Issues for men with CAH

The problems of weight gain and the side effects of treatment can affect men as much as women. Short stature, which can result from difficulties in treatment of CAH in childhood, can be a particular psychological burden for men. High levels of testosterone in CAH can cause problems with aggression and excessive sex drive in men.

There are two important long term consequences of CAH which only affect men, both of which are the result of too little treatment with cortisol. These are infertility and testicular enlargement. If adrenal suppression is inadequate then the adrenal gland makes too much testosterone. High testosterone production from the adrenal gland can occur because the dose of cortisol is too low or because tablets have been missed. The testicles, which also make testosterone, then shut down as the testosterone levels are high. Unfortunately, 'shutting down' the testicles also means that sperm are not produced in normal quantities and this can cause infertility. Sperm production usually picks up if the adrenal cortisol treatment is increased allowing the testosterone production from the adrenal glands to fall, so the testicles can begin to work again. It can take several months for the sperm count to rise after an increase in steroid treatment.

Testicular enlargement is a rare effect of under dosage of cortisol treatment and it takes many years of inadequate treatment for this to occur. Normal testicles contain a few adrenal cells that enlarge if the levels of cortisol in the body are low. This enlargement usually goes away if the dose of cortisol treatment is increased. Occasionally doctors advise a biopsy of the enlarged testicle to make sure that there is no hidden cancer. CAH does not cause cancer but it is reassuring to make this check.