Heat stress due to climate warming can have significant effects on sex hormone synthesis in male adolescents. Here's a detailed overview of how heat stress can impact the endocrine system and hormone synthesis.
2.1. Impact on the Hypothalamic-Pituitary-Gonadal (HPG) Axis
The HPG axis is crucial for the regulation of sex hormone production. Heat stress can disrupt this axis in several ways [
17]. With the onset of puberty, the hypothalamic-pituitary-gonadal axis begins to regulate gonadotropin levels and gonadal function [
18]. The outline is briefly as follows (
Figure 1). The hypothalamus releases several tropical hormones along with gonadotropin-releasing hormone (GnRH), a peptide hormone that controls the HPG axis. GnRH is released into the hypothalamic-pituitary portal system, which consists of two connected capillary beds that transport the hormone directly from the hypothalamus to the pituitary gland [
19]. The pituitary gland is composed of the anterior lobe and the posterior lobe. The anterior pituitary is associated with the HPG axis, and GnRH stimulation of gonadotropin cells results in the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) [
20].
In men, FSH acts on Sertoli cells in the testes to stimulate spermatogenesis(
Figure 1) [
20]. LH acts on interstitial Leydig cells to stimulate the production and release of testosterone (
Figure 1) [
21]. GnRH production increases significantly at the onset of puberty, which leads to the release of gonadotropins that stimulate spermatogenesis and testosterone production [
18]. On the other hand, the secretion of anterior pituitary hormones is regulated through hormone release and inhibition in the hypothalamus [
18]. For growth hormone (GH), it secretes growth hormone-releasing hormone (GHRH) to stimulate its release and somatostatin to inhibit it. For LH and FSH, the hypothalamus releases GnRH in a pulsatile manner to stimulate their secretion [
22]. Testosterone produced by interstitial Leydig cells undergoes negative feedback to maintain appropriate testosterone levels in the body [
23]. Testosterone functions to feedback and inhibit the release of GnRH from the hypothalamus as well as to suppress the release of gonadotropins by the anterior pituitary (
Figure 1) [
24].
However, heat stress can impair the hypothalamus's ability to secrete GnRH, which is crucial for stimulating the pituitary gland to release LH and FSH (
Figure 2). This disruption can negatively impact reproductive functions in mammals [
25]. For instance, research on Wenchang chicks demonstrated that heat stress alters the expression of GnRH in the hypothalamus, which subsequently affects the levels of LH and FSH, leading to reproductive dysfunctions [
26]. Similarly, studies in dairy cows have revealed that heat stress reduces the expression of hypothalamic kisspeptin, an upstream regulator of the HPG axis, thereby impacting the release of GnRH and consequently lowering the levels of LH and FSH [
27].
Further, investigations in cattle have found that heat stress disrupts the hormonal balance necessary for successful reproduction. It decreases compromises sperm quality, which leads to lower fertility rates [
28]. In the pituitary gland, the production of LH and FSH decreases due to reduced GnRH secretion. Likewise, as gonadotropin (LH and FSH) levels decrease, sex steroid levels also decrease (
Figure 2). In testes, FSH acts on Sertoli cells to stimulate spermatogenesis, and LH acts on the smooth endoplasmic reticulum of Leydig cells to stimulate the production and release of testosterone (
Figure 2) [
29]. Therefore, reduced levels of these hormones due to heat stress at the onset of puberty ultimately has a negative impact on spermatogenesis and testosterone synthesis, which may lead to delayed puberty and fertility issues [
30].
The testes are particularly sensitive to temperature changes. Elevated temperatures can lead to impaired spermatogenesis, reduced testosterone synthesis, and Leydig cell dysfunction [
31].
Mammalian spermatogenesis is a temperature-sensitive process, and increases in testicular temperature impair spermatogenesis. For optimal spermatogenesis under normal conditions, testicular temperature must be 2 to 6°C lower than body temperature [
32]. The spermatogenic process proceeds with blood and oxygen supply fairly independent of other vascular bed changes in the body [
33]. Despite this well-controlled local environment, testicular temperature may be elevated by heat stress, and higher temperatures may result in increased testicular metabolism without increased blood supply, leading to local hypoxia and detrimental effects on the tissue [
33,
34]. That is, elevated testicular temperature can cause hypoxia-reperfusion injury, which can lead to oxidative imbalance after normothermia is restored and tissues are reperfused [
33], which is similar to the hypoxia-reperfusion injury that occurs during organ transplantation [
35].
Heat stress has been shown to reduce testosterone synthesis by damaging the testicles, which is due to various mechanisms, such as increased oxidative stress, disruption of steroidogenic enzyme expression, and apoptosis of Leydig cells [
10]. Moreover, heat stress causes oxidative stress to the testicles, which increases the production of reactive oxygen species (ROS) and lipid peroxidation while decreasing antioxidant defenses [
36]. This oxidation environment can damage Leydig cells, which can damage testosterone generation. Particularly, heat stress reduces the expression of major steroids such as 3β-HSD, CYP11A1, HSD3B1 and Cytochrome P450 series (CYP17A1), which are essential for the biosynthesis of testosterone [
37]. In addition to this, heat stress causes histopathological changes in Leydig cells, such as dilated smooth endoplasmic reticulum and enlarged mitochondria, which further contribute to their dysfunction [
38].
Recently, various animal and human experiments have been reported on the adverse effects of heat stress on male reproductive function. In animal experiments, various studies have been reported, including studies on the modification of sheep sperm surface proteins by heat stress [
39], studies on ruminants showing reduced fertility [
40], and studies on reduction of testosterone synthesis using rodents [
41,
42]. In human experiments, it has been demonstrated that varicose veins reduce human fertility [
43] and that male germ cells are sensitive to heat stress due to testicular heat stress [
44,
45]. The overall result is a significant decrease in serum and testicular testosterone levels, which can lead to male fertility issues.
2.3. Chronic Heat Stress Can Lead to an Imbalance of Testosterone and Estradiol
Spermatogenesis requires an appropriate balance between testicular testosterone and estradiol [
24]. Testosterone is produced by Leydig cells, which are involved in testicular steroidogenesis, and is converted to estradiol by cytochrome P450 aromatase [
46]. Estradiol is involved in male sexual differentiation and spermatogenesis, and affects sperm motility, receptivity, and survival [
24]. Aromatase is expressed in Leydig cells, Sertoli cells, and germ cells of the mammalian testis, and Leydig cells have been considered the major source of estradiol [
46]. Therefore, regulation of aromatase expression in Leydig cells is essential for regulating the endocrine environment between the testes.
Recently, Shintaro et al reported that chronic heat stress (40°C for over 12 hours) stimulated aromatase transcription in R2C rat Leydig tumor cells, whereas acute heat stress did not affect transcription [
47], which suggests that the increase in aromatase levels in Leydig cells due to chronic heat stress is a factor causing an imbalance between testosterone and estradiol in men with spermatogenesis failure. For example, the seminal plasma and serum of infertile men have been reported to have high estradiol levels [
48] and low testosterone to estradiol ratios [
49]. In addition, it has been evaluated that the quality of semen of workers exposed to heat stress in the steel industry is significantly reduced [
50]. Based on these findings, avoiding exposure to chronic heat stress may be necessary to achieve a balanced testosterone to estradiol ratio in male adolescence. Based on these findings, avoidance of exposure to chronic heat stress is necessary to maintain a balanced testosterone-to-estradiol ratio and protect reproductive function in male adolescence.