Spinal Cord Injury

[Michael Scally MD]

Ibrahim E, Lynne CM, Brackett NL. Male fertility following spinal cord injury: an update. Andrology. http://onlinelibrary.wiley.com/doi/10.1111/andr.12119/abstract

Spinal cord injury (SCI) occurs most often in young men at the peak of their reproductive health. The majority of men with SCI cannot father children naturally.

Three major complications contribute to infertility in men with SCI:
erectile dysfunction,
ejaculatory dysfunction, and
abnormal semen quality.

Erectile dysfunction can be managed by regimens available to the general population, including oral administration of phosphodiesterase-5 (PDE-5) inhibitors, intracavernosal injections, vacuum devices, and penile prostheses.

Semen may be obtained from anejaculatory men with SCI via the medically assisted ejaculation methods of penile vibratory stimulation (PVS) or electroejaculation (EEJ). Sperm retrieval is also possible via prostate massage or surgical sperm retrieval.

Most men with SCI have abnormal semen quality characterized by normal sperm concentrations but abnormally low sperm motility and viability. Accessory gland dysfunction has been proposed as the cause of these abnormalities. Leukocytospermia is evident in most SCI patients. Additionally, elevated concentrations of pro-inflammatory cytokines and elevated concentrations of inflammasome components are found in their semen. Neutralization of these constituents has resulted in improved sperm motility.

There is a recent and alarming trend in the management of infertility in couples with SCI male partners. Although many men with SCI have sufficient motile sperm in their ejaculates for attempting intrauterine insemination (IUI) or even intravaginal insemination, surgical sperm retrieval is often introduced as the first and only sperm retrieval method for these couples.

Surgical sperm retrieval commits the couple to the most advanced, expensive, and invasive method of assisted conception: in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI).

Couples should be informed of all options, including semen retrieval by PVS or EEJ. Intravaginal insemination or IUI should be considered when indicated.

 

[Michael Scally MD]

Sullivan SD, Nash MS, Tefera E, Tinsley E, Blackman MR, Groah S. Prevalence and Etiology of Hypogonadism in Young Men with Chronic Spinal Cord Injury: A Cross-Sectional Analysis from Two University-Based Rehabilitation Centers. Pm R. http://www.pmrjournal.org/article/S1934-1482(16)31169-8/abstract

BACKGROUND: Spinal cord injury (SCI) triggers an 'accelerated aging' process that may include development of hypogonadism, even among younger men with SCI; however, few studies have investigated the prevalence or etiology of hypogonadism in men with SCI. Young men with SCI are also at increased risk for developing metabolic dysfunction after injury, which may be exacerbated by concomitant testosterone (T) deficiency, thus identifying the prevalence and risk factors for T deficiency in men with SCI is important for their long-term health.

OBJECTIVE: To investigate the prevalence, risk factors, and etiology of T deficiency (hypogonadism) in otherwise healthy men with chronic, motor complete SCI. DESIGN: Secondary cross-sectional analysis.

SETTING: Rehabilitation research centers in Washington, DC, and Miami, Florida, USA.

PARTICIPANTS: Men (n=58) aged 18-45 with chronic (>/=1 year), motor complete SCI without co-morbidities or use of testosterone therapy.

METHODS: Plasma concentrations of hormones were measured using standardized assays. Body composition was assessed with DXA scan.

MAIN OUTCOME MEASUREMENTS: Serum total testosterone and calculated free T.

RESULTS: T deficiency was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI vs 6.7%, non-SCI, P<.001). The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat. The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI.

CONCLUSIONS: Hypogonadism is more common in young men with SCI than in similarly-aged men without SCI, suggesting that SCI should be identified as a risk factor for T deficiency and that routine screening for hypogonadism should be performed in the SCI population.

 

[Michael Scally MD]

Bauman WA, La Fountaine MF, Cirnigliaro CM, Kirshblum SC, Spungen AM. Testicular responses to hCG stimulation at varying doses in men with spinal cord injury. Spinal Cord. http://www.nature.com/sc/journal/vaop/ncurrent/full/sc20178a.html

Study design: Prospective.

Objectives: To test whether provocative stimulation of the testes identifies men with chronic spinal cord injury (SCI), a population in which serum testosterone concentrations are often depressed, possibly due to gonadal dysfunction. To accomplish this objective, conventional and lower than the conventional doses of human chorionic gonadotropin (hCG) were administered.

Methods: Thirty men with chronic SCI (duration of injury >1 year; 18 and 65 years old; 16 eugonadal (>12.1 nmol l−1) and 14 hypogonadal (12.1 nmol l−1)) or able-bodied (AB) men (11 eugonadal and 27 hypogonadal) were recruited for the study.

Stimulation tests were performed to quantify testicular responses to the intramuscular administration of hCG at three dose concentrations (ithat is, 400, 2000 and 4000 IU).

The hCG was administered on two consecutive days, and blood was collected for serum testosterone in the early morning prior to each of the two injections; subjects returned on day 3 for a final blood sample collection.

Results: The average gonadal response in the SCI and AB groups to each dose of hCG was not significantly different in the hypogonadal or eugonadal subjects, with the mean serum testosterone concentrations in all groups demonstrating an adequate response.

Conclusions: This work confirmed the absence of primary testicular dysfunction without additional benefit demonstrated of provocative stimulation of the testes with lower than conventional doses of hCG. Our findings support prior work that suggested a secondary testicular dysfunction that occurs in a majority of those with SCI and depressed serum testosterone concentrations.

 

[KeithO]

I suffered a SCI when I was 27. Thankfully, it was a partial injury and I recovered about 50% strength in one leg and about 75% strength in the other. I was also able to father two healthy kids the old-fashion way. I started TRT at age 54, but am totally convinced that my injury led to my hypogonadism. I had symptoms of low T for many years. I know feel better than I did in my 30's!

 

[Just Fish]

Sullivan SD, Nash MS, Tefera E, Tinsley E, Blackman MR, Groah S. Prevalence and Etiology of Hypogonadism in Young Men with Chronic Spinal Cord Injury: A Cross-Sectional Analysis from Two University-Based Rehabilitation Centers. Pm R. http://www.pmrjournal.org/article/S1934-1482(16)31169-8/abstract

BACKGROUND: Spinal cord injury (SCI) triggers an 'accelerated aging' process that may include development of hypogonadism, even among younger men with SCI; however, few studies have investigated the prevalence or etiology of hypogonadism in men with SCI. Young men with SCI are also at increased risk for developing metabolic dysfunction after injury, which may be exacerbated by concomitant testosterone (T) deficiency, thus identifying the prevalence and risk factors for T deficiency in men with SCI is important for their long-term health.

OBJECTIVE: To investigate the prevalence, risk factors, and etiology of T deficiency (hypogonadism) in otherwise healthy men with chronic, motor complete SCI. DESIGN: Secondary cross-sectional analysis.

SETTING: Rehabilitation research centers in Washington, DC, and Miami, Florida, USA.

PARTICIPANTS: Men (n=58) aged 18-45 with chronic (>/=1 year), motor complete SCI without co-morbidities or use of testosterone therapy.

METHODS: Plasma concentrations of hormones were measured using standardized assays. Body composition was assessed with DXA scan.

MAIN OUTCOME MEASUREMENTS: Serum total testosterone and calculated free T.

RESULTS: T deficiency was more common in men after SCI than in a matched cohort of similarly-aged men without SCI (25%, SCI vs 6.7%, non-SCI, P<.001). The risk of hypogonadism appeared to be increased in men with more extensive injury and with higher percent body fat. The majority of men with SCI with low T had low serum LH levels, suggesting that central suppression of the hypothalamic-pituitary-gonadal axis may be the most common etiology of hypogonadism after SCI.

CONCLUSIONS: Hypogonadism is more common in young men with SCI than in similarly-aged men without SCI, suggesting that SCI should be identified as a risk factor for T deficiency and that routine screening for hypogonadism should be performed in the SCI population.

This is interesting all the signs of low testosterone began a few years after I injured multiple cervical discs. To bad my Dr hadn't read this. I believe their is something to this

 

[Michael Scally MD]

Nightingale TE, Moore P, Harman J, et al. Body Composition changes with Testosterone Replacement Therapy following Spinal Cord Injury and Aging. A Mini Review. J Spinal Cord Med. http://www.tandfonline.com/doi/abs/10.1080/10790268.2017.1357917?journalCode=yscm20

Hypogonadism is a male clinical condition in which the body does not produce enough testosterone. Testosterone plays a key role in maintaining body composition, bone mineral density, sexual function, mood, erythropoiesis, cognition and quality of life. Hypogonadism can occur due to several underlying pathologies during aging and in men with physical disabilities, such as spinal cord injury (SCI). This condition is often under diagnosed and as a result, symptoms undertreated.

Methods - In this mini-review, we propose that testosterone replacement therapy (TRT) may be a viable strategy to improve lean body mass (LBM) and fat mass (FM) in men with SCI.

Evidence Synthesis - Supplementing the limited data from SCI cohorts with consistent findings from studies in non-disabled aging men, we present evidence that, relative to placebo, transdermal TRT can increase LBM and reduce FM over 3-36 months. The impact of TRT on bone mineral density and metabolism is also discussed, with particular relevance for persons with SCI. Moreover, the risks of TRT remain controversial and pertinent safety considerations related to transdermal administration are outlined.

Conclusion - Further research is necessary to help develop clinical guidelines for the specific dose and duration of TRT in persons with SCI. Therefore, we call for more high-quality randomized controlled trials to examine the efficacy and safety of TRT in this population, which experiences an increased risk of cardiometabolic diseases as a result of deleterious body composition changes after injury.

 

[Michael Scally MD]

Sullivan SD, Nash MS, Tefara E, Tinsley E, Groah S. Relationship Between Gonadal Function and Cardiometabolic Risk in Young Men with Chronic Spinal Cord Injury. Pm R. http://www.pmrjournal.org/article/S1934-1482(17)30321-0/abstract

BACKGROUND: We previously reported that young men with chronic spinal cord injury (SCI) have a higher prevalence of testosterone deficiency when compared to an age-matched healthy control population. Young men with SCI are also at increased risk for developing cardiometabolic dysfunction after injury. It is unclear whether or not testosterone deficiency is associated with heightened cardiometabolic risk in men with SCI.

OBJECTIVE: To investigate associations among levels of testosterone in young men with chronic SCI and surrogate markers of cardiometabolic risk.

DESIGN: Secondary cross-sectional analysis.

SETTING: Rehabilitation research centers in Washington, DC, and Miami, Florida, USA.

PARTICIPANTS: Men (n=58) aged 18-45 with chronic (>/=1 year), motor complete SCI without co-morbidities or use of testosterone therapy.

METHODS: Plasma concentrations of testosterone, lipids, inflammatory markers (CRP and IL-6), HbA1C%, glucose, and insulin were measured in a fasting state using standard assays. A two-hour oral glucose tolerance test (OGTT) and Framingham Risk Score (FRS) were assessed for each subject. Body composition was assessed by DXA scan.

MAIN OUTCOME MEASUREMENTS: Surrogate markers of cardiometabolic risk among men based on the level of total testosterone (TT)(</=300, 301-500, or >500 ng/dL) and free testosterone (fT) (</=9 or >9 ng/dL). Comparisons were made between men with normal and low TT or fT.

RESULTS: FRS was significantly higher in men with low fT (P<.05). Percent body fat (P<.05) and waist-to-hip ratio (P<.05), but not body mass index (BMI) (P>.08), were higher in men with low TT or low fT.

Men with low TT or low fT had lower high density lipoprotein cholesterol (HDL) levels (P<.05) without differences in fasting triglycerides (P>.1) or low density lipoprotein cholesterol (LDL) (P>.07).

Men with low TT had higher levels of inflammatory markers CRP (P<.05) and IL-6 (P<.05). Men with low TT or low fT had higher fasting glucose (P<.05) and greater insulin resistance (P<.04), without differences in HbA1C% (P>.8).

CONCLUSIONS: In young men with chronic SCI, who undergo an accelerated aging process post-injury, hypogonadism is associated with an unfavorable cardiometabolic risk profile. Further research is needed to determine if a causal relationship exists between hypogonadism and heightened cardiometabolic risk in men with SCI, and whether routine screening for testosterone deficiency is warranted in this population.

 

[ddp7]

As usual you are the man Dr Scally

well story is the follow

but first what was my injury managment in summary:
2012 had treatment to scoliosis,do you know it?

well the long story is n pls dont laught

in the sect times i did a lot of fake pranayamas i know that shit names again but
i wake up from my bed to do that sexual control breathing exercises.

aftet the years the scoliosis was painful so i pay to treatment n in theory my back normal
well u are the expert

 

[ddp7]

note:in that time i was very young like 18-19 years old

 

[Michael Scally MD]

Barbonetti A, D'Andrea S, Samavat J, et al. Can the positive association of osteocalcin with testosterone be unmasked when the preeminent hypothalamic-pituitary regulation of testosterone production is impaired? The model of spinal cord injury. Journal of endocrinological investigation 2019;42:167-73. Can the positive association of osteocalcin with testosterone be unmasked when the preeminent hypothalamic–pituitary regulation of testosterone production is impaired? The model of spinal cord injury

PURPOSE: Osteocalcin (OCN), released from the bone matrix during the resorption phase, in its undercarboxylated form, stimulates testosterone (T) biosynthesis in mouse and a loss-of-function mutation of its receptor was associated with hypergonadotropic hypogonadism in humans. Nevertheless, when population-based studies have explored the OCN-T association, conflicting results have been reported.

Hypothesizing that the evidence of a positive association between OCN and T could have been hindered by the preeminent role of a well-functioning hypothalamus-pituitary axis in promoting T biosynthesis, we explored this association in men with chronic spinal cord injury (SCI), exhibiting high prevalence of non-hypergonadotropic androgen deficiency.

METHODS: Fifty-five consecutive men with chronic SCI underwent clinical/biochemical evaluations, including measurements of total T (TT), OCN and 25(OH)D levels. Free T (FT) levels were calculated by the Vermeulen formula. Comorbidity was scored by Charlson comorbidity index (CCI).

RESULTS: A biochemical androgen deficiency (TT < 300 ng/dL) was observed in 15 patients (27.3%). TT was positively correlated with OCN, 25(OH)D and leisure time physical activity and negatively correlated with age, BMI and CCI. OCN was also positively correlated with calculated FT and negatively correlated with BMI and HOMA-IR. At the multiple linear regression analyses, a positive association of OCN with TT and calculated FT persisted after adjustment for confounders.

CONCLUSIONS: The positive association here found between OCN and T levels in men with chronic SCI reinforces the notion that a bone-testis axis is also functioning in humans and suggests that it can be unmasked when the preeminent hypothalamic-pituitary regulation of T production is impaired.