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Abstract and Introduction
Abstract
Introduction The aim of this study was to demonstrate the influences of three different treatment strategies on biochemical parameters and testicular volume (TV) in patients with idiopathic hypogonadotropic hypogonadism (IHH).
Subjects design and methods Seventy-seven never-treated patients with IHH and age and body mass index (BMI)-matched 42 healthy controls were analysed in a retrospective design. Twenty-eight patients were treated with testosterone esters (TE), 25 patients were treated with human chorionic gonadotropin (hCG) and 24 patients were treated with testosterone gel (TG). Biochemical parameters, tanner stages (TS) and TV were evaluated before and after 6 months of treatment.
Results Pretreatment TV, TS and biochemical test results were similar among the three treatment subgroup. In the TE-treated group, BMI, haemoglobin, haematocrit, creatinine, triglyceride, total testosterone (TT), TS and TV increased, but HDL-cholesterol (C) and urea level decreased significantly. In the hCG-treated group, triglyceride level decreased, and luteinizing hormone level, TS and TV increased significantly. BMI, TT, TS and TV increased, and leucocyte count, total-C, HDL-C levels decreased significantly in the TG-treated patients. No treatment type resulted in any changes in insulin resistance markers.
Conclusion hCG treatment resulted in favourable effects particularly on TV and lipid parameters. When TV improvement is considered less important, TG treatment may be a better option for older patients with IHH because of its easy use, neutral effects on triglyceride, haemoglobin and haematocrit, and its beneficial effects on total cholesterol level.
Introduction
Male hypogonadism is one of the most common endocrine disorders. Hypoandrogenism was defined as a morning serum testosterone <300 ng/dl. The diagnosis is based on clinical signs and symptoms plus laboratory confirmation via the measurement of low morning testosterone level on two occasions. Serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels distinguish between primary (hypergonadotropic) and secondary (hypogonadotropic) hypogonadism.
Hormone replacement is the first-line option in the treatment of male hypogonadotropic hypogonadism. Androgen replacement therapy is used to induce and maintain normal secondary sexual characteristics, sexual function and behaviour in prepubertal boys or men with either primary or secondary hypogonadism. In subjects with secondary hypogonadism, gonadotropin or GnRH therapy may be used instead of testosterone therapy to stimulate testosterone secretion from Leydig cells. Gonadotropin therapy is initiated with human chorionic gonadotropin (hCG) alone, which may be sufficient to stimulate spermatogenesis and fertility; but, the optimal strategy for hormone replacement in hypogonadotropic hypogonadism remains debatable.
Infertility, mood disorders, anaemia, central obesity, insulin resistance, metabolic syndrome, type 2 diabetes mellitus and coronary artery disease are among the long-term risks that patients with hypogonadism are likely to experience. Although testosterone and hCG treatments are successful in inducing and maintaining normal secondary sexual characteristics, effects of these medications on the metabolic parameters have been questioned. Studies showed controversial results with testosterone therapy concerning their effects especially on lipid profile, and metabolic effects of gonadotropins have not been much examined in detail.
The aim of this study was to assess the influences of different testosterone treatments (testosterone esters and gel) and hCG replacement on a variety of parameters including blood chemistry, lipid profile, hepatic/renal functions and testicular volume (TV) in patients with hypogonadotropic hypogonadism.
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