Effect of treatment with chronic gonadotropin releasing hormone agonist on human testis.
We removed and examined 24 testes from 12 patients with metastatic carcinoma (stages C2 and D2) of the prostate who had been treated previously with either the gonadotropin releasing hormone analogue buserelin alone or combined buserelin and flutamide for a mean of 13.8 months. The histological changes noted included severe generalized atrophy of the seminiferous tubules, prominent degeneration of the Sertoli cells, with ultimate total tubular hyalinization, partial Sertoli-cell-only syndrome in 50 per cent of the testes (number of germ cells less than or equal to 0.95 per tubule), and pronounced collagenization and fibrosis of the interstitium (50 per cent) with total atrophy of the Leydig cells in 92 per cent of the testes. These results show that the effect of prolonged high doses of buserelin in the majority of patients caused irreversible damage, particularly to spermatogenesis and the Sertoli cells, and thus to the intratesticular ultra-short loop. Therefore, when it is applied continuously in a high dose daily for a long period this drug does not appear to be suitable as a male contraceptive.