Endokrinologi Reproduksi Pria

Gede Wira Buanayuda

(Fakultas Kedokteran Universitas
Mataram)
 Hypothalamus
• Receives neural input from many brain centers
and is the pulse generator for the cyclical
secretion of pituitary and gonadal hormones
• GnRH
synthesis and release of both gonadotropic
hormones,LH and FSH
Pulsatile : 1 pulse every 70 to 90 min
very short half-life in the blood of approx 2 to 5
min
 ANTERIOR PITUITARY
• LH and FSH
• regulate testicular function
• secreted in an episodic manner
• FSH : longer half-life
• LH : rapidly metabolized
 TESTES
• 2 fungsi : spermatogenesis, steroidogenesis
(sintesis androgens)
• LH melekat pada reseptor membran Sel leydig
 testosteron
• FSH melekat pada reseptor membran sel
sertoli  sintesis ABP (androgen binding
protein, inhibin, inisiasi spermatogenesis)
 Kontrol Umpanbalik
• LH
• testosterone—is a primary inhibitor of LH
secretion in men
• Estrogens also inhibit LH secretion
• FSH
• both testosterone and estradiol are capable of
suppressing FSH serum levels
• Inhibin produced by the Sertoli cells of the testes
 suppressing FSH release.
 PROLACTIN AND GONADOTROPINS
• Hyperprolactinemia
• inhibit GnRH secretion directly
• Excessive prolactin may affect sexual functions
by having a direct effect on the central nervous
system and also from inhibition of androgen
secretion
• Bromocriptine, a dopamine agonist with
prolactin-lowering activities, improves sexual
function
 ANDROGEN PHYSIOLOGY
• regulate gonadotropin secretion
• initiation and maintenance of
spermatogenesis
• formation of male phenotype during sexual
differentiation
• promotion of sexual maturation at puberty
• controlling sexual drive and potency
• In normal males
• 2% of testosterone is
free (unbound), 44% is
terikat kuat “sex
hormone-binding
globulin” (SHBG), sisanya
terikat ke albumin
• Free- and albumin-
bound portions 
bioavailable testosterone
 HORMONAL CONTROL OF
SPERMATOGENESIS
• Spermatogenesis is primarily controlled by the
gonadotropins—FSH and LH.
FSH
LH LC

SC
T ABP

Qualitative sperm production can be achieved by

replacement of either FSH or LH alone
both FSH and LH are necessary
to maintain quantitative normal spermatogenesis in humans
 Initiation and maintenance of
spermatogenesis
• T & FSH  SC (SINERGISTIK)
• Testosterone
Qualitatively will initiate and maintain spermatogenesis
in humans
• FSH
necessary for the maintenance of quantitatively normal
sperm production
initiating spermatogenesis in pubertal males and
reinitiating spermatogenesis in men whose germinal
epithelium has regressed after hypophysectomy
 Spermatogenesis
• 3 TAHAP
SPERMATOSITOGENESIS
Mulai dari spermatogonium s/d spermatosit
primer.
MEIOSIS
Pembelahan reduki (meiosis) 2X, pd
spermatosit primer  spermatosit sekunder
 terbentuk spermatid.
SPERMIOGENESIS
Transformasi spermatid menjadi spermatozoon.
SPERMIOGENESIS
 SPERMIASI
• PELEPASAN SPERMATOZOA DARI SEL SERTOLI
MEMASUKI LUMEN TUBULUS SEMINIFERUS.
• SPERMATOZOA INI SECARA MORPHOLOGIS
SUDAH MATANG, TETAPI SECARA
FUNGSIONAL.
 Aspek klinis
• History
• Pemeriksaan pisik
• Evaluasi hormonal
 diagnosis of endocrine causes
• Severe oligo/Azoospermia  FSH, LH, T
• N T, N LH, N FSH : Nonendocrine
• T , LH , FSH : Primary testiscular failure
(Hipergonadotrophic-hipogonadism)
• T , LH , FSH : Secondary testiscular failure
(Hipogonadotrophic-hipogonadism)
• N T ,N LH , FSH : Isolated Germ Cell Failure
• T , LH , N FSH : Androgen Resistance
 diagnosis of endocrine causes
• Hyperprolactinemia
• Libido , ED , T , Prol
Contoh Kasus
tks