Vasectomy linked to low testosterone and gyne

[hypo]

I have scanned from Dr Malcolm Carruthers (M.D, FRCPATH, MRCGP endocrinologist) book the Testosterone Revolution, a whole chapter of which is set aside to discuss the connection between vasectomy and low testosterone.  The most interesting sections/extract of which are below.

If a Vasectomy causes low testosterone, it follows that this can easily lead to the development of gynecomastia, given that low testosterone is often a cause of gynecomastia.



Vasectomy and Low Testosterone  
 
Quote  
Vasectomy is a deceptively simple 'minor' operation and can be, and often is, carried out by the most junior and inexperienced of surg_ons. It takes 15 minutes to one-half hour and so lends itself to mass application in clinics set up for the purpose on a conveyor belt system.  The actual procedure is carried out under local anesthetic. Through a small incision, the tube carrying the sperm from the testis on each side to the prostate gland below the bladder, the vas deferens which gives the operation its name, is exposed. It is then dissected free of the fine nerves and blood vessels which run alongside it in the spermatic cord, and sealed off. This may be done by cutting it and tying off one or both ends, by frying it with electrocautery or by blockIng it with a plastic spigot (this is claimed to be more easily reversible).  
 
To the patient and surgeon alike it is seen as a simple plumbing job to turn off the stopthingys and prevent sperm getting out of the testes. It is presented as a cheap and effective form of contraception.    
 
However, after the operation there may be a variety of complications, which can be divided into short and long term. The vas itself may be damaged, as can the fine blood vessels, nerves and lymph vessels which run alongside it in the spermatic cord. These nourish the testis, control its temperature to within very critical limits and-drain fluid away from it.  
 
Temperature control of the testis can sometimes be impaired after vasectomy, along with fluid drainage from around it so that collections of fluid called hydrocele are formed in some cases. This insulating effect tends to raise the temperature, which can have a harmful effect on the testes' ability to produce both sperm and testosterone.  
 
Not only this, but there are also nerve connections between the two testes and damage to one can affect the other in a variety of ways.  
 
There is often mild to moderate discomfort which may cause the patient to stay off work for anything from an hour to a week, depending on his pain threshold, motivation and how many of the fine nerve endings that run alongside the vas get caught up in the operation.  
 
Over the last 10 years, I have been impressed by the fact that nearly 250 out of the 1,000 men in my initial research series complaining of symptoms of low testosterone have had vasectomies.  
 
It is difficult to get accurate reports on the proportion of men in different countries who have had vasectomies, because the operation is assumed safe and thought too trivial to be worth recording. However, as the best estimate of the frequency of vasectomy in British men of this age and social group is between 5 and 10 percent, there seems to be a significantly higher proportion of men who have had this operation in the low testosterone group.  
 
Not only are these patients on average five years younger than the rest, but often this operation appears to be the only risk factor present.  
 
The most common time for the symptoms to appear is 10 to 15 years after the vasectomy. This time scale was confirmed independently by another group in London, who also showed a fall in testosterone levels at this time.    
 
13 Other studies from Egypt and Belgium have shown that the amount of testosterone and one of its active fractions, dihydrotestosterone (DHT), in the semen, are reduced to one third by vasectomy.  
 
Most of tpe studies of the effects of vasectomy on hormone production are relatively short term, taking place over three to five years at most!    
 
Almost all were carried out 10 to 20 years ago, before vital factors such as sex hormone binding globulin (SHBG) and prostate specific antigen (PSA) were even being included in research studies. It's true they excluded any dramatic drop in total testosterone levels in the first five years after vasectomy, and some even showed an increase in DHT and follicle stimulating hormone (FSH).  
 
However this indicates at least some hormonal changes occur even in this relatively short time scale, which could be taken to show some disturbance in testicular function, if not actual damage to its structure.  
 
Vested interests (separate chapter my edit)  
 
There are powerful lobbies both inside and outside the medical profession with vested interests in maintaining the 'safe' image of vasectomy. First, doctors who have been promoting it for many years don't want to change their tune and to have to face the possibility of being in the wrong.  
 
I saw this very clearly in 1979 when, alarmed by the similarities between Dr Moller's experience with his men and the evidence from the research in monkeys, I encouraged a very well informed and level headed medical correspondent to write an article analyzing the vasectomy dilemma.  
 
Having done his homework very thoroughly, including a visit to Dr Moller's clinic in Copenhagen, he stated in his article: 'The view I have reached can be summarized as follows: with the present state of knowledge, I wouldn't dream of having a vasectomy myself' His conclusion was: 'It's safer to wait."  
 
Although this article was cautious by journalistic standards, there was an immediate, outcry by the medical establishment. The British Pregnancy Advisory Service dismissed the report as 'scare-mongering' and other experts the journalist had consulted to get a balanced view before the publication asked him not to write about it at all.  
 
I was involved in several radio and television debates on the question at the time, and the main argument of the antagonistic doctors was that vasectomy operations had been carried out for about a century and there had never been reports of an association between vasectomy and low testosterone.  
 
This reluctance of the medical profession to discuss vasectomy issues is likely to be even greater when the financial considerations of the vasectomy industry are taken into account.  
Unquote  
 
Here is a link to a site that has a personal story relating to testosterone being lowered post vasectomy  
 
Here is the personal story of one man affected by a vasectomy.

I had a vasectomy at the age of 26 back in 1985 (three kids in 20 months; twins). At both the 2 month and one and one-half year mark after the vasectomy, I returned to the urologist complaining of pain from the vasectomy. He convinced me that this was normal and would have to live with it. As he is was a licensed doctor, I believed him and basically assumed it was a “price to pay” thing. As all men are, I pushed the pain to the back of my mind and never spoke to anyone about it again as that we don’t talk about this kind of thing and I don’t like the “pity party” mindset some people have. Mistake? Certainly! Of course I NOW question and research everything. The good book has said for two thousand years, “Question all things”; sounds like good advice to me.
About two years ago, I suffered two kidney stones and at that time, decided to get a complete medical workup to see what I needed to do to prevent another stone. During the question/answer part, I responded affirmative to low libido, low general and sexual drive, erection problems, high weight, mood swings, depression and difficulty in the ability to concentrate. One of the tests was Total testosterone which returned with 147ng/dl. (This is the American value; for comparison, the “normal” range is 300 to 900ng/dl; the healthy range is about 700 – 900 based on free T, SHBG and albumin percentages – reference AACE Hypogonadism Task Force 2002 update for evaluation and treatment of hypogonadism.)

Over the last two years, I went through a structured series of tests to determine the bilateral failure etiology. Based on several different facts including a family history of an abnormal scar tissue build up from injuries, pain etiology in totality indicates bilaterally a hydrocele of the cords and/or scar tissue at or near the ductus deferens excision sites. This then caused a blood flow reduction of the testicular artery/vein plexus. This in turn caused the constant low level and spiking pain in the testicles. The reduced blood flow condition is most likely responsible for the complete testicular failure and atrophy of testicles slowly over time starting at the time of the vasectomy until the first T level test. Diagnosis now recognized as Post Vasectomy Pain Syndrome combined with testicular failure.

Notice that above, the sole testosterone test was for total testosterone. It turns out that is pretty much the standard in the US. I have done a large amount of study on this issue and have found that the UK is much further ahead in common knowledge and treatment protocol. In particular is Dr. Malcolm Carruthers and the associated web site. Another excellent research site is your site, Nick, www.androids.org.uk.

After starting TRT, within two weeks libido and drive was returning, within a month spontaneous erections were happening and the erection was like a teenage rock. Within two months my mood swings and depression had nearly disappeared. And, within a year weight went down 36 pounds and my ability to maintain long periods of concentration was greatly improved.

Over time, I was able to gather enough clinical research paper, clinical testing results, book information and the like to build the knowledge of my doctor to where he has started to test total T, SHBG, albumin, estradiol, prolactin, LH and FSH to determine the real state of hormone health. Further, I was on Androgel for a long while and I convinced him to go ahead with testosterone pellets.

I am currently experimenting on the Bartar 75mg T pellet. I came off Androgel mostly because of the information found about zero order deviation and small SHBG increases with the pellets. First application was eight pellets. Clinical trails show the 75mg pellet delivers about .75mg/day.