Ravikumar Shah1, Virendra Patil1, Vijaya Sarathi2, Anurag R Lila3, Margaret Zacharin4, Brijesh Krishnappa1, Manjeetkaur Sehemby1, Sanjeet Kumar Jaiswal1, Pratap L Jadhav5, Swati Ramteke-Jadhav1, Nalini Shah1, Tushar Bandgar1. 1. Department of Endocrinology, Seth GS Medical College & KEM Hospital, 103, 1st floor, OPD Building, KEM Hospital Campus, Parel, Mumbai, Maharashtra, 40012, India. 2. Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India. 3. Department of Endocrinology, Seth GS Medical College & KEM Hospital, 103, 1st floor, OPD Building, KEM Hospital Campus, Parel, Mumbai, Maharashtra, 40012, India. anuraglila@gmail.com. 4. Department of Endocrinology, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. 5. Department of Preventive & Social Medicine, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India.
Abstract
OBJECTIVE: To study the effect of prior testosterone replacement therapy (TRT) on the spermatogenic response to combined gonadotropin therapy (CGT) in severe and partial phenotype congenital hypogonadotropic hypogonadism (CHH) patients. DESIGN: Retrospective cohort study. SETTING: Tertiary care center. PATIENTS: Patients of CHH without (n = 17) and with prior TRT (n = 18) were subdivided into severe and partial groups, based on mean testicular volume ≤ 3 cc and > 3 cc respectively. INTERVENTION: Participants were treated with hMG at a dose of 75-150 U 3/week and gradually escalating doses of hCG until maximum dose (2000 U 3/week or 5000 U 2/week) or serum total testosterone of ≥ 3.5 ng/ml was reached. MAIN OUTCOME MEASURES: Final mean TV, trough serum testosterone (T), sperm concentration RESULTS: Thirty-five patients (20 severe, baseline mean TV of 3.6 ± 2.7 ml) were started on CGT at 24.8 ± 6.1 years. The median duration of prior TRT was 38 (IQR 10-63.75) months in the exposed group. After 33 ± 12 months, final mean TV was 8.9 ± 5.5 ml, 86% achieved serum testosterone > 3.5 ng/ml and 70% achieved spermatogenesis [median 5 (0-12.6) million/ml]. Patients without prior TRT had significantly higher peak sperm count than those with prior- TRT (median 9 vs 0.05 million/ml, p = 0.004). This effect of prior TRT was more pronounced in severe phenotype patients (median 7 vs 0 million/ml, p = 0.01). CONCLUSION: Prior-TRT may interfere with spermatogenic response to CGT in CHH patients, especially in those with a severe phenotype.
OBJECTIVE: To study the effect of prior testosterone replacement therapy (TRT) on the spermatogenic response to combined gonadotropin therapy (CGT) in severe and partial phenotype congenital hypogonadotropic hypogonadism (CHH) patients. DESIGN: Retrospective cohort study. SETTING: Tertiary care center. PATIENTS: Patients of CHH without (n = 17) and with prior TRT (n = 18) were subdivided into severe and partial groups, based on mean testicular volume ≤ 3 cc and > 3 cc respectively. INTERVENTION: Participants were treated with hMG at a dose of 75-150 U 3/week and gradually escalating doses of hCG until maximum dose (2000 U 3/week or 5000 U 2/week) or serum total testosterone of ≥ 3.5 ng/ml was reached. MAIN OUTCOME MEASURES: Final mean TV, trough serum testosterone (T), sperm concentration RESULTS: Thirty-five patients (20 severe, baseline mean TV of 3.6 ± 2.7 ml) were started on CGT at 24.8 ± 6.1 years. The median duration of prior TRT was 38 (IQR 10-63.75) months in the exposed group. After 33 ± 12 months, final mean TV was 8.9 ± 5.5 ml, 86% achieved serum testosterone > 3.5 ng/ml and 70% achieved spermatogenesis [median 5 (0-12.6) million/ml]. Patients without prior TRT had significantly higher peak sperm count than those with prior- TRT (median 9 vs 0.05 million/ml, p = 0.004). This effect of prior TRT was more pronounced in severe phenotype patients (median 7 vs 0 million/ml, p = 0.01). CONCLUSION: Prior-TRT may interfere with spermatogenic response to CGT in CHH patients, especially in those with a severe phenotype.
Authors: Peter Y Liu; Val J Gebski; Leo Turner; Ann J Conway; Susan M Wishart; David J Handelsman Journal: Hum Reprod Date: 2002-03 Impact factor: 6.918
Authors: Jacques Young; Cheng Xu; Georgios E Papadakis; James S Acierno; Luigi Maione; Johanna Hietamäki; Taneli Raivio; Nelly Pitteloud Journal: Endocr Rev Date: 2019-04-01 Impact factor: 19.871
Authors: Valerie F Sidhoum; Yee-Ming Chan; Margaret F Lippincott; Ravikumar Balasubramanian; Richard Quinton; Lacey Plummer; Andrew Dwyer; Nelly Pitteloud; Frances J Hayes; Janet E Hall; Kathryn A Martin; Paul A Boepple; Stephanie B Seminara Journal: J Clin Endocrinol Metab Date: 2013-01-01 Impact factor: 5.958
Authors: Peter Y Liu; H W Gordon Baker; Veena Jayadev; Margaret Zacharin; Ann J Conway; David J Handelsman Journal: J Clin Endocrinol Metab Date: 2008-12-09 Impact factor: 5.958