Abstract
Several endocrinologic abnormalities have been described in patients with chronic renal failure. In this paper we report sexual dysfuction in male patients on chronic hemodialysis.
1) The investigation of sexual activity through questionnaires performed 4 times during 1968 to 1981 shows that 36.9% of the patients have no interest in sexual activity, 72.9% complain of diminished libido after the onset of dialysis therapy, and 28.4% enjoy sexual life. The loss of libido results from impotence in 32% of the patients, and reduced potency such as an inability to maintain erection or inadequate penile tumescence in 67%.
2) The histological chages of testis consist of atrophy and hyalinosis of the seminiferous tubules, thickened tubular basement membranes, severe hypospermatogenesis hyperplasia of interstitial connective tissues, and apparent hyperplasia of Leydig cell. These findings are regarded as the partial changes to be seen in the chronic wasting diseases rather those of renal failure.
3) As the period of the conservative therapy before hemodialysis is longer, azo-or oligospermia to be severer. Though the once acquired changes seem to be irreversible, the acceleration can be prevented by the adequate dialysis therapy together with high protein diet, and the fertility may be preserved longer. Therefore, an early initiation of hemodialysis is recommended in the young mal patients with renal failure.
4) Serum levels of prolactin are elevated, and LH and testosterone are reduced. When compared with patients with normal prolactin level (group A: 23.7±7.34mIU/ml), the hyperprolactinemic patients (group B: 91.6±24.5mIU/ml) show significantly higher serum level of LH (A: 10.1±4.0, B: 64.1±29.8mIU/ml), and lower level of testosterone (A: 286±86, B: 227±87ng/dl). But the serum levels of FSH, GH, 17β-estradiol and cortisol are not significantly different between the two groups. Hyporesponsiveness in TRH test and abnormal pattern in clomiphene test suggest the hypothalamic-pituitary axis dysfunction as well as atrophy of testis.
5) Endocrinologic abnormalitites reflecting in hyperprolatinemia, lower serum levels of LH, testosterone, along with the psychological and nutritional factors play the major role in the pathogenesis of the sexual dysfunction commonly recognized in chronic hemodialysis patients. It is aiso suggested that lowering prolactin with bromocriptine or ZnSO4 may restore the gonadal function to normal.
