Testosterone treatment of men with idiopathic hemochromatosis

Abstract

Patients with chronic liver disease usually exhibit low plasma levels of testosterone with loss of libido and potency; this is also valid in male patients suffering from idiopathic hemochromatosis (IHC), in whom nowadays the diagnosis is made at an earlier age. Therefore, the effect of testosterone treatment was studied in 10 patients with IHC. After the application of 250 mg testosterone enanthate i.m., the plasma testosterone (from 2.4 +/- 1.9 to 20.1 +/- 7.4 ng/ml) and estradiol (from 17.4 +/- 6.3 to 38.5 +/- 14.2 pg/ml) levels increased significantly. The rise of estradiol was in the range of controls and smaller than reported in other chronic liver diseases. In a long-term study, 250 mg testosterone enanthate was given 4-weekly for 33-96 months to 5 patients with IHC. General well-being, libido, and potency recovered almost immediately. Over a treatment period of 27.3 patient years, symptoms of hyperestrogenism (gynecomastia) or (portal vein) thrombosis were not seen, both of which had been described in patients with alcoholic liver cirrhosis. There was no deterioration of liver function. The effect of testosterone treatment on the patients' well-being and plasma hormone concentrations remained unchanged over the whole period of testosterone treatment. Thus, in male patients with IHC and lowered plasma testosterone, treatment with testosterone enanthate may be instituted. Because of the positive effects on general well-being, liver regeneration capacity, and potency, testosterone should especially be administered to younger subjects suffering from IHC.

Hypogonadotropic hypogonadism in men with hereditary hemochromatosis

“…Indeed, patients with hemochromatosis have chronic liver disease and low testosterone blood levels with repercussions on erectile function and libido. Kley et al showed the benefit of treatment with testosterone enanthate on the quality of life, libido and erectile function [26]. These results agreed with the publication of Gama et al which presented the case of a 44-years-old man with hemochromatosis C282Y/C282Y and suffering from HH [27].…”

Conséquences endocrines des hémochromatoses

“…Bien que réputés irréversibles, des cas bien documentés de régression de l'hypogonadisme hypogonadotrophique ont été décrits après des saignées itératives aussi bien chez l'homme que des femmes [30,46,47]. Parallèlement le traitement comprend chez l'homme une substitution par la testostérone, le plus souvent sous forme d'esters administrés par voie intramusculaire [47,48]. En cas de désir de procréation, le rétablis-sement de la spermatogenèse est tenté par une administration des 2 gonadotrophines FSH et hCG (human Chorionic Gonadotrophin).…”

All that is hypogonadal in haemochromatosis is not due to iron deposition

“…This is of importance as both the treatment and longterm prognosis may vary according to the nature of the underlying pathological process. For example, in hypogonadism due to HH, while testosterone supplements are of proven benefit [7], it is possible in some cases to restore sexual function and fertility through vigorous iron depletion [7][8][9]. Restored fertility has also been reported following treatment with human chorionic gonadotrophin (HCG) and human menopausal gonadotrophin (HMG) [10,11].…”