Stikkelbroeck et al. (2001) investigated the prevalence of testicular tumors in 17 adolescent and adult male patients with CAH aged 16 to 40 years. In 16 of 17 patients, one or more testicular tumors ranging in maximal length from to cm were found on ultrasonography. In 6 patients, the testicular tumors were palpable. Undertreatment, defined as the presence of a salivary androstenedione level above the upper reference morning level, was found in 5 of 17 patients at the time of investigation. The other 12 patients were treated adequately or even overtreated at the time of investigation. Nevertheless, 11 of these 12 patients showed testicular tumors on ultrasonography. Tumor size was significantly larger in patients who were heterozygous or homozygous for deletion or conversion of the CYP21 gene than in patients who did not have this genotype. Impairment of Leydig cell function as manifested by decreased plasma levels of testosterone was found in 6 of 17 patients. Semen analysis in 11 patients revealed azoospermia in 3 patients and poor semen quality in 4 patients. The authors concluded that, when carefully sought for, testicular adrenal rest tumors are frequently present in adolescent and adult males with CAH and are often accompanied by impaired spermatogenesis and Leydig cell failure.
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It is also important to remember that the use of an injectable testosterone will quickly suppress endogenous testosterone production. It may therefore be good advice to use a testosterone stimulating drug like HCG and/or Clomid/Nolvadex at the conclusion of a cycle. This should help the user avoid a strong "crash" due to hormonal imbalance, which can strip away much of the new muscle mass and strength. This is no doubt the reason why many athletes claim to be very disappointed with the final result of steroid use, as there is often only a slight permanent gain if anabolics are discontinued incorrectly. Of course we cannot expect to retain every pound of new bodyweight after a cycle. This is especially true whenever we are withdrawing a strong (aromatizing) androgen like testosterone, as a considerable drop in weight (and strength) is to be expected as retained water is excreted. This should not be of much concern; instead the user should focus on ancillary drug therapy so as to preserve the solid mass underneath. Another way athletes have found to lessen the "crash", is to first replace the testosterone with a milder anabolic like Deca-Durabolin. This steroid is administered alone, at a typical dosage (200-400 mg per week), for the following month or two. In this "stepping down" procedure the user is attempting to turn the watery bulk of a strong testosterone into the more solid muscularity we see with nandrolone preparations. In many instances this practice proves to be very effective. Of course we must remember to still administer ancillary drugs at the conclusion, as endogenous testosterone production will not be rebounding during the Deca Durabolin therapy.