type III collagen contained in plaques, leading to plaque dissolution and reduction in penile curvature. Peyronie's plaques, however, also contain fibrin and calcium, which CCh cannot digest. It is unclear if plaque calcification prevents CCh from breaking down plaques. We collected ten tissue samples: five calcified penile plaques and five control samples of corpus cavernosum. They were incubated in CCh or PBS. Soluble collagen measurements and collagen staining assays were completed to measure tissue breakdown. Calcified plaques incubated in CCh showed significantly higher levels of soluble collagen (301.07 ug ± 21.28 vs. PBS: 32.82 ug ± 3.68, p = 0.02), and significantly lower levels of collagen (type I and III) compared to tissues incubated in PBS (0.12 ± 0.08, vs. 0.44 ± 0.17, p = 0.002). When comparing different tissues (calcified vs. control) incubated in CCh and PBS solutions, there were no significant differences in collagen staining or breakdown. Although higher collagen staining was seen in the calcified group, soluble collagen showed no significant differences between control and calcified tissues in the CCh group (control: 0.08 ± 0.02 vs. calcified: 0.17 ± 0.09, p = 0.08) or the PBS group (control: 0.50 ± 0.23 vs. calcified: 0.39 ± 0.39, p = 0.23). CCh exposure led to significantly more tissue breakdown in both tissue groups when compared to PBS however, there was no significant difference in plaque digestion found between calcified and control tissue exposed to CCh or PBS. This suggests that plaque calcification does not affect the action of CCh. Further research into CCh for calcified plaques is necessary to inform clinicians as to the optimal management of this population.

Congenital bilateral absence of the vas deferens (CBAVD) occurs in almost all men with cystic fibrosis. Prevailing theories on this pathophysiology relate to pathogenic mutations in the cystic fibrosis transmembrane regulator gene leading to agenesis or obliteration of vas deferens in utero. In this study, we present a case of two brothers with congenital anomalies of the vas deferens who were found to have carried a rare, heterozygous cystic fibrosis transmembrane regulator variant p.r347h without pulmonary or gastrointestinal signs or symptoms of cystic fibrosis .

PURPOSE:Testosterone replacement therapy (TRT) can potentially cause decreased spermatogenesis and subsequent infertility. Recent studies have suggested that 17-hydroxyprogesterone (17-OHP) is a reliable surrogate for intratesticular testosterone (ITT) that is essential for spermatogenesis. We evaluated data from two ongoing open-label, randomized, two-arm clinical trials amongst different treatment preparations (Trial I) subcutaneous testosterone pellets (TP) and (Trial II) intranasal testosterone (NT) or intramuscular testosterone cypionate (TC).MATERIALS AND METHODS:Seventy-five symptomatic hypogonadal men (2 serum testosterone <300 ng/dL) were randomized into open label randomized clinical trials. Eligible subjects received 800 mg TP, 11 mg TID NT or 200 mg ×2 weeks TC. 17-OHP and Serum testosterone were evaluated at baseline and follow-up. The primary outcome was changes in 17-OHP. Secondary outcome was changes in serum testosterone. Data was analyzed by two-sample and single-sample t-tests, and determination of equal or unequal variances was computed using F-tests.RESULTS:Median participant age was 45 years old, with overall baseline 17-OHP of 46 and serum testosterone of 223.5 ng/dL. 17-OHP significantly decreased in subjects prescribed long-acting TP or TC. The 4-month change in 17-OHP in the NT group (-33.3% from baseline) was less than the change seen in TC (-65.3% from baseline) or TP (-44% from baseline) (p=0.005). All testosterone formulations increased serum testosterone levels at follow-up, with the largest increase seen in TC (+157.6%), followed by NT (+114.3%) and TP (+79.6%) (p=0.005).CONCLUSIONS:Short-acting nasal testosterone appear to have no impact on serum 17-OHP especially in comparison to long-acting testosterone formulations. All modalities saw significant increases in serum testosterone levels at follow-up. NT and other short acting testosterone formulations may better preserve ITT and be beneficial for hypogonadal men seeking to maintain fertility potential while on TRT.

Background: Cellphones emit radiofrequency electromagnetic radiation (RF-EMR) for transmission of data for social media communication, web browsing, and music/podcast streaming. Use of Bluetooth ear buds has probably prolonged the time during which cellphones reside in the trouser pockets of men. It has been postulated that RF-EMR increases oxidative stress and induces free radical formation.Objective: To investigate the effect of wireless-spectrum (4G, 5G, and WiFi) RF-EMR emitted by modern smartphones on sperm motility and viability and explore whether these effects can be mitigated using a physical barrier or distance.Design, setting, and participants: Semen samples were obtained from fertile normozoospermic men aged 25-35 yr. A current-generation smartphone in talk mode was used as the RF-EMR source. A WhatsApp voice call was made using either 4G, 5G, or WiFi wireless connectivity. We determined if exposure effects were mitigated by either a cellphone case or greater distance from the semen sample. Outcome measurements and statistical analysis: The semen samples were analyzed according to 2010 World Health Organization laboratory guidelines. Statistical analysis was performed using SPSS v.28. Results and limitations: We observed decreases in sperm motility and viability with WiFi exposure but not with exposure to 4G or 5G RF-EMR. With large variability among smartphones, continued research on exposure effects is needed.Conclusions: Our exploratory study revealed that sperm motility and viability are negatively impacted by smartphones that use the WiFi spectrum for data transmission. Patient summary: We looked at the effect of cellphone use on sperm motility and viability. We found that cellphones using WiFi connectivity for data usage have harmful effects on semen quality in men. (c) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

You have accessJournal of UrologyCME1 Apr 2023MP27-05 ANDROGEN RECEPTOR SIGNALING IN THE HUMAN PENIS IS SIMILAR REGARDLESS OF SERUM TESTOSTERONE LEVEL Katherine Campbell, Alexandra Dullea, Braian Ledesma, Kajal Khodamoradi, Himanshu Arora, and Ranjith Ramasamy Katherine CampbellKatherine Campbell More articles by this author , Alexandra DulleaAlexandra Dullea More articles by this author , Braian LedesmaBraian Ledesma More articles by this author , Kajal KhodamoradiKajal Khodamoradi More articles by this author , Himanshu AroraHimanshu Arora More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testosterone (T) plays an important role in the proper development and maintenance of male reproductive tissues. The normal serum testosterone levels can vary between 300 to 1000 ng/dL. However, it is unclear whether androgen receptor (AR) signaling varies based on serum T levels. The aim of this study was to assess the impact of varied serum testosterone levels on AR signaling in Human Corpus Cavernosum tissue. Based on our previous work on the Androgen Saturation hypothesis, we hypothesized that above 200 ng/dL, AR signaling would not vary. METHODS: We obtained corpus spongiosum biopsies from men undergoing inflatable penile prosthesis placement for high grade erectile dysfunction. After mechanical dispersion of tissue with a homogenizer, the total protein was extracted using RIPA buffer. Quantitative detection of VEGF (Vascular endothelial growth factor), an androgen receptor marker, and AR (Androgen Receptor) expression was evaluated by western blot. The density of the bands in all the blots was quantified using densitometry analysis with ImageJ software. RESULTS: The median age of participants was 60.7 (57.6, 65.9) years. The median serum testosterone level was 378 (257, 419) ng/dl. The western blot results (Figure 1) showed no association in the expression level of VEGF or AR regardless of the serum testosterone level. CONCLUSIONS: Even with a wide range of serum testosterone levels (209-1478 ng/dl), androgen receptor signaling was similar in penile tissue. The results of this study support our previous work to demonstrate that AR signaling may be similar regardless of T level above 200 ng/dL. This suggests that serum testosterone levels might not reflect downstream androgen receptor signaling within the penile tissue. Understanding the AR saturation hypothesis provides important context necessary for appropriate prescribing of exogenous testosterone replacement therapy to optimize patient outcomes. Markers of androgen receptor signaling in tissue could be similar regardless of serum testosterone levels. Therefore, the utility of only serum testosterone levels in considering the effect of testosterone therapy needs to be re-evaluated. Source of Funding: This work was supported by: NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to Ranjith Ramasamy, SMSNA Sexual Medicine Grant to Kajal Khodamoradi © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e363 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Campbell More articles by this author Alexandra Dullea More articles by this author Braian Ledesma More articles by this author Kajal Khodamoradi More articles by this author Himanshu Arora More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Over the past decade, the relationship between humans and their smartphones have been marked with stark symbiosis. The advent of Bluetooth earbuds has presumably prolonged the amount of time the cell phone resides in the trouser pockets of men. This places the smartphone and its respective radiofrequency - electromagnetic radiation (RF- EMR) near the testicles. RF-EMR has been postulated to increase oxidative stress and induce free radical formation.

You have accessJournal of UrologyCME1 May 2022PD48-10 TESTICULAR TRANSCRIPTOME ANALYSIS REVEALS POTENTIAL GENES ASSOCIATED WITH ENDOCRINE SYSTEM IN A MOUSE MODEL OF COMPENSATED TESTICULAR HYPERTROPHY Daniel E. Nassau, Alexandra Dullea, Eliyahu Kresch, Vinayak Madhusoodanan, Shathiyah Kulandavelu, Miguel Castellan, Himanshu Arora, and Ranjith Ramasamy Daniel E. NassauDaniel E. Nassau More articles by this author , Alexandra DulleaAlexandra Dullea More articles by this author , Eliyahu KreschEliyahu Kresch More articles by this author , Vinayak MadhusoodananVinayak Madhusoodanan More articles by this author , Shathiyah KulandaveluShathiyah Kulandavelu More articles by this author , Miguel CastellanMiguel Castellan More articles by this author , Himanshu AroraHimanshu Arora More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Animal models demonstrate compensatory growth after unilateral orchiectomy when loss occurs before puberty, but absent if performed post-pubertally. The mechanisms leading to testicular hypertrophy after tissue loss remain unknown. We hypothesized that cellular pathways involving somatic growth and reproduction would be upregulated in the prepubertal groups compared to control. We performed RNA sequencing (RNASeq) on the contralateral testis after hemi-castration was performed at different ages in C57BL/6 mice. METHODS: An abdominal approach unilateral orchiectomy was performed in C57BL/6 mice at either the neonatal, prepubertal or post-pubertal periods between days of life (DOL) 2-4, 20-22 and 42-44, respectively. Experimental mice and controls were sacrificed after reaching physical maturity (DOL 80). The remaining testis was weighed and underwent RNASeq. The RNA library was generated and protein coding genes with p<0.05, FDR<0.05 were subjected to enrichment using Ingenuity pathway analysis (IPA). Expression of the candidate genes was evaluated using two-way ANOVA, allowing the identification of significantly different expression within the experimental groups compared to the control. RESULTS: Mean testis weight in each group (n=3) was 110.6mg (Neonate), 104.7mg (Prepubertal), 101.2 (Post-pubertal) and 85.5 (control) indicating larger testis on the contralateral side as an adult if orchiectomy was at an earlier age. IPA showed 502 different pathways/functions with which candidate genes were involved. A total of 58 unique protein coding genes met the criteria for analysis. Of these, Tubulin Tyrosine Ligase Like 2 (Ttll2) and Sacrosine Dehydrogenase (SARDH) had significantly increased, and decreased expression compared with controls, respectively (Figure). Ttll2 and SARDH are enriched in pathways such as endocrine system disorder, reproductive system disease, developmental disorders and metabolic diseases. CONCLUSIONS: We identified two genes involved in endocrine pathways that likely have altered expression in response to hemi-castration. Further work is needed to understand how these genes may be involved in testicular growth, and how pre-pubertal testis loss influences hypertrophy as compared to loss of testis as an adult. Source of Funding: This work was supported by National Institutes of Health Grant R01 DK130991, and Clinician Scientist Development Grant from the American Cancer Society to Ranjith Ramasamy © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e803 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel E. Nassau More articles by this author Alexandra Dullea More articles by this author Eliyahu Kresch More articles by this author Vinayak Madhusoodanan More articles by this author Shathiyah Kulandavelu More articles by this author Miguel Castellan More articles by this author Himanshu Arora More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF DownloadLoading ...

In men, Leydig cells (LCs) are the primary source of testosterone (T) production. Dysfunction of the LC can lead to T deficiency and male hypogonadism. The development of LCs is influenced by the paracrine factors released by the testicular microenvironment (TME). In our recent study, we demonstrated using cells isolated from human testis biopsies that Leptin, a paracrine factor secreted by TME, is critical for Leydig stem cell (LSCs) differentiation into Adult Leydig Cells (ADL), and subsequent T production. However, one of the limiting aspects of our findings was the lack of intact testicular immune microenvironment in-vitro conditions. This study focuses on overcoming this limitation by evaluating the effect of different doses of Leptin in an intact testicular immune microenvironment.

SARS-CoV-2 infection arose in 2019 and has changed life as we know it. With our ever-advancing knowledge, therapies, and vaccines, more functions of the SARS-CoV-2 virus are being investigated outside of its pulmonary invasion. Here, we set out to review the current and pertinent literature on the impact of SARS-CoV-2 on the male genitourinary system including the bladder, lower urinary tract, prostate, testis, and penis. The biggest newsworthy stake was if SARS-CoV-2 could be transmitted through semen. Although initially thought to occur, more recent studies have opposed this hypothesis. Outside of the reproductive spread of SARS-CoV-2, multiple studies in this review highlight where the virus resides and what effect it may be having on this genitourinary system including increased voiding problems, viral persistence months after systemic clearance, and rare penile complications post-infection. Long-term outcomes are still needed to fully understand how SARS-CoV-2 infection can alter the genitourinary system.

Testosterone (T) deficiency is estimated to affect up to 20% of males. T is primarily produced by Leydig Cells (LC) and LC dysfunction can lead to T deficiency (TD). The development and function LC is influenced by paracrine factors released by the testicular micro-environment (TME), including Leptin. Our previous work has demonstrated the role of Leptin in the development of LC into Adult Leydig Cells, capable of producing T. We have also shown that low doses of leptin influence the testicular microimmune-environment (TMIE) in mice with a normal body habitus. There is also significant research linking obesity and TD. However, the effect of leptin on TMIE in different BMI conditions is not understood. Therefore, we evaluated the effects of Leptin on the TMIE in different BMI conditions (lean and obese).

You have accessJournal of UrologyCME1 May 2022MP34-05 IMPACT OF NASAL, INTRAMUSCULAR, AND SUBCUTANEOUS TESTOSTERONE PELLETS ON INTRATESTICULAR TESTOSTERONE: EVALUATION OF DATA FROM TWO RANDOMIZED CLINICAL TRIALS Parris Diaz, Rohit Reddy, Ruben Blachman-Braun, Alexandra Dullea, Isaac J. Zucker, Daniel C. Gonzalez, Eliyahu Kresch, and Ranjith Ramasamy Parris DiazParris Diaz More articles by this author , Rohit ReddyRohit Reddy More articles by this author , Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Alexandra DulleaAlexandra Dullea More articles by this author , Isaac J. ZuckerIsaac J. Zucker More articles by this author , Daniel C. GonzalezDaniel C. Gonzalez More articles by this author , Eliyahu KreschEliyahu Kresch More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002588.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testosterone replacement therapy (TRT) can potentially cause decreased spermatogenesis and subsequent infertility due to decrease in intratesticular testosterone (ITT) production. Serum 17-hydroxyprogesterone (17-OHP) is a reliable surrogate for ITT that is critical for preserving male fertility. We hypothesized that long-acting T formulations will decrease ITT compared to short-acting formulations. We evaluated data from two open-label, randomized, two-arm clinical trials amongst different testosterone therapies with subcutaneous T pellets (TP), Intranasal Testosterone (NT) or Intramuscular Testosterone cypionate (TC). METHODS: A total of 75 symptomatic hypogonadal men (2 serum T <300 ng/dL drawn before 10AM) were randomized into open-label randomized clinical trials. Eligible subjects received 800mg TP, 11mg TID NT or 200 mg×2 weeks TC. Lab values were evaluated at baseline and follow-up. The primary outcome was changes in serum 17-OHP. Secondary outcome was changes in serum T. Data analyzed via Kruskal Wallis and Chi square test.Trials: NCT04439799 (June 19,2020) & NCT04523480 (August 21,2020). RESULTS: Median participant age was 45 years old, with overall baseline 17-OHP of 46 and serum testosterone of 223.5 ng/dL. Serum 17-OHP significantly decreased in all three TRT regimens (Table 1). The 4-month change in 17-OHP in the NT group (−33.3% from baseline) was less than the change seen in TC (−65.3% from baseline) or TP (−44% from baseline) (p=0.005). All T formulations increased serum testosterone levels at follow-up, with the largest increase seen in TC (+157.6%), followed by NT (+114.3%), and TP (+79.6%) (p=0.005). CONCLUSIONS: Short-acting nasal testosterone appears to decrease 17-OHP less than long-acting T formulations. All modalities saw significant increases in serum T levels at follow-up. Intranasal T and other short acting T formulations may better preserve ITT and be beneficial for hypogonadal men seeking to maintain fertility potential while on TRT. Source of Funding: Investigator Initiated Grant funded by Acerus Pharmaceuticals and Empower Pharmacy (RR). This work was also supported by National Institutes of Health Grant R01 DK130991 and Clinician Scientist Development Grant from the American Cancer Society to RR © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e580 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Parris Diaz More articles by this author Rohit Reddy More articles by this author Ruben Blachman-Braun More articles by this author Alexandra Dullea More articles by this author Isaac J. Zucker More articles by this author Daniel C. Gonzalez More articles by this author Eliyahu Kresch More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective:To determine whether the COVID-19 mRNA vaccines can negatively impact the semen parameters of young healthy men in the long-term.Design:We conducted semen analyses on 12 men before, 3 and 9 months after achieving fully vaccinated status. Individuals who admitted a history of infertility or previous azoospermia were excluded from study participation.Subjects:Healthy male volunteers between the ages of 18-50 years old were recruited between September 2021 - March 2022.Main Outcome Measures:Semen analyses were performed and evaluated volume, sperm concentration, total motility, and total motile sperm count (TMSC). The primary outcome was median change in the TMSC at baseline, 3 months, and at least 9 months following vaccination.Results:A total of 12 men volunteered in our study (median age 26 [25 - 30] years). Subjects provided follow-up semen samples at a median of 10 months following the second vaccine dose. There were no significant changes in any semen parameters between baseline, 3 months, and 10 months following vaccination. Baseline samples demonstrated median sperm concentrations and TMSC of 29.5 million/cc [9.3 - 49] and 31 million [4-51.3], respectively. At 9-month follow-up, sperm concentration and TMSC were 43 [20.5 - 63.5] (P=.351) and 37.5 [8.5 - 117.8] (P=.519), respectively. Of note, there were no significant changes in semen volume nor total motility (%) for participants at follow-up.Conclusion:COVID-19 mRNA vaccines and the booster dose does not appear to negatively impact the semen parameters of healthy males up to 10 months following vaccination.

Introduction: Optimal male reproductive health is dependent upon critical mediators of cell-cell communication: exosomes or extracellular vesicles. These vesicles are nano-sized particles released into a variety of bodily fluids, such as blood and semen. Exosomes are highly stable and can carry genetic and other molecules, including DNA, RNA, and proteins, which provide information about their origin cells. Objective: To identify exosomes as potential biomarkers or therapeutic mediators in male sexual and reproductive disorders like erectile dysfunction (ED), varicocele, and testicular injury. Methods: A PubMed search was performed to highlight all articles available relating to exosomes and extracellular vesicles in the pathogenesis of different male sexual and reproductive disorders, and their importance in clinical use as both diagnostic markers and potential therapeutic mediators. Results: Various male reproductive system disorders, such as ED, varicocele, and testicular injury, are linked to increased or decreased levels of exosomes. Exosomes have a higher number of molecules such as DNA, RNA, and proteins, which can give a more precise and comprehensive result when compared to other biomarkers. Exosomes can be considered as plausible diagnostic biomarkers for male sexual and reproductive diseases, with considerable advantages over other diagnostic procedures such as invasive tissue biopsy. Exosomes can carry cargo such certain drugs and therapeutic molecules making them a promising therapeutic approach. Several studies have begun to test treating various male sexual reproductive disorders with exosomes. Conclusion: Exosomes deliver many components that can regulate gene expression and target signaling pathways. Understanding how extracellular vesicles can be utilized as biomarkers in diagnosing men, particularly those with idiopathic erectile dysfunction, will not only aid in diagnosis but also help with making therapeutic targets. Khodamoradi K, Golan R, Dullea A, et al. Exosomes as Potential Biomarkers for Erectile Dysfunction, Varicocele, and Testicular Injury. Sex Med Rev 2022;10:311-322. Copyright (c) 2021, International Society of Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Testosterone (T) plays an essential role in properly developing and maintaining male reproductive tissues (1). The normal serum testosterone levels can vary between 300 to 1000 ng/dL. However, it is unclear whether androgen receptor signaling can vary based on serum T levels. What remains unknown is whether there is a consistent serum T level above which androgen receptor signaling within the tissue remains similar. Therefore, we evaluated whether varying serum levels of T alter androgen receptor (AR) signaling in human penile tissue.

Background Infertility is defined as the inability to establish a pregnancy within 12 months of regular and unprotected sexual intercourse. In response to these problems, assisted reproductive techniques (ARTs) have made profound impacts on the therapeutic management of infertility. However, in-vitro fertilization (IVF) success rates are confounded by several internal and external factors. A relatively new approach to embryo assessment is known as MitoScore (Igenomix, Miami, USA). As a result, we sough to evaluate whether MitoScore can help in predicting in IVF outcomes, and to assess the relationship between MitoScore, BMI, and body fat percentage in determining the success of ARTs. Methods Using retrospective cohort, a study population consisting of 166 women aged 26-43 who were undergoing ART with pre-implantation genetic testing for aneuploidy (PGT-A) was assessed to determine if MitoScore, BMI, and body fat percentage impacted IVF outcomes. Results MitoScore, BMI, and body fat percentage were significantly lower in pregnant women as compared to non-pregnant women. Furthermore, MitoScore was correlated with subclasses of IVF outcomes (delivery, biochemical pregnancy, and spontaneous abortion) and was found to be positively correlated with BMI in patients with biochemical pregnancies. Conclusion Our findings suggest that MitoScore, BMI, and body fat percentage could act as critical parameters in determining the success of ART. However, the association between MitoScore, BMI, and body fat percentage does not appear to be a significant confounding factor to determine pregnancy outcome at this stage. Still, many factors need to be considered to establish the correlation reliably.