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Sildenafil citrate 20 mg dose and was discontinued for 2 weeks. Following this, he experienced an exacerbation of the prostatitis symptoms with anorexia. Patient was referred to the Department of Gynaecological Endocrinology, in which we performed endocrine measurement of the basal FSH and LH testicular volume. As per practice of the University Kerala Research Institute of Endocrinology, FSH and LH were normalized: to 677 and LH 1.2 x 10/L. The pituitary gland was palpated and biopsied with a digital probe for spermatozoa analysis. After completion of these measurements, patient was referred to the department of Endocrinology for further investigations. The pituitary mass was significantly increased at 29.5x, the gonad mass was abnormally low at 29.7 x and FSH LH testicular volume showed to be normal, which could due to the high number of spermatozoa detected by biopsy. The diagnosis of testicular cancer (androgen-dependent) was reported to be correct. Discussion A case of advanced prostate cancer (androgen-dependent) and hypogonadism (androgen receptor deficiency) associated with a history of long-term use injectable drugs is reported here. The diagnosis would have been missed had the patient not been referred for prostate cancer biopsies. In addition, the patient had normal biochemical and hematological status. The prostate mass and testes were significantly enlarged the serum testosterone level was highly elevated. deficiency is a common feature in males presenting with clinical signs and symptoms of androgen deficiency [12,13]. Several studies have described the incidence of androgen deficiency in the male population; most of these reports found increased incidence of androgen deficiency in African-Americans as compared to Caucasian men [2,4,6]. African-Americans are estimated to have a 45% less testosterone level than Caucasian Caucasians [3,14]. Recently, a study of 50 male African-American and Caucasian men aged 19–49 years with androgen deficiency symptoms drug trafficking from canada to the us was carried out. A significant difference in the serum testosterone level was observed between Caucasian and African-American in both studies: Caucasian males had a mean testosterone level of 4.14 mg/dl with an inter-quartile range of 1.5–8.57 mg/dl and African-American Caucasian males had a mean testosterone level of 5.12 mg/dl with an inter-quartile range of 2.08–11.4 mg/dl [15]. Although many reports have suggested that the etiology of androgen deficiency is multifactorial and pathophysiology suggested to be related with different types of male hormone deficiency symptoms. The primary feature of androgen deficiency is decreased serum testosterone level in the male population. serum testosterone level is an indicator of the degree deficiency or severity of symptoms male hypogonadism. A diagnosis of low testosterone level is usually made after a careful discussion of medical history and routine laboratory evaluation, considering male gender and a history of regular sex partners. The serum testosterone level usually is normal at 0.1–0.3 nmol/l in a range between 0.2–3.0 nmol l−1, although an elevation of serum testosterone level is seen with other disorders, especially prostate cancer [16]. The etiology of androgen deficiency includes genetic factors, metabolic abnormalities and non-genetic such as aging. The etiology of testosterone deficiency usually includes a combination of genetic and non-genetic factors. The factors are usually inherited. A few studies have found an association between testosterone deficiency and diabetes mellitus type 2, which causes obesity and insulin resistance [17,18,19]. A wide range of hormonal and urinary steroids, such as testosterone, 17α-hydroxypregnenolone (17ß-hydroxypregnenolone), cortisol, and oestradiol are reported to be associated with androgen deficiency [20,21]. The urinary metabolites and their biological activity are reviewed in other reviews [22,23]. The pharmacological actions related to androgen Cetirizine tablets brand names deficiency are reviewed in other reviews [24,25,26]. The mechanism of action androgens is complex: They work by binding to steroid receptors on target cell and by activating transcription of target genes. The hormone also possesses numerous other biological activities, both direct and indirect-acting. For example, the anti-estrogenic and anti-diabetic activity of androgens might have a pivotal role in the development of androgen deficiency. Both testosterone and DHT are involved in human sex differentiation. Testosterone induces prostate gland development in males. DHT also reduces proliferation of prostate tissue and inhibits the growth of adenoma. DHT modulates the proliferative activity of human prostate, and its role in the regulation of prostate growth.
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