A 26-year-old man comes to the emergency department due to a 10-hour history of progressively worsening right-sided scrotal pain. Clinical and radiological evaluations confirm testicular torsion with significant ischemic damage and the patient undergoes unilateral orchiectomy. Three months later, he comes to the office for follow-up. The patient is otherwise healthy and takes no medications but is worried about the risk of sexual dysfunction and infertility. Further evaluation is most likely to show which of the following sets of findings in this patient?

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11ec160b_3cb7_004c_9249_730660532771_MD0001_00 Spermatogenesis in the testis is dependent on 2 primary hormone systems. Testicular Leydig cells produce testosterone in response to LH from the pituitary; in turn, LH is regulated by feedback inhibition from testosterone. At the same time, FSH from the pituitary induces the Sertoli cells to produce androgen binding protein (ABP), which concentrates testosterone in the seminiferous tubules and facilitates spermatogenesis. The Sertoli cells also produce inhibin, which provides feedback regulation of FSH. Following unilateral orchiectomy, the initial drop in circulating testosterone stimulates pituitary LH secretion, leading to compensatory testosterone production and Leydig cell hyperplasia in the remaining testis. Testosterone levels are quickly restored, maintaining normal libido, erectile function, and secondary sex characteristics. Concurrently, the loss of inhibin following unilateral orchiectomy leads to increased pituitary FSH release, stimulating ABP production and facilitating spermatogenesis in the remaining testis. However, due to the loss of seminiferous tubules in the orchiectomized testis, most patients experience decreased net spermatogenesis, often with reduced fertility (Choice C). (Choice A) Bilateral testicular damage (eg, orchitis, bilateral orchiectomy) leads to azoospermia. In addition, nontesticular sources of testosterone (eg, adrenals) are often inadequate to maintain normal libido and erectile function. (Choice D) Erectile dysfunction (ED) with normal sperm counts can be caused by a variety of disorders (eg, neurologic or vascular disorders, psychogenic ED), but most patients who have loss of testosterone production severe enough to cause ED will also have impaired spermatogenesis. Educational objective: Following unilateral orchiectomy, the drop in testosterone stimulates pituitary LH secretion, which stimulates increased testosterone production in the remaining testis and maintains libido, erectile function, and secondary sex characteristics. However, the loss of sperm-producing tissue usually causes a drop in sperm counts.

A 26-Year-Old Man Comes to the Emergency Department Due to a 10-Hour