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Hum. Reprod. Advance Access published online on May 14, 2009
Human Reproduction, doi:10.1093/humrep/dep174
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Opinion

Does a testicular dysgenesis syndrome exist?

Olof Akre1,2,3 and Lorenzo Richiardi1

1 Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Turin, Italy 2 Clinical Epidemiology Unit, Department of Medicine (Solna), M9:01, Karolinska Institutet, Stockholm, Sweden

3 Correspondence address. Tel: +46-8-5177-9324; Fax: +46-8-5177-9304; E-mail: olof.akre{at}ki.se

The concept of an increasingly common Testicular Dysgenesis Syndrome (TDS) has been widely adopted with little epidemiological appraisal. In this paper we critically review the epidemiologic evidence of the existence of a non-genetic TDS. We systematically assess and discuss the evidence of all six possible associations between the four defining conditions of TDS: impaired spermatogenesis, undescended testis, hypospadia and testicular cancer. We also evaluate whether there are common risk factors for these four conditions. We conclude that epidemiologic studies provide little support for existence of a widespread TDS because there are no consistent non-causal associations between its different manifestations. There is furthermore little evidence of shared causes between the alleged components of the syndrome.

Key words: testicular dysgenesis syndrome/testicular cancer/hypospadias/cryptorchidism/undescended testis

Submitted on February 11, 2009; resubmitted on April 7, 2009; accepted on April 8, 2009.


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