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The various germ cells are arranged in typical cellular associations within the seminiferous tubules known as spermatogenic stages (Fig. 5) and the entire spermatogenic process can be divided into four phases: 1. Mitotic proliferation and differentiation of diploid germ cells (spermatogonia) (spermatogoniogenesis) 2. Meiotic division of tetraploid germ cells (spermatocytes) resulting in haploid germ cells (spermatids) 3. Transformation of spermatids into testicular sperm (spermiogenesis) 4. Release of sperm from the germinal epithelium into the tubular lumen (spermiation).

The complete duration of the human spermatogenic process is still not entirely clear (Amann 2008). Ad = A-dark spermatogonium (testicular stem cells, divides rarely), Ap = A-pale spermatogonium (self-renewing and progenitor cell for spermatogenesis), B = B spermatogonium, Pl = preleptotene spermatocytes, L = leptotene spermatocytes, EP = early pachytene spermatocytes, MP = mid pachytene spermatocytes, LP = late pachytene spermatocytes, II = 2nd meiotic division, RB = residual body, Sa1–Sd2 = developmental stages of spermatid maturation G.

Testosterone is already produced by the fetal testicle during the 10th week of gestation, under the stimulation of fetal LH and maternal hCG. 30 The role of maternal hCG in this crucial phase of gonadal development is suggested by the fact that a mutation of the LH ß chain leading to a biologically inactive gonadotropin is associated with normal sexual differentiation (Huhtaniemi et al. 1999). Conversely, inactivating mutations of the LH receptor produce a clinical syndrome resembling complete androgen insensitivity, with a phenotype of female external genitalia (Themmen et al.

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