Why Does Cirrhosis Cause Testicular Atrophy?
Written by Ben Bunting: BA, PGCert. (Sport & Exercise Nutrition) // British Army Physical Training Instructor // S&C Coach.
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Cirrhosis is a serious liver condition that can lead to a range of complications, including testicular atrophy.
This condition can cause the testicles to shrink and may lead to infertility in men. Understanding the causes and potential treatments for testicular atrophy in cirrhosis is important for managing this condition.
What is Cirrhosis and How Does it Affect the Body?
Advanced cirrhosis occurs when the liver cannot adequately remove toxins from your blood, leading to ascites buildup in your abdomen and brain damage (hepatic encephalopathy).
People suffering from cirrhosis often struggle with fighting infections; this could result in complications like bacterial peritonitis which is potentially life-threatening; additionally it makes processing nutrients harder for your body resulting in weakness and weight loss.
Cirrhosis can be caused by various factors, including viral hepatitis (Hepatitis A, B or C), nonalcoholic fatty liver disease and alcoholism. Genetic conditions like hemochromatosis cystic fibrosis or Alagille syndrome may also contribute to its progression.
The liver provides your body with essential protection from harmful toxins and creates bile to aid digestion. When your liver becomes damaged, scar tissue replaces healthy liver cells and it stops working correctly.
Cirrhosis is one of many diseases which cause liver damage; its scarring interferes with blood flow to and from your liver cells, the ability of those cells to add or remove substances from blood, as well as how efficiently waste leaves your body.
Cirrhosis often develops slowly without showing any symptoms in its early stages, and is usually detected during physical exams or tests done to diagnose another condition.
Symptoms of cirrhosis
Medical staff typically detect it by looking out for red blotches on palms of hands or spider angiomas on face, torso, arms, distended abdomen filled with fluid, and high liver enzyme levels.
As your cirrhosis progresses to decompensated stages, more noticeable symptoms may emerge, including jaundice (caused by excess bilirubin buildup that causes yellow skin and eye whites) and fluid accumulation in legs and abdomen (ascites).
If decompensated stages occur, bleeding from varices might occur as well as difficulty thinking clearly, fatigue and appetite loss as well as vomiting blood or producing black tarry-looking stool - symptoms indicative of severe hepatic encephalopathy.
Cirrhotic livers no longer filter blood efficiently, leaving behind excess waste products that build up in skin, joints, and nerves.
You may experience abdominal pain that feels like dull or throbbing beneath your ribs due to scarring in cirrhotic livers that causes your spleen to enlarge due to scarring (hepatic splenomegaly).
Some individuals with cirrhosis develop a serious lung condition known as Hepatopulmonary Syndrome. This occurs when your lungs cannot get enough oxygen because your liver fails to produce sufficient red blood cells that deliver oxygen directly into them.
Once cirrhosis has begun to progress, there is no cure; however, treatments may help slow further damage and complications.
Your medical service will recommend treatment depending on what caused it; for instance if excessive alcohol use was the source, quitting drinking will likely be advised as one approach.
With regards to Hepatitis B or C related cirrhosis antiviral medications can help protect against further liver damage, decreasing risk for Hepatocellular Carcinoma while surgery could be an option as a potential way out.
What is Testicular Atrophy?
Testicular atrophy is not a condition that will go away on its own and it can have serious repercussions if left unchecked.
Therefore, seeking professional advice to address testicular atrophy should be your first step toward action.
A doctor can conduct physical exams to assess size, shape and texture of balls; test for STDs; or conduct ultrasound scans to look at internal function, blood flow and damage within your testis.
Doctor's typically ask about a person's medical history and any medications being taken by patients, and may suggest lifestyle or treatment changes or interventions for the root cause of any symptoms they observe.
For instance, those using steroids might need to switch hormone treatments in order to prevent testicular atrophy caused by them - while excessive drinkers might need to quit or reduce their alcohol consumption as part of this strategy.
Clinton explained that any condition which impairs the normal blood flow to a testicle can lead to atrophy, such as varicocele (swollen veins in the scrotum).
For instance, varicocele causes pooled blood rather than being properly circulated around it, and trauma or infections such as orchitis - an inflammation of the testicle which if left untreated can obstruct blood flow leading to atrophy of testicular tissue and atrophy of testicle tissue.
Testicular atrophy may also be caused by cancer, leading to the loss of one or both testicles.
Symptoms of testicular atrophy may include pain in the scrotum or abdomen, lumps or bumps on the testis and bleeding or bruising; in certain instances a biopsy will be necessary in order to properly identify its source.
Symptoms
Testicular atrophy symptoms typically include shrinkage of one or both testicles. You may also observe them feeling smaller and softer than usual and loss of normal scrotal skin sensation.
It is best to contact medical professional as soon as you notice these symptoms as the longer they persist the greater concern they pose
Depending on its cause your doctor will perform a physical exam as well as possibly taking blood samples in order to assess hormone levels in your system.
Testes are male reproductive glands located within the scrotum. Their purpose is to maintain temperature around them by contracting when cold weather approaches and relaxing when warm weather arrives, with too long of contraction making the testicles appear smaller than they usually would be.
Orchitis, which is an inflammation in the testicles caused either virally or bacterially, usually manifests with pain in the testicles and may make them appear enlarged initially before eventually leading to testicular atrophy if left untreated.
Bacterial orchitis most often occurs as a result of gonorrhea/chlamydia infections as well as urinary tract/catheter infections.
Aging can cause testicular atrophy, as testosterone production slows as one ages. If this symptom arises, it's crucial that you consult a healthcare provider immediately, as this could have serious ramifications on fertility.
There are also medications which can contribute to testicular atrophy, including steroids and narcotics, that interfere with your body's production of sperm and male reproductive hormones.
If you are taking such medication it's wise to discontinue them immediately to prevent further damage to your testes.
Prevent testicular atrophy by leading a healthy lifestyle, such as eating well-balanced meals and regularly exercising.
Furthermore, avoid smoking and excessive alcohol consumption which both damage your testes. Furthermore, get regular cancer screenings between 18-38 as this is when your risk for testicular cancer increases most dramatically.
Why Does Cirrhosis Cause Testicular Atrophy?
Cirrhosis is a condition in which the liver no longer performs as it should, leading to its organs' dysfunction and eventually breakdown. It can be exacerbated by excessive alcohol drinking, hepatitis B or C virus infections or any disease that damages liver tissue.
Treatment aims to slow the progress of liver cirrhosis and minimize complications, with liver cancer, kidney failure and complications from cirrhosis-related problems including skin problems, bones issues and nervous system problems being the most likely consequences.
Cirrhosis can lead to testicular atrophy due to lack of oxygen in the blood that supplies it.
Under normal circumstances, the spleen filters red blood cells and removes old platelets used to clot blood - with draining blood entering the portal vein before entering the intestines through portal vein.
With cirrhosis however, liver function becomes compromised and pressure in portal vein increases which blocks flow from spleen leading to its swelling - known as splenomegaly.
Research suggests that one of the first steps in the development of this condition is a decrease in the expression of transferrin, which can lead to dysfunction of Sertoli cells and a disruption in the integrity of the blood-testis barrier.
Cirrhosis, can lead to hypogonadism and feminization in men. Studies have shown that these men have lower levels of testosterone in their blood, but only a small percentage have increased levels of estrogen. This hormonal imbalance can lead to a variety of symptoms and complications.
Over time, this disease leads to testicular atrophy. Cirrhosis of the liver results in scarring that hinders its function and manifests as ascites and hepatic encephalopathy symptoms, among other issues.
Cirrhosis may also lead to fertility problems associated with oligospermia or teratospermia; further complications include infertility.
Cirrhosis may lead to secondary hypogonadism as a result of reduced serum free testosterone levels, increased conversion of testosterone to estrogen via the hepatic aromatase mechanism and impaired hypothalamic-pituitary-gonadal axis impairment.
The exact cause of these changes is not fully understood, but it is believed to be a combination of factors. One possible factor is a decrease in the liver's ability to clear certain estrogen compounds from the body.
Additionally, there may be an autoimmune component that affects the function of the testes. Finally, alcohol consumption may also play a role in exacerbating these hormonal changes.
This can manifest itself with symptoms like gynecomastia as well as diminished primary and secondary sex hair and diminished libido.
Unfortunately, the exact role that hypogonadism has played in these symptoms has yet to be established; also unknown is whether testosterone therapy could improve them or not.
Previous experimental data has demonstrated that rats suffering early stage cirrhosis experience severe testicular atrophy and gonadal dysfunction.
They experienced reduced transferrin expression and altered blood-testis barrier changes, possibly contributing to reduced cell proliferation and gonadal axis integrity resulting from abnormal negative feedback loops within their pituitary glands.
Treatment with IGF-1 for short period reverses these early changes in testes, restoring cell proliferation as well as hypophyso-gonadal axis integrity.
Recombinant human IGF-1 restored testicular function for these rats; suggesting an altered hepato-testicular barrier and reduced IGF-1 bioavailability are primary contributors.
Oral androgens, on the other hand, may actually increase estrogen levels, possibly leading to greater sexual dysfunction than originally intended.
Studies conducted on men with organic hypogonadism have demonstrated the efficacy of testosterone replacement therapy to increase muscle mass, bone density and hematopoiesis. However, its effect in patients suffering from cirrhotic liver disease remains unknown.
Other causes of testicular atrophy
Untreated testicular atrophy can result in irreversible male infertility. It also increases the risk of complications like varicose veins and blood clots in the scrotum, as well as contributing to low concentrations of sperm cells with poor morphologies (oligospermia/teratospermia) as well as contributing to other conditions that lower fertility such as oligospermia/teratospermia/oligoteratospermia/teratospermia.
Testicular atrophy may be caused by different factors, ranging from an imbalanced hormone environment and consumption of steroids, to natural age-related decline and low sperm counts or infertility. It can even happen naturally as men age.
Medication such as antibiotics and sexually transmitted diseases may contribute to testicular atrophy.
Viral orchitis, an inflammation in the testicles caused by viruses like the mumps virus that impacts up to one-third of post-puberty men, as well as bacterial orchitis caused by infections like Chlamydia or Gonorrhoea can also result in testicular atrophy.
Testicular torsion also contributes significantly - this occurs when one or both testicles twist placing undue pressure on their spermatic cords resulting in atrophy in that area of testicle tissue.
Treatment
On the bright side, it is possible to halt cirrhosis from progressing and, in many cases, even reverse years of heavy drinking.
Cutting back on alcohol consumption is the first step. Also important are treating any infections such as Hepatitis B/C as well as treating any hereditary conditions like Hemochromatosis; some doctors recommend immunization against Hepatitis A & B to avoid recurrent infections.
Cirrhosis disrupts hepatic blood flow, leading to an increase in portal vein pressure that in turn causes fluid buildup in legs and abdomen.
Portal hypertension also increases leukocyte and platelet accumulation within the spleen, potentially trapping leukocytes that trigger severe bleeding into varices (the pouches located inside either esophagus or stomach).
Once varices bleed they tend to rebleed frequently so treatment options must be considered immediately: medications to lower pressure in portal veins as well as surgery to remove enlarged varices.
Scientists recently conducted a study that demonstrated how IGF-I therapy can restore testicular function in rats with epididymis atrophy and fibrosis.
IGF-I increased transferrin expression, an indicator for maintaining barrier integrity as well as Sertoli cell functionality.
An inverse correlation was also discovered between transferrin expression levels and histopathological damage score, suggesting IGF-I may improve response to hepatocellular injury in testes.
Conclusion
Cirrhosis is a chronic disease that affects the liver and can have negative impacts on other parts of the body.
One such impact is on the Leydig cells in the testis, which can lead to the release of cytokines and an increase in the conversion of androgens to estrogens.
This can lead to hypogonadism and feminization in men. This is often accompanied by a decrease in testosterone production and low levels of testosterone in the bloodstream. These clinical signs are commonly observed in men with chronic liver disease.
This condition is characterized by reduced testicular size and inadequate testicular function. In fact, a 1977 review states that between 50-75% of cirrhotic men experience testicular atrophy.
Additionally, 80-90% of these men are impotent and have abnormal seminal fluid. Other symptoms of hypogonadism include decreased body hair, reduced beard growth, and smaller prostatic size.
Interestingly, cirrhotic men have a lower incidence of benign prostatic hypertrophy when examined histologically.
