Endocrine Abstracts

Introduction: Hypogonadotropic hypogonadism(HH) is mandatory treated with testosterone (T). However, gonadotropin(hCG/FSH) administration might be the challenging optimal therapy.

Case 1: Male, 23-y-old, hypophisectomy pp. adenoma hromophobum, one month later- FSH 1.5 U/L, LH 0.55 U/L. Primogonyl(hCG) test; testosteronemia: 0 day 0.069, 3 day 19.01 nmol/l. After 5 m in ejaculate no sperm. 5 m after introduction of hCG twice weekly 1,500 i.u. and FSH+LH 150 i.u. tree times weekly sperm reappeared, 22×10⁶/mL (testicular volume normal). On testosteron parenterally, after 6 m, sperm 3×10⁶/mL. Mood stable.

Case 2: Male, 19-y-old with anosmia- Sy Kallmann(KS), BH 182 cm, BW 85kg, sexual development (Tanner stages): genitals stage 2, testes 1.5 cm (on ultrasonography), penis 2 cm, breast size stage 3 (for female), pubic hair density- stage 2, with few darker hairs at base of penis. Reduced sex steroids with absent body hair distribution, cariotip 46 XY. LHRH test; FSH: 0’ 0.81, 30 min. 3.27 U/L, LH 0’ 0.15, 30 min. 2.81 U/L. hCG test; testosteron: 0 day 1.32, 3 day 2.81 nmol/L. After hCG 3×3000 i.u./week, testosterone 13.9 nmol/l, gynaecomasthia almost disappeared, male body shape, penis longer and widened, pubic hare- stage 5/6, new found sexuality but testes almost without change in size. Still changes in mood, but physically feeling well-being.

Case 3: Male, 26-year-old, KS, similar phenotype as Case 2. Libido and erection (penis 2.5 cm) present but without ejaculation. After hCG 3000j./2–3day he started with ejaculation, voice deeper, libido increased. In 33y. hCG and HMG administered. After 2m. in ejaculate sperm was detected 0.5×10⁶/mL, after 4 month sperm 3×10⁶/mL, and testicular growth was 4×2 cm. Patient with postive mood and after 5 m of tretment, with spem 4.2–9.2×10⁶/mL, sperm frozen in storage tank containing liquid nitrogen.

Conclusion: Patients with HH should be treated until testes become enlarged and sperm conformed in ejaculate, initially. Beside eliminating psychosocial impact of small testes safety reasons (e.g. possible allergy on gonadotropins) should indicate the storage of a sperm before chronic testosteron therapy.