Managing Testosterone Levels
Androgens are the main sex hormones in males with testosterone being the major androgen in males. Testosterone is the major sex hormone in males. About 95% of testosterone concentration in the male body comes from the testicles and the remaining levels are produced by the adrenal glands (Jones, 2006). Testosterone is needed for the sexual response in males and needed to maintain secondary sexual characteristics in males. The role testosterone has during the male sexual response is still a field under study due to very little knowledge about the exact causes of testosterone.
In the males, the hormomal pathway begins with gonadotropin releasing hormone (GnRH) secreted and released from the hypothalamus. It then acts on the adenohypophysis to release lutenizing hormone (LH) which then acts on the leydig cells in the testicles. LH acts on the leydig cells in the testicles to produce testosterone (Jones, 2006). In genital injuries where the testicles have been rendered non-functional or have been removed, this pathway is shutdown. Without leydig cells to produce testosterone, the main source of testosterone production has been eliminated in the male body.
The management of hormone levels after genital trauma is an issue of concern. Post genital trauma requires hormone replacement to compensate for what has been lost during the injury and reconstruction processes. Hormone levels have been found to affect functions of the male sex organs, affect male secondary sexual characteristics, and affect other health issues in males.
Hormone replacement therapy (HRT) has been used to compensate for this drop in testosterone to manage testosterone levels. The small concentrations of testosterone from the adrenal glands is insufficient to maintain secondary sexual characteristics and to maintain proper sexual function. The purpose of HRT is to supply the victim with testosterone supplements to increase testosterone levels. The testosterone produced from these treatments aims to raise serum testosterone levels to control and maintain high enough testosterone concentrations allowing the maintenance of secondary sexual characteristics. The raised testosterone level can affect sexual function by raising libido and possibly prevent erectile dysfunction. (Handelsman and Zajac, 2004)
There are numerous health implications associated with HRT that are both harmful and beneficial. Increases in testosterone from HRT can lead to lower risks of being diabetic, suffering from osteoporosis, having cardio vascular problems, and being obese. Other benefits involved are maintaining sexual functions, increasing libido, maintaining secondary sexual characteristics, and maintaining healthy joins and muscle mass. The harmful factors of HRT are periods of rage, depression, aggression, and other self esteem problems, risks of cancer, enlargement of the prostate, sterility, and more. The most common symptoms affect the prostate causing enlargement or cancer, so checking a patients prostate specific antigen (PSA) is required before HRT will be administered to the patient (Myers and Meacham, 2003). Many of these side effects result from the body not producing natural testosterone from the testicles and from the introduction of synthetic testosterone into the body. HRT can be giving to patients through injections, transdermal patches, gels, or orally (Meacham, 2003).
Genital trauma cases where both of the testicles have been lost, removed, or damaged to be non-functional, known as bilateral genital injury, causes sterility in males. Males fertility comes from the testicles producing high counts of sperm that will fertilize the female egg during sexual intercourse. No production of sperm due to the absence of testicles causes permanent sterility for the male. HRT will not allow for the production of sperm as it only affects serum testosterone levels. HRT is required in these males because they need the testosterone replacement to raise and control testosterone levels. Physicians prescribe testosterone to patients to maintain their secondary sexual characteristics and to monitor other health factors. These patients have decreased libido and possibly erectile dysfunction. Researchers hypothesize that higher concentrations of testosterone during HRT will result in even greater libido and prevent erectile dysfunction as testosterone concentrations will be sufficient for proper male sexual functions (Wood, 2012). However, this is still an area under research and it is an area of psychological concern for males.
More common in males is a unilateral genital injury involving only one testicle. Here one testicle is saved or not impacted by the force causing the injury, while the other testicle is critically affected. In these cases, the one remaining testicle will compensate for the slight drop in sperm production and enable the male to remain fertile. Males with one testicle do not experience sexual dysfunction nor sterility because the one testicle will compensate for the loss of the other testicle. Males with one testicle may require HRT later in life to manage and control their serum testosterone levels. The testosterone pathway works in these males because the leydig cells are present in the one testicle for LH to act on and produce testosterone. However, in these males there is a side effect of becoming sterile because if testosterone levels become too high, sperm maturation will be affected. This would result in non-viable sperm and sterility.
The psychology of genital trauma, such as a unilateral and even a bilateral genital injury, is an issue that affects every victim. Many of the soldiers that fight in war then return home are faced with challenges within spouse relationships or relationships with people they meet in the future as they are single. Men are faced with the psychological problem of wondering, “Who’s going to want to be with me now?” said Marine Staff Sgt. Glen Silva in an article title “Afghanistan’s Wounded Struggle With Genital Injuries” by David Wood. This can be a serious problem for men to overcome and unfortunately HRT cannot solve the problem. However, in the victims who maintain a functioning penis, their sex lives can still be maintained because the testicles only play a role in sperm production and maturation. The male will still have orgasms and may be able to have erections as orgasms are a nerve sensation from the spinal nerves during the spinal reflex and erections are a result in the dilation of blood vessel in the penis (Ducharme, 2000). However, both can be harder to achieve, less frequent, and in some cases even painful at times. HRT with these patients hopes to return them to a normal sex life as testosterone levels increase leading to increases in libido, desire, and more frequent erections.
Increases in technologies on and off the battlefield has led to these sexual functions gaining more attention. Today, soldiers are surviving highly traumatic injuries and this has imposed a great demand on the medical field to treat these injuries. The use of HRT in patients by medical professions have grown dramatically over the years of war. HRT is prescribed to patients to raise and/or maintain testosterone levels via injections, gels, patches, or oral methods. The more successful methods in which patients are given testosterone are through gels or injections. However, injections can be problematic as it is introduces unnatural testosterone to the body by introducing a high concentration of testosterone initially and the levels tapering off over the next few weeks (Johnson, 2007). Gels have been seen to be a more effective use for HRT because there is not a high fluctuation in serum testosterone levels. A gel currently in the market and seen in advertisements for HRT is called AndroGel. This gel is applied to the back and shoulder area then allowed to diffuse through the skin and introduce synthetic testosterone into the body’s circulatory system. Testosterone levels will rise causing maintenance and other implications mentioned above associated with HRT (Abbott Laboratories, 2011). All treatment methods and treatments overall need to be monitored by a physician as a lifelong process once having begun treatments.
HRT treatments are critical for soldiers who have experienced and are suffering from genital trauma. Those soldiers need a way to replace the natural levels of testosterone that have been lost as a result from the trauma on the testicles. Replacing the testosterone via any technique of HRT will maintain their secondary sexual characteristics and raise libido to help restore a more normal sex life. It will also be beneficial to the male to help reduce devastating problems and diseases to the individual; however, the unnatural testosterone replacement has harmful side effects that could cause damage to the body, cause cancer, and multiple psychological effects. Individuals who still have testicles and are fertile can be effected through inhibiting spermatogenesis causing sterility. Once the soldier is on HRT, they will be required to remain on HRT for the remainder of life. More knowledge and research is still to come about all aspects of this topic as it is a new and more common problem physicians are now addressing.