Endocrine Abstracts

Background: Guidance on pubertal-induction in hypogonadal adult men is sparse. For adolescent boys, in whom delay is usually constitutional, treatment is typically initiated with pulsed low-dose IM testosterone (T); the dose being progressively increased if/when it becomes clear that endogenous gonadotrophin secretion is not being initiated. In teenagers with organic hypogonadism, the aims are to recapitulate the normal tempo of puberty over 2–3 years and optimise linear growth. However, such regimes may be inappropriate for older apubertal men, who have already attained near-final height, exhibit segmental disproportion and, having experienced years-decades of treatment-delay, typically wish to complete the process as rapidly as possible.

Aim: To review the effectiveness and tolerability of a 1-year pubertal-induction regime with IM T in adult men with congenital hypogonadism presenting with absent puberty.

Methods: Records of 9 older men with congenital hypogonadotrophic hypogonadism (CHH) who underwent pubertal-induction (2000–16) were reviewed, comprising Kallmann’s (n=4), normosmic CHH (n=4) and CHARGE syndrome (n=1). One man had major physical and learning impairments and another presented following major self-harm episode. Median age at commencement of pubertal induction was 53.4 years (range 22.9−70). Treatment over the 1^st year was with T undecanoate 1g injections (TU) spaced around 4-monthly (n=8), or Sustanon® 250 mg/monthly (n=1).

Results: All patients had completed pubertal development within a year of treatment-initiation and there were no recorded adverse physical or psychological events (apart from male-pattern baldness, n=1), nor any excursions of trough serum T or haematocrit. Extended follow-up revealed major improvement in bone density in all but the oldest.

Conclusions: Patients’ experiences were overwhelmingly positive and similar to published data on older Trans-Men (F2M) receiving virilising cross-hormone treatment, reflecting the paucity of evidence behind traditional concerns about relatively rapid elevation of serum T into the adult male range causing behaviour-disturbance in T-naïve adults. To this end, 4-monthly TU injections are safe, convenient and effective, and can minimise clinic visits.