These results provide a rationale for the high rate of success in the testicular sperm extraction plus ICSI procedures when applied to Klinefelter patients. It is also in agreement with previous studies in the XXY-mouse model. These spermatogenic foci most probably originate from clones of spermatogonia that have randomly lost one of the X chromosomes, probably during periods of life when high spermatogonial mitotic activity occurs.

The bone mineral density (BMD) at the lumbar spine, proximal femur, and total skeleton was evaluated in 38 men with primary osteoporosis and vertebral fractures. BMD of the patients was significantly reduced over all skeletal areas compared with controls. The Z-score of the lumbar spine (-2.8 +/- 0.9) was less than that of the other areas (P < 0.001) except the legs (-2.5 +/- 1.1) (p.n.s.) showing that bone loss had a tendency to be greater over the axial skeleton. Vertebral dimensions compared with age-matched controls were as follows: projected L2-L4 area (cm 2): 45.7 +/- 5.6 versus 53.7 +/- 3. 6 (P < 0.001); vertebral width (cm): 4.37 +/- 0.44 versus 4.90 +/- 0. 36 (P < 0.001). Serum biochemical parameters and testosterone levels were similar between osteoporotic and control men. We conclude that men with vertebral osteoporotic fractures have reduced vertebral BMD and vertebral dimensions compared with age-matched controls. Thus, these findings indicate that the achievement of a reduced bone size at the end of the growth period or a failure of periosteal increase during adult life is likely to contribute to the pathogenesis of the vertebral fractures observed in older men.

An infertile XYY man was studied by synaptonemal complex analysis of microspread spermatocytes and by quantitation of germ cells in semithin sections. All the 74 spermatocytes micrographed have an XYY constitution, and the biopsy shows a homogeneous arrest of spermatogenesis at the spermatocyte/young spermatid stages. The overwhelming majority (86%) of spermatocytes showed a Y-Y bivalent plus a univalent X. The Y-Y bivalent is totally synapsed in 48% of the cells. In the remaining cells, the YY bivalent has an average synaptic segment covering 43% of its length that always includes Yp. Another 9% of the spermatocytes showed an XYY trivalent and 4% of the spermatocytes showed univalence of the three gonosomes. Progression through all the pachytene substages was observed in cells with the two main synaptic configurations, but a high level of germ cell death was observed at or immediately after the meiotic divisions. The prevalence of Y-Y synapsis arises from the longer homologous region and the higher speed of pairing between the two Y chromosomes. Germ cell death is probably related to the univalence of the X chromosome. Synaptic competition between three gonosomes seems to be similar to that found in triploid birds but is somewhat different from that of XYY mice.

Introduction: Finasteride is widely used in the treatment of benign prostatic hyperplasia and androgenetic alopecia. Persistent sexual adverse events in patients that withdraw the drug was poorly studied. Materials and methods: case report study of two clinical cases of post-finasteride syndrome. Case 1: 27 year old male who, after 7 months of finasteride 1mg/day intake for androgenetic alopecia, began with erectile dysfunction, low libido, hypospermia, muscular hipotrophy and penile shrinking, in a persistent and progressive way although withdrawal of the drug. He was also evaluated by a psychiatrist. Case 2: 23 year old male that after the intake of 1 pill of finasteride 1mg for androgenetic alopecia began with erectile dysfunction, low libido, hypospermia, less intense orgasms, asthenia, muscle pain and penile shrinking, in a persistent and progressive way although withdrawal of the drug. He is under psychiatric evaluation. Results: Case 1: Hormonal profiles were normal, with a dihydrotestosterone of 192 pg/ml and the penile ultrasound showed an hyperechogenicity at the distal portion of the right corpus cavernosum. The genetic determination of the CAG triplets of the androgen receptor gene showed a value of 24 repetitions. Treatment with Tadalafil and vacuum therapy was effective, although not complete, but he didn't benefit from the 3 month application of Andractim®, with a posterior benefit from the application of HCG 6000 UI/week associated with Anastrozole 2mg/week, with normal hormonal controls. Case 2: penile Doppler and hormonal profiles were normal. Treatment with Tadalafil was effective, although not complete. There was no adherence to other treatments. Conclusion: post-finasteride syndrome is a little known entity with an unknown physiopathology, and is currently under study. Awareness should be promoted about the existence of this syndrome in order to give the best assistance to these patients until we have a better comprehension of this entity.

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