Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

The use of testosterone replacement therapy (TRT) for hypogonadism continues to rise, particularly in younger men who may wish to remain fertile. Concurrently, awareness of a more pervasive use of anabolic-androgenic steroids (AAS) within the general population has been appreciated. Both TRT and AAS can suppress the hypothalamic-pituitary-gonadal (HPG) axis resulting in diminution of spermatogenesis. Therefore, it is important that clinicians recognize previous TRT or AAS use in patients presenting for infertility treatment. Cessation of TRT or AAS use may result in spontaneous recovery of normal spermatogenesis in a reasonable number of patients if allowed sufficient time for recovery. However, some patients may not recover normal spermatogenesis or tolerate waiting for spontaneous recovery. In such cases, clinicians must be aware of the pathophysiologic derangements of the HPG axis related to TRT or AAS use and the pharmacologic agents available to reverse them. The available agents include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their off-label use is poorly described in the literature, potentially creating a knowledge gap for the clinician. Reviewing their use clinically for the treatment of hypogonadotropic hypogonadism and other HPG axis abnormalities can familiarize the clinician with the manner in which they can be used to recover spermatogenesis after TRT or AAS use

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

The use of testosterone replacement therapy (TRT) for hypogonadism continues to rise, particularly in younger men who may wish to remain fertile. Concurrently, awareness of a more pervasive use of anabolic-androgenic steroids (AAS) within the general population has been appreciated. Both TRT and AAS can suppress the hypothalamic-pituitary-gonadal (HPG) axis resulting in diminution of spermatogenesis. Therefore, it is important that clinicians recognize previous TRT or AAS use in patients presenting for infertility treatment. Cessation of TRT or AAS use may result in spontaneous recovery of normal spermatogenesis in a reasonable number of patients if allowed sufficient time for recovery. However, some patients may not recover normal spermatogenesis or tolerate waiting for spontaneous recovery. In such cases, clinicians must be aware of the pathophysiologic derangements of the HPG axis related to TRT or AAS use and the pharmacologic agents available to reverse them. The available agents include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their off-label use is poorly described in the literature, potentially creating a knowledge gap for the clinician. Reviewing their use clinically for the treatment of hypogonadotropic hypogonadism and other HPG axis abnormalities can familiarize the clinician with the manner in which they can be used to recover spermatogenesis after TRT or AAS use

Testosterone deficiency in the aging male

Treatment for hypogonadism is on the rise, particularly in the aging population. Yet treatment in this population represents a unique challenge to clinicians. The physiology of normal aging is complex and often shares the same, often vague, symptoms of hypogonadism. In older men, a highly prevalent burden of comorbid medical conditions and polypharmacy complicates the differentiation of signs and symptoms of hypogonadism from those of normal aging, yet this differentiation is essential to the diagnosis of hypogonadism. Even in older patients with unequivocally symptomatic hypogonadism, the clinician must navigate the potential benefits and risks of treatment that are not clearly defined in older men. More recently, a greater awareness of the potential risks associated with treatment in older men, particularly in regard to cardiovascular risk and mortality, have been appreciated with recent changes in the US Food and Drug Administration recommendations for use of testosterone in aging men. The aim of this review is to provide a framework for the clinician evaluating testosterone deficiency in older men in order to identify correctly and treat clinically significant hypogonadism in this unique population while minimizing treatment-associated harm

Evidence for extreme floods in arid subtropical northwest Australia during the Little Ice Age chronozone (CE 1400-1850)

Here we report a ~2000-year sediment sequence from the Fortescue Marsh (Martuyitha) in the eastern Pilbara region, which we have used to investigate changing hydroclimatic conditions in the arid subtropics of northwest Australia. The Pilbara is located at the intersection of the tropical Indian and Pacific Oceans and its modern rainfall regime is strongly influenced by tropical cyclones, the Intertropical Convergence Zone (ITCZ) and the Indo-Pacific Warm Pool. We identified four distinct periods within the record. The most recent period (P1: CE ~1990-present) reveals hydroclimatic conditions over recent decades that are the most persistently wet of potentially the last ~2000 years. During the previous centuries (P2: ~CE 1600-1990), the Fortescue Marsh was overall drier but likely punctuated by a number of extreme floods, which are defined here as extraordinary, strongly episodic floods in drylands generated by rainfall events of high volume and intensity. The occurrence of extreme floods during this period, which encompasses the Little Ice Age (LIA; CE 1400-1850), is coherent with other southern tropical datasets along the ITCZ over the last 2000 years, suggesting synchronous hydroclimatic changes across the region. This extreme flood period was preceded by several hundred years (P3: ~CE 700-1600) of less vigorous but more regular flows. The earliest period of the sediment record (P4: ~CE 100-700) was the most arid, with sedimentary and preservation processes driven by prolonged drought. Our results highlight the importance of developing paleoclimate records from the tropical and sub-tropical arid zone, providing a long-term baseline of hydrological conditions in areas with limited historical observations