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     hCG response– hCG testosterone secretion stimulation is a method of evaluating Leyding cells function in prepubertal boys which secrete reduced levels of endogen gonadotropins. On the contrary, men with Leyding functional insufficiency present increased LH levels. The administration of hCG to these patients increases the circulatory testosterone level, though less then in men with normal Leyding function. Short term hCG administration usually produces an attenuated seric testosterone elevation in men with gonadotrophic deficit due to the LH chronic sub-stimulation of the Leyding cells. These patients show decreased levels of testosterone and LH which outlines an abnormal gonadotropins secretion. This is why the hCG test is not usually clinically relevant.
     The response to inhibitor and antagonist gonadal steroids is another common male test which consists in the administration of estrogen antagonists (Clomiphene citrate –CC or tamoxiphene) raises the gonadotrophic level in healthy men through the blockage of estradiol’ feedback effect. This is a dosage/time-bound effect and it requires many weeks of treatment before it can show notable changes in the patient’s clinical condition. The test has a limited reliance and also LH level is increased when the testosterone production is blocked by steroid-genesis inhibitors such as Ketoconazole or antiandrogens as Flutamide.
     GnRH test– generally, post GnRH administration, raise of the FSH and LH levels is proportional with the basic hormonal levels. The maximum level of gonadotropins is above average in men with primary testicular insufficiency. Patients with slightly affected testicular function can have a normal basic FSH, but they show an exaggerated FSH response to GnRH stimulation. In patients who suffer from hypophysis or hypothalamic diseases, post GnRH administration, gonadotropins release can either be reduced but also normal. Also the GnRH response cannot differentiate these two possibilities. In patients with GnRH deficit but normal hypophysis, repeated GnRH administration can restore gonadotrophic secretion. Also, repeated GnRH administration has been proven useful in the diagnosis of men who suffer from gonadotrophic deficit, eligible to the GnRH therapy. Nowadays GnRH test has low utility in masculine infertility evaluation.
     Radiologic investigations-when clinical and biochemical evaluation suggests hypogonadotrophic hypogonadism, the radiological investigation can be useful. A vasography is usually used when there is a prior diagnosis of genital tract obstruction, especially when reparatory surgery is taken into consideration. Because it is an expensive and invasive procedure other methods can be recommended. Trans-rectal Ultrasonography is useful in highlighting the obstruction or absence of the seminal vesicles which can also evidence chronic infections of the prostate. Doppler Ultrasonography, thermography, technetium radionuclide and spermatic vasography are useful methods of discovering the varicocele presence, but only the last of them is commonly accepted as a prove of varicocele evidence.
     Testicular biopsy– histological examination of the testicular tissue of the infertile man reveals seminiferous tubules abnormalities which include the shrinking of the diameter of the seminiferous tubules, the germinal cells piled up along the lumen of the tubules and peritubular hyalinization. Testicular biopsy doesn’t interfere with the therapy but it provides little relevant data for the infertility, this is why it is not frequently used. On the other hand testicular biopsy is used to identify patients with obstructive azoospermia, eligible to micro-surgical treatment or semen intracytoplasmic injection –ICSI. On the other hand men who suffer from azoospermia with increased levels of FSH show seminiferous tubules dysfunctions and they shouldn’t be submitted to a biopsy.

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