Reproductive Function In Men Following Exposure to Chemical Warfare Containing Sulfur Mustard

  SUMMARY In order to investigate acute and chronic effects of exposure to warfare containing mustards in young men, the time course of changes in serum concentrations of total and free testosterone, dehydroepiandrosterone (DS), FSH, LH and prolactin was evaluated in 16 men in the first 3 months and testicular function in 42 men one to three years after injury. Serum total and free testosterone and DS were markedly decreased in the first 5 weeks after exposure. The lowest values were: Total testosterone 237 ± 165, free testosterone 22.5 ±9.7, DS 39 ±25, as compared to controls: Total testosterone 773 ± 245 ng/dl, free testosterone 35.5±11.2 pg/ml and DS 207±37 µg/dl. FSH, LH, prolactin and 17a-OH progesterone were normal in the first week. The response to GnRH was subnormal in 4 of 5 subjects. LH increased by the 3rd and FSH and prolactin by the 5th week. All hormone levels hadreturned to normal by 12th week after exposure. In 28 of 42 men seen 1 to 3 years following injury, sperm count was below 30 million cells/ml, and FSH was increased as compared to men with sperm above 60 million cells/ml. Testicular biopsy showed complete or relative arrest of spermatogenesis. This study demonstrates that the exposure to sulfur mustard results in very low androgen levels and hyporesponsiveness to GnRH in the first 5 weeks and normalization by 12th week after injury. However, side effects of mustard on sperm cells persist and may cause defective spermatogenesis years after exposure.