User:Lwupharm/Testicular atrophy

Lead
Original:

Testicular atrophy is a medical condition in which the male reproductive organs (the testes, which in humans are located in the scrotum) diminish in size and may be accompanied by loss of function.

Testicular atrophy may be brought on by surgical repairs to certain types of hernias.

Rewrite:

Testicular atrophy is a medical condition in which one or both testicles (also called testes) diminish in size and may be accompanied by reduced testicular function. Some causes may include age, drug and alcohol use, direct damage to the testicles, and infection. It does not describe a shrinkage of the surrounding scrotum, which occurs in response to cold temperature.

Causes
Original (mainly includes primary sources):

Research has found testicular atrophy to be caused by scrotal trauma, inguinal hernia repair (rarely, and more often in very young children), anabolic steroid use, and oestrogen therapy, varicocele, and ischaemia (most often secondary to salvage procedures to treat testicular torsion).

Phthalate esters and Zika virus infection have been found to cause testicular atrophy in animals.

Rewrite (with secondary source(s)):

Age
Shrinkage of the testicles is common with advanced age, as overall reproductive function declines.

Alcohol use
High alcohol usage lowers testosterone levels by direct damage to the Leydig cells (which produce testosterone) and by affecting hormones involved in signaling to the Leydig cells to produce testosterone. As a result, testicular atrophy is a common feature among individuals with high alcohol use. In individuals with alcoholic liver disease, this effect is worsened as the liver damage itself causes lower testosterone levels and other hormonal imbalances.

Infection
Orchitis, or inflammation of the testicles due to a bacterial or viral infection, can lead to testicular atrophy. Mumps has historically been highly associated with orchitis and resulting testicular atrophy, but has become rare in countries that now have high mumps vaccination rates.

Research has shown evidence in the relationship of COVID and testicular atrophy by the reduced level of production of testosterone due to changes in the secretions of gonadotropins. Results reveal that the inflammation and oxidative stress from testicular abnormalities in COVID-19 survivors may lead to infertility. It is important to monitor the COVID-19 patients' and survivors' health parameters and HPG axis abnormalities for any possible complications that may occur.

Anabolic steroid use and hormone therapy
Anabolic steroid use and testosterone replacement therapy (TRT) have been found to cause testicular atrophy through a similar mechanism. Anabolic steroids and TRT are both used (either by prescription or illicitly) to mimic the effects of testosterone produced by the body, such as building muscle and increasing sex drive. However, they also inhibit the body's own production of sperm and testosterone, which can lead to shrinkage of the testicles.

Testicular atrophy is also a side effect of estrogen therapy.

Other health conditions
Varicoceles and testicular torsion are conditions in which direct damage to the testicles can potentially lead to testicular atrophy. Varicoceles are pooling of blood in the veins that deliver blood away from the testicles and are very common, occurring in 15% of adults and 20% of adolescents with testicles. However, varicoceles only rarely interfere with testosterone and sperm production to the point where someone experiences noticeable symptoms. Testicular torsion is the twisting of the testicle within the scrotum and can rapidly result in damage due to interruption in blood flow to the affected testicle. Unlike varicoceles, testicular torsion is considered a medical emergency.

There is a possible correlation of cystic fibrosis and its impact to bilateral testicular atrophy. Evidence has shown that cystic fibrosis is a disease that affects multiple systems in the human body which can impact the reproductive system. Around 97-98% of male patients are infertile due to the missing presence of the vas deferens.

Signs and symptoms
before puberty: lack of facial hair, lack of pubic hair, lack of larger penis size

after puberty: infertility, soft testicles

Physical examination
A healthcare provider may assess size and shape, as well as firmness and texture, of the testicles.

Testicular Volume

In addition, testicular atrophy can be recognized as >50% loss of testicular volume or a postoperative testicular volume <25% of the volume of the contralateral testis.

Sperm DNA Fragmentation

Men with varicoceles would have higher levels of sperm DNA fragmentation due to the higher levels of oxidative stress in the semen. In some cases, men with testicular damage that do not undergo repair of the varicoceles will have testicular atrophy.

Labs
Assessment of testicular function also dependent on labs. Low testosterone is a potential cause of testicular atrophy, and laboratory values of blood samples can confirm low free or bioavailable testosterone.

Treatment
Treatment with selective estrogen receptor modulators (SERMs) alone or in addition to self-administered injections of hCG has been shown to prevent and reverse testicular atrophy caused by anabolic steroid use.