Prior testosterone replacement therapy may impact spermatogenic response to combined gonadotropin therapy in severe congenital hypogonadotropic hypogonadism

Pituitary ◽  
2020 ◽  
Author(s):  
Ravikumar Shah ◽  
Virendra Patil ◽  
Vijaya Sarathi ◽  
Anurag R. Lila ◽  
Margaret Zacharin ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Hypogonadotropic Hypogonadism ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Congenital Hypogonadotropic Hypogonadism ◽  
Gonadotropin Therapy

scholarly journals Switch to restoration therapy in a testosterone treated central hypogonadism with erythrocytosis

2017 ◽  
Vol 2017 ◽  
Author(s):  
B Cangiano ◽  
C Cacciatore ◽  
L Persani ◽  
M Bonomi
Keyword(s):  
Side Effects ◽  
Replacement Therapy ◽  
Late Onset ◽  
Clomiphene Citrate ◽  
Hypogonadotropic Hypogonadism ◽  
Vitamin D Supplementation ◽  
Testicular Volume ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
List Type

We describe a case of severe erythrocytosis caused by testosterone replacement therapy in a 66-year-old man affected with hypogonadotropic hypogonadism (HH) determining osteoporosis, resolved by switching to restoration therapy with clomiphene citrate. The patient complained fatigue, loss of libido and defective erections and a spontaneous vertebral fracture despite bisphosphonate therapy and vitamin D supplementation. The examinations proved isolated HH and he was therefore treated with testosterone gel with regression of specific manifestations but elevated hemoglobin and hematocrit values. Therefore, it was decided to switch to a restoration therapy with clomiphene citrate 25 mg/die, which resulted in the resolution of symptoms without evident side effects. In a couple of months, the patient showed normalization of testosterone levels and increment of testicular volume. Since secondary hypogonadism is the consequence of an insufficient stimulation of the gonads by hypothalamic–pituitary axis, therapeutic approaches aimed to restore endogenous testosterone production should be considered in alternative to testosterone replacement, particularly if side effects intervene. Among these strategies, clomiphene citrate seems to have a high efficacy and safety profile also in the elderly with isolated HH and no evident pituitary lesion. Learning points: Hypogonadism should always be assessed in patients with severe loss in BMD and undergo appropriate medical treatment. In hypogonadotropic hypogonadism, more approaches are available other than testosterone replacement therapy alone. In patients with severe late-onset central hypogonadism presenting with erythrocytosis even at low doses of replacement therapy, restoration therapy with clomiphene could prove to be an effective solution, particularly in patients with a reversible disruption of GNRH/gonadotropin functions. Clomiphene citrate increases gonadotropin levels and testicular volume and should therefore be considered in hypogonadal men who wish to remain fertile.

scholarly journals Androgen Receptor Gene CAG Repeat Polymorphism Regulates the Metabolic Effects of Testosterone Replacement Therapy in Male Postsurgical Hypogonadotropic Hypogonadism

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Giacomo Tirabassi ◽  
Nicola delli Muti ◽  
Giovanni Corona ◽  
Mario Maggi ◽  
Giancarlo Balercia
Keyword(s):  
Androgen Receptor ◽  
Replacement Therapy ◽  
Receptor Gene ◽  
Hypogonadotropic Hypogonadism ◽  
Cag Repeat ◽  
Pituitary Function ◽  
Metabolic Effects ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Repeat Polymorphism

Aim. To evaluate the independent role of androgen receptor (AR) gene CAG repeat polymorphism on metabolic effects of testosterone replacement therapy (TRT) in male postsurgical hypogonadotropic hypogonadism, a condition frequently associated with hypopituitarism and in which the TRT-related metabolic effects are combined with those deriving from concomitant administration of metabolically active pituitary-function replacement therapies.Methods. 15 men affected by postsurgical hypogonadotropic hypogonadism were evaluated before and after TRT. Cardiovascular risk factors (CVRFs), pituitary-dependent hormones, and AR gene CAG repeat polymorphism were considered.Results. Testosterone, insulin-like growth factor 1 (IGF-1), and estradiol were the only hormones, which varied significantly between the two phases. All CVRFs significantly improved after TRT. The number of CAG triplets was positively and significantly correlated with all the variations (Δ-) of CVRFs (except for a significant negative correlation with Δ-high-density lipoprotein); the opposite occurred between the latter and Δ-testosterone. No correlation between Δ-IGF-1 or estradiol and Δ-CVRFs was found. At multiple linear regression, after correction for Δ-testosterone, nearly all the associations between the number of CAG triplets and Δ-CVRFs were confirmed.Conclusions. In male postsurgical hypogonadotropic hypogonadism, shorter AR gene CAG tract length seems to yield greater metabolic improvement after TRT, independently of the effects of concomitant pituitary-function replacement therapies.

scholarly journals Effect of testosterone replacement therapy on arterial stiffness in older hypogonadal men

2009 ◽  
Vol 160 (5) ◽  
pp. 839-846 ◽  
Author(s):  
Marianna Yaron ◽  
Yona Greenman ◽  
Joseph B Rosenfeld ◽  
Elena Izkhakov ◽  
Rona Limor ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Replacement Therapy ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Hypogonadotropic Hypogonadism ◽  
Applanation Tonometry ◽  
Testosterone Replacement ◽  
Control Group ◽  
Testosterone Replacement Therapy ◽  
Male Hypogonadism

ObjectiveTo assess arterial stiffness in a cohort of hypogonadal males and to investigate the effect of testosterone replacement therapy on arterial properties in this specific group.DesignEighteen male patients with untreated acquired hypogonadism due to either adult-onset idiopathic hypogonadotropic hypogonadism (n=9) or pituitary tumor (n=9) and 12 age-, sex, and weight-matched eugonadal healthy controls were recruited for the study. Arterial properties, plasma glucose, lipid profile, total, and bioavailable testosterone (BT) levels were measured in fasting state. In the hypogonadal subjects, the effect of transdermal testosterone replacement therapy on arterial properties was studied by repeat noninvasive measurements at baseline, as well as 48 h and 90 days following the initiation of treatment.MethodsArterial stiffness was evaluated using applanation tonometry and pulse wave analysis by three different standard devices that assess various measures of arterial stiffness: pulse wave velocity (PWV), augmentation index (AIx), and large/small artery compliance (C1 and C2).ResultsAge- and blood pressure-adjusted PWV was significantly higher in hypogonadal men (8.90±2.29 vs 6.78±1.16 m/s in the control group;P=0.025). Testosterone therapy increased BT level from 2.01±1.04 to 4.68±2.43 and 7.83±6.2 nmol/l after 48 h and 3 months respectively (P=0.001). PWV decreased from 8.9±2.29 to 8.24±1.39 and 8.25±1.82 m/s after 48 h and 3 months of treatment respectively (P=0.03).ConclusionsMale hypogonadism is associated with increased PWV, which is rapidly but incompletely ameliorated by normalization of circulating testosterone levels.

957: PSA & LIPID Dynamics in Hypogonadal Men Treated with Testosterone Replacement Therapy

2007 ◽  
Vol 177 (4S) ◽  
pp. 316-317
Author(s):  
Jay Simhan ◽  
R. Matthew Coward ◽  
Culley C. Carson
Keyword(s):  
Replacement Therapy ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy ◽  
Lipid Dynamics

Testosterone Replacement Therapy

2006 ◽  
Vol 39 (13) ◽  
pp. 16
Author(s):  
WILLIAM E. GOLDEN ◽  
ROBERT H. HOPKINS
Keyword(s):  
Replacement Therapy ◽  
Testosterone Replacement ◽  
Testosterone Replacement Therapy
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