Male Fertility in Congenital Adrenal Hyperplasia

It has been shown that the majority of noncentral precocious sexual developments in boys are due to overproduction of adrenal androgens in patients with late onset congenital adrenal hyperplasia (CAH) with 21-hydroxylase deficiency. In these cases the diagnosis is easily suspected because the testes size remains prepubertal. This characteristic has diagnostic value, especially in patients with bone ages of 13 or more years (1). This can be physiologically explained by the inhibitory effect that high levels of circulating adrenal androgens exert on the secretion of gonadotropins.