ESPE Abstracts

Purpose: Therapeutic goals in the adolescent male with hypogonadotropic hypogonadism(HH) are virilization, optimal adult height, normal bone mass, body composition, psychosocial development, and fertility. Until recently, only testosterone was used to treat adolescent males with HH. However, this treatment did not cover all treatment goals and adverse effects on fertility were reported. Therefore, gonadotropin therapy can be used in addition to testosterone in adolescent males with HH. However, there is no consensus on treatment protocols. In this study, we aimed to share the follow-up data of the cases who received recombinant follicle-stimulating hormone(rFSH), human chorionic gonadotropin(hCG) and testosterone treatment for HH.

Methods: Male patients who were followed-up with the diagnosis of HH and gonadotropin and testosterone replacement therapy were initiated between 2016-2021 were retrospectively analyzed. The treatment protocol was created based on the recommendations of Sato et al. (Sato et al., 2015). Treatment was started with 75 IU/day rFSH for 60 days. Then, weekly hCG, rFSH and monthly testosterone treatments were started. Treatments were continued with increasing doses every 6 months. Demographic data, complaints, physical examination, imaging and laboratory findings of the cases at admission and during the follow-up period were obtained from medical records

Results: The mean age of the 9 patients included in the study was 21.3(16.5–25.3) years. In infancy, 5 cases were referred for bilateral undescended testis+micropenis and 1 case for isolated micropenis. Other cases presented with micropenis (15years), absence of ejaculation (17.5years), and short stature (16.5years). Kallman was detected in two of three cases with anosmia. In pituitary MRI, hypoplasia in three cases and empty sella in one case were detected. The mean age of starting rFSH, hCG and testosterone treatment was 17.6 years(14.2–19.8). Five cases had used testosterone treatment before. An increase in testicular volumes was observed in all cases with treatment, and measured similar to pubertal size in 6 cases. In three cases, the adult dose was reached in the third year of treatment. The patient who received treatment for 4.5 years, testicular volumes were found to be 15/12cc and 8 million/ml sperm concentration in the spermiogram.

Conclusions: Although gonadotropin therapy is quite costly compared to testosterone therapy alone, it allows testicular development and fertility by mimicking physiology. This study has given hope that gonadotropin therapy can have positive results on fertility. More data are needed to establish the most appropriate treatment protocol.