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The enzyme 17α-hydroxylase (CYP 17) is not present in the outer layer of the cortex and, thus, cortisol and androgens cannot be formed in this layer. Steroids and their metabolic by-products (notably lipid hydroperoxides) are released into the adrenal circulation and inhibit critical enzymes in subsequent layers through which the blood flows. As a result, no aldosterone can be synthesized by cells below the outer glomerulosa layer. In the inner layer, 17α-hydroxyprogesterone cannot be converted to cortisol but is shunted into the formation of androgens. Interestingly high cortisol concentrations reaching the adrenal medulla stimulate the synthesis of phenylethanolamine- N -methyltransferase which catalyzes the conversion of norepinephrine to epinephrine (see Box ). Thus, the structural relationship between the cortex and medulla and its blood supply has additional functional implications within the medulla.
If a young man's low testosterone is a problem for a couple trying to get pregnant , gonadotropin injections may be an option in some cases. These are hormones that signal the body to produce more testosterone. This may increase the sperm count. Hedges also describes implantable testosterone pellets, a relatively new form of treatment in which several pellets are placed under the skin of the buttocks, where they release testosterone over the course of about three to four months. Injections and nasal gels may be other options for some men.