Treatment of hypogonadotropic male hypogonadism: Case-based scenarios

Abstract

The aim of this study is to review four case-based scenarios regarding the treatment of symptomatic hypogonadism in men. The article is designed as a review of published literature. We conducted a PubMed literature search for the time period of 1989-2014, concentrating on 26 studies investigating the efficacy of various therapeutic options on semen analysis, pregnancy outcomes, time to recovery of spermatogenesis, as well as serum and intratesticular testosterone levels. Our results demonstrated that exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Cessation of exogenous testosterone should be recommended for men desiring to maintain their fertility. Therapies that protect the testis involve human chorionic gonadotropin (hCG) therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. Off-label use of SERMs, such as clomiphene citrate, are effective for maintaining testosterone production long-term and offer the convenience of representing a safe, oral therapy. At present, routine use of aromatase inhibitors is not recommended based on a lack of longterm data. We concluded that exogenous testosterone supplementation decreases sperm production. It was determined that clomiphene citrate is a safe and effective therapy for men who desire to maintain fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment. Core tip: Symptomatic hypogonadism is both a common and growing health issue. Our four case-based scenarios assess different treatment options for hypogonadotropic male hypogonadism such as clomiphene citrate, human chorionic gonadotropin, and anastrozole. Furthermore, we provide clinical recommendations that can help physicians when confronted with situations such as the ones presented in this article. MINIREVIEWS 245May 6, 2015|Volume 4|Issue 2|

Cyclophilin D participates in the inhibitory effect of high‐fat diet on the expression of steroidogenic acute regulatory protein

“…One of the reasons might be that HFD mouse model has yet not attained the morbid obesity extent. Under physiological conditions, the levels of intratesticular testosterone (ITT) in male were some 40‐ to 100‐fold higher than those in the circulation . So, the concentrations of ITT were measured subsequently.…”

“…Under physiological conditions, the levels of intratesticular testosterone (ITT) in male were some 40-to 100-fold higher than those in the circulation. [39][40][41] The Ppif +/+ mice and Ppif −/− mice were bred by sexual hybridization of Ppif ± male and female mice. Ppif −/− mice were born at the expected Mendelian frequency, developed normally, and did not have any detectable phenotype and viability anomalies.…”

Low Testosterone in Adolescents & Young Adults

“…Patients with obesity, poorly controlled diabetes, or opioid usage should be counseled on weight loss, diet, exercise, and drug abuse before starting testosterone replacement therapy (TRT). Formal weight loss programs have not only shown that the percentage of weight loss correlated with increased T levels, but parameters related to fertility including sperm motility and morphology also improved (38). While there is evidence that T may reduce HbA 1C , lower BMI, and reduce waist circumference other studies have not shown any change in HbA 1C with testosterone compared to placebo (39).…”

Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility

“…Although the exact mechanism of action and production site in males are not fully understood, it is known that hCG mimics the effects of LH and stimulates the Leydig cells in the testicles to produce endogenous testosterone [3585960]. Additionally, studies have shown that low-dose hCG can be used with TRT to maintain high levels of intra-testicular testosterone while men are being treated for hypogonadism [5261]. While hCG is effective in increasing testosterone, various studies have shown that it is also efficacious in inducing spermatogenesis [6263].…”