Background: Testosterone enanthate (TE) therapy was established for children and adolescents with male hypogonadotropic hypogonadism (c/a MHH). However, the effect of TE therapy on adult height (AH), genital maturation, and bone mineral density (BMD) in c/a MHH has not been described well.
Objective: To assess the effect of TE therapy in c/a MHH on the achievement of genetic height potential, pubertal development, and bone acquisition and the possible adverse effect on spermatogenesis by subsequent gonadotropin therapy.
Methods: This study retrospectively evaluated c/a MHH patients who were treated with TE at Department of Pediatrics at Keio University Hospital between April 1984 and March 2019. We excluded patients with history of gonadotropin therapy before TE therapy or those with NR0B1 mutation. We reviewed medical records and analyzed variables included AH, target range (TR), pubic hair Tanner stage, stretched penile length (SPL), and lumbar BMD by DXA before TE therapy and after the attainment of AH, as well as sperm concentration by subsequent gonadotropin therapy.
Results: The present study included 18 c/a MHH, six of whom had isolated hypogonadotropic hypogonadism, five had idiopathic hypopituitalism, four had hypopituitalism due to brain tumors, and three had Kallmann syndrome. The median age at the start of TE therapy was 15.1 (range: 13.3 22.9) years. The median age at the attainment of AH was 18.9 (range: 17.1 24.8) years. The median duration of TE therapy until the attainment of AH was 3.7 (range: 1.8 6.3) years. The median AH (N=18) was 175.5 (range: 160.1 187.6) cm. All of AH were greater than the lower limit of TR. Pubic hair Tanner stage (N=16) remained 1 or 2 before treatment, reached 4 or 5 after the attainment of AH.The median of SPL Z-score (N=17) was -3.1 (range: -7.3 -1.4) before treatment and -1.4 (range: -3.5 1.7) after the attainment of AH (P=0.004).The median of lumbar BMD Z-score (N=15) was -3.5 (range: -4.8 -0.9) before treatment and -2.4 (range: -3.2 0.00) after the attainment of AH (P=0.005). Five of seven (71.4%) patients achieved sperm concentration of ≧1.5*106/mL. A patient with azoospermia had untreated bilateral cryptorchidism at 22 years old.
Conclusion: These data indicate that TE therapy in c/a MHH is effective in achievement of appropriate AH for genetic potential, maturation of external genitalia, and improvement of BMD and also suggest that subsequent gonadotropin therapy can induce spermatogenesis.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology