In an XY individual, a decrease in the expected androgen production can lead to a penis that is much smaller than average, and termed micropenis. The following image illustrates the spectrum that can exist in clitoral size during adrenal hyperplasia. For more information and a figure of differentiation of the gonads, seek additional content on fetal development. FSH and LH affect reproductive structures to cause the formation of sperm and the preparation of eggs for release and possible fertilization. Reproductive endocrinologists undergo extensive medical training, first in a four-year residency in obstetrics and gynecology, then in a three-year fellowship in reproductive endocrinology. Doctors may use fertility drugs, surgery, or assisted reproductive techniques (ART) in their therapy. A reproductive endocrinologist is a physician who treats a variety of hormonal disorders related to reproduction and infertility in both men and women. Estrogen is involved in calcium metabolism and, without it, blood levels of calcium decrease. The endometrium begins to degenerate as the progesterone levels drop, initiating the next menstrual cycle. The level of estrogen produced by the corpus luteum increases to a steady level for the next few days. In humans, testosterone plays a key role in the development of male reproductive tissues such as testicles and prostate, as well as promoting secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair. Some secondary sexual characteristics are common to both males and females, such as the growth of pubic hair, onset of body odor, and changes in skin (e.g., acne) . Estrogen (American English) or oestrogen (Commonwealth English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. Green arrows from the ovary show estrogen release, leading to folliculogenesis and female secondary sex characteristics including breast development and maturation, hip broadening, and pubic hair growth. This diagram illustrates the hormonal regulation of puberty and development of secondary sex characteristics in both males and females. Two of the most significant differences between puberty in females and puberty in males are the age at which it begins, and the major sex steroids involved, the androgens and the estrogens. If sexual stimulation stops before orgasm, the physical effects of the stimulation, including the vasocongestion, will subside in a short time. Viagra is a drug that males with erectile dysfunction can take to maintain an erection. An increase in cGMP causes a decrease in calcium levels, leading to vasodilation of smooth muscle cells and engorgement. Note the effect of hormones on target tissues and the negative feedback mechanisms that control hormone release. Before puberty, the external sex organs, known as primary sexual characteristics, are sex characteristics that distinguish males and females. Increases in sex steroid hormones also lead to the development of secondary sex characteristics such as breast development in girls and facial hair and larynx growth in boys. Estrogens are responsible for the development of female secondary sexual characteristics during puberty, including breast development, widening of the hips, and female fat distribution. While estrogens are present in both men and women, they are usually present at significantly higher levels in biological females of reproductive age. Though the outcomes of puberty for boys and girls are very different, the hormonal control of the process is very similar. Without such sustentacular cell secretion, the Müllerian duct will develop; without testosterone, the Wolffian duct will degrade. For proper reproductive function in the adult, one set of these ducts must develop properly, and the other must degrade. To become a male, an individual must be exposed to the cascade of factors initiated by a single gene on the male Y chromosome. In 1993, the FDA determined that not all over-the-counter topically applied hormone-containing drug products for human use are generally recognized as safe and effective and are misbranded. Estrogens are among the wide range of endocrine-disrupting compounds because they have high estrogenic potency. The SRY gene actively recruits other genes that begin to develop the testes, and suppresses genes that are important in female development. In both male and female embryos, the same group of cells has the potential to develop into either the male or female gonads; this tissue is considered bipotential. Reproductive development continues in utero, but there is little change in the reproductive system between infancy and puberty. The name estrogen is derived from the Greek οἶστρος (oîstros), literally meaning "verve" or "inspiration" but figuratively sexual passion or desire, and the suffix -gen, meaning "producer of". Follicle-stimulating hormone (FSH) stimulates the ovarian production of estrogens by the granulosa cells of the ovarian follicles and corpora lutea. In rodents, estrogens (which are locally aromatized from androgens in the brain) play an important role in psychosexual differentiation, for example, by masculinizing territorial behavior; the same is not true in humans. Menstrual exacerbation (including menstrual psychosis) is typically triggered by low estrogen levels, and is often mistaken for premenstrual dysphoric disorder. Clinical recovery from postpartum, perimenopause, and postmenopause depression has been shown to be effective after levels of estrogen were stabilized and/or restored. Sudden estrogen withdrawal, fluctuating estrogen, and periods of sustained low estrogen levels correlate with a significant lowering of mood. These scores vary in direct proportion to estrogen levels throughout the menstrual cycle, pregnancy, and menopause. Androgens such as testosterone powerfully oppose estrogen action in the breasts, such as by reducing estrogen receptor expression in them.