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Posted: September 18th, 2023

Impact of Low Testosterone and GnRH Levels on Male Fertility

BIOL121 ASSIGNMENT 3: Written assessment
Scenario: David
David is a 41-year-old male, who has made an appointment to see his GP for his biannual health check. He
tells the doctor that he has been feeling “a bit puffed” walking around the course during his weekly game of
golf and that he seems to be urinating more frequently of late. David reports he has gained nine kilos since
his 30th birthday, and his waist measurement has expanded. He laughs this off as “middle-aged spread” and
says his wife tells him he needs to watch what he eats and drink less alcohol. David works as a software
engineer, which he has been finding very stressful of late, and spends a lot of his time in the office sitting in
front of a computer, snacking on his favourite salt and vinegar chips. David and his wife are keen to start a
family but have not yet been successful in conceiving.
On the advice of his doctor, David has been taking aspirin in the evenings for the past 18 months to lower his
risk of heart attack and Zocor® to address cholesterol.
Physical examination:
Height 174 cm
Weight 94 kg
Appearance Neat appearance, overweight, pale
Temperature 37.1◦
C
Blood work Blood type = O+
Blood glucose = 10 mmol/L
Blood Testosterone levels = 154 ng/dL
GnRH = low
BP 155/99 mm Hg
Respiratory rate 19 bpm
Diet Mostly healthy meals. Snacks on high
fat & sugar, processed foods. Heavy
alcohol consumption.
Past patient history Ex-smoker. Regular check-ups every six
months. Cholesterol levels have been
high at the last three check-ups. Takes
Aspirin in the evenings. Gall bladder
removed 5 years ago.
Social status Lives with his wife and mother-in-law.
Sexually active.
Urinalysis:
Blood –
Bilirubin –
Urobilinogen 0.1 mg/dL
Ketone –
Protein –
Nitrite –
Glucose ++
pH 6
Specific Gravity 1.035
Leukocytes –
©ACU 2022 2
All topics and their key points listed below must be discussed in your essay
Topic 1: Reproduction (10 marks total)
David and his wife are keen to start a family but have had no success so far. Considering David’s blood test results, indicate whether there is need for further investigation. Your discussion should include the
homeostatic regulation of male reproductive physiology and the relevant glands, cells, and hormones. (10marks)
Topic 2: Respiratory system (5 marks total)
David is late for work and the lift is broken; he must run up six flights of stairs to make it on time.
Describe the gas exchange occurring between David’s blood and the skeletal muscles in his legs. Discuss how the rate of gas exchange was affected during the run up the stairs (i.e., during exercise). (5 marks)
Topic 3: Digestion/metabolism (8 marks total)
After speaking to his doctor, David has decided to try to lose weight and he going to start a diet…tomorrow.
Tonight, David is enjoying his last high carbohydrate/high fat meal for a while.
Discuss the potential impact of David’s gall bladder removal upon his ability to digest his dinner. (4.5 marks)
State the hormone that is MOST active in maintaining David’s blood glucose levels at this time. Explain your answer. (3.5 marks)
Topic 4: Pharmacology (7 marks total)
Under the advice of his doctor, David has taken Zocor® tablets each evening for the past 18 months.
Discuss the route of administration, which route the drug is likely to be excreted after administration, and its likely bioavailability. Justify your response by discussing whether the drug would be subjected to hepatic first
pass. (4 marks)
To help with weight loss, a friend has advised David to drink grapefruit juice with his meals.
As a health care professional, would you consider this to be a good idea for David? In your answer, discuss the role of the liver in the administration of Zocor and grapefruit juice? (3 marks)

___________________________
Impact of Low Testosterone and GnRH Levels on Male Fertility
instructions:
General information: All health professionals need to be able to communicate and justify their work to a non-specialist audience, which may comprise those involved in policy-making decisions as well as the general public. As you will be aware, the health sciences are often poorly represented by the media. There are plentiful examples of reporting that may be sensationalistic, misleading, biased (e.g. on vaccine safety), inaccurate (e.g. many media sources seem to view the words bacteria and viruses as interchangeable), or all four. Hence, there is a need for, and a potential career in, good writing and communication in the health professional arena.

This assessment involves addressing a series of generic questions in the form of an essay. The questions relate directly to the case studies presented. Key points to note are below:

Your answers must be incorporated into sentences and paragraphs that include facts from the case study.
All answers must be specific for the person in the case study; marks will not be given where your essay does not relate to the person in the case study.
The answers to the questions in the case study must be integrated into an essay, which should include an appropriate introduction and conclusion; your written communication mark will be heavily penalised if a question-answer style presentation will be .
You can present the information in the order that you feel flows best; you don’t have to present it in the order of the questions.
The information you present must be synthesised from reliable sources (e.g. peer-reviewed articles in the scientific and clinical research literature, and textbooks).
Care must be taken in all aspects of the essay, including spelling and grammar.
Do I need to reference my case study essay? Yes, you must include appropriate in-text citations and a reference list in APA style (7th edition). Penalties will be applied as per the marking criteria for inadequate and/or incorrect referencing.

Impact of Low Testosterone and GnRH Levels on Male Fertility
David, a 41-year-old man reports to have been urinating more frequently and feeling “a little puffed” while walking around the golf course. He has gained nine kilograms in the past ten years and his waist size has increased as well. After conducting some tests, David’s doctor discovered that his testosterone and GnRH levels were both low. This could have an impact on his ability to conceive. The doctor advised consulting a fertility specialist for further examination based on his blood test results. It is possible that the low levels of these hormones are interfering with his ability to conceive. More research is required to determine the cause of these low levels and whether they interfere with conception.
The HPG (hypothalamic-pituitary-gonadal) axis is a hormone feedback loop that regulates the production of testosterone in men. Testosterone is essential for the development and maintenance of male reproductive tissues, including the testes, prostate, and seminal vesicles. It plays a role in the development of secondary sexual characteristics, such as facial and body hair growth, deepening of the voice, and muscle development. Nevertheless, the HPG axis can be disrupted by a variety of factors, including stress and obesity. When the HPG axis is disrupted, it can lead to low testosterone levels, which can impact fertility, sexual function, and overall health.
The hypothalamic-pituitary-gonadal (HPG) axis is made up of the hypothalamus, pituitary gland, and gonads, and is governed by a negative feedback loop. In the loop, testosterone and estradiol inhibit the secretion of gonadotropin-releasing hormone (GnRH). GnRH is a hormone produced in the hypothalamus and it is responsible for triggering the release of other hormones, such as LH and FSH, from the pituitary gland. LH and FSH play key roles in the development of sperm cells and testosterone production. When GnRH levels are low, it can result in low LH and FSH levels, which in turn can lead to low testosterone levels.
David’s poor diet, high alcohol intake, stress, and sedentary lifestyle may be contributing to his fertility troubles. Carrageta et al. (2019) found that poor diet, high alcohol intake, stress, and sedentary lifestyle can lead to decreased GnRH production. This can in turn lead to decreased LH and FSH production, which can lower testosterone levels and sperm production. Leisegang and Dutta argue that male fertility may be declining due to detrimental lifestyle practices and exposures (2021), such as those employed by David’s lifestyle. He should consider making some lifestyle changes to improve his fertility. It should purpose a healthy diet, regular exercise, and low stress levels. David should talk to his doctor about his low GnRH levels and ask if there is anything that can be done to increase them.
When David runs up the stairs, his skeletal muscles produce energy through aerobic respiration. This process produces carbon dioxide, which diffuses from the muscles into the blood. The blood transports carbon dioxide to the lungs, where it is exhaled. At the same time, the lungs take in oxygen, which diffuses into the blood. The blood transports the oxygen to the muscles, where it is used in aerobic respiration.
The rate of gas exchange is affected by the rate of respiration. When David is running up the stairs, his respiration rate increases to supply his muscles with the oxygen they need, which results in an increased rate of gas exchange between his blood and the lungs. More carbon dioxide is produced because of the increased heart and breathing rates. The increased carbon dioxide production results in an increased ventilation rate that removes the excess carbon dioxide from the lungs. This results in a decrease in the carbon dioxide concentration in the blood, which in turn decreases the rate of gas exchange.
Generally, the rate of gas exchange between David’s blood and his skeletal muscles is affected by the rate of respiration. When David is running up the stairs, his respiration rate increases to supply his muscles with the oxygen they need, which results in an increased rate of gas exchange between his blood and the lungs..
The removal of David’s gallbladder may impact his ability to digest his final high-fat and carbohydrate meal before starting his diet tomorrow. The gallbladder is responsible for storing and releasing bile, which helps to break down fats in the small intestine. Without a gallbladder, David may not be able to effectively digest and absorb all the nutrients from his meal, which could lead to gastrointestinal discomfort. The hormone that is most active in maintaining David’s blood glucose levels at this time is insulin. Insulin is secreted by the pancreas in response to elevated blood glucose levels. It helps to move glucose from the blood into the cells, where it can be used for energy.
Additionally, bile produced by the liver and necessary for the breakdown of lipids, is stored and concentrated by the gall bladder. Without a gall bladder, bile enters the small intestine directly from the liver, which may increase fat absorption and result in weight gain. By storing and releasing glucose into the bloodstream as necessary, the gall bladder additionally aids in the control of blood sugar levels. Blood sugar levels may become unpredictable and difficult to manage without a gall bladder. David’s decision to start a diet is a positive step towards improving his overall health. However, it is important to speak with a doctor or registered dietitian before starting any new diet, especially if you have a medical condition.
Oral administration is the most common route of administration for Zocor, and the drug is likely to be excreted via the feces after administration. This is because Zocor is a lipophilic drug, meaning that it is soluble in fats and oils. Lipophilic drugs are typically absorbed better when taken with food, so it is recommended that Zocor be taken with a meal. Zocor has a high bioavailability, meaning that it is absorbed well into the bloodstream because it is not subjected to hepatic first pass metabolism. This means that the drugs do not have to be metabolized by the liver before it enters the bloodstream, and as a result, more of the drug is available for absorption. Overall, the oral administration of Zocor is a convenient and effective way to take the drug, and its high bioavailability makes it an ideal choice for patients who need to take the drug on a regular basis.
The grapefruit diet is not a myth as suggested by a recent study. The researchers claim that adding grapefruit and grapefruit juice to one’s diet can result in weight loss (Modi and Priefer, 2020). Another study suggests a physiological relationship between grapefruit and insulin in terms of weight management. The researcher hypothesizes that grapefruit’s chemical characteristics lower insulin levels and promote weight loss (Tobore, 2020). Grapefruit juice, however, can interfere with various drugs, including Zocor impacting the liver’s metabolization of Zocor that results in an elevated amount of Zocor in the blood (Kang et al., 2020). The study also notes that grapefruit and grapefruit juice can interact with other drugs such as cholesterol-lowering statins and calcium channel blockers. The grapefruit diet is a fad diet that has been debunked by nutrition experts (Li, 2020). The diet is not sustainable in the long term and does not promote healthy eating habits. The grapefruit diet is not recommended for people with diabetes or other health conditions.
Low testosterone and GnRH levels could be interfering with David’s ability to conceive with his wife. A specialist will give specific guidance on how to deal with his problem. David’s sedentary lifestyle may be contributing to his fertility situation. Making appropriate dietary and exercise modifications, as well as reducing stress, can help enhance his fertility.

References
Carrageta, D. F., Oliveira, P. F., Alves, M. G., & Monteiro, M. P. (2019). Obesity and male hypogonadism: tales of a vicious cycle. Obesity Reviews, 20(8), 1148-1158.
Kang, T. J., Kim, J. Y., Ryu, J. H., Kim, D. H., & Lee, C. J. (2020). A Review on Interaction between Drug and Healthy Functional Food, and the Nutrient Deficiency as the Side Effects of Prescription Drugs. Yakhak Hoeji, 64(2), 95-102.
Leisegang, K., & Dutta, S. (2021). Do lifestyle practices impede male fertility?. Andrologia, 53(1), e13595. homework help writing assignment service
Li, A. P. (2020). In vitro human cell–based experimental models for the evaluation of enteric metabolism and drug interaction potential of drugs and natural products. Drug Metabolism and Disposition, 48(10), 980-992.
Modi, N., & Priefer, R. (2020). Effectiveness of mainstream diets. Obesity Medicine, 18, 100239.
Tobore, T. O. (2020). Towards a comprehensive theory of obesity and a healthy diet: The causal role of oxidative stress in food addiction and obesity. Behavioural brain research, 384, 112560.

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