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BMJ. 2007 September 8; 335(7618): 472.
PMCID: PMC1971194
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Hypogonadotropic hypogonadism may not need lifelong treatment

Boys with hypogonadotropic hypogonadism reach 18 years of age with incomplete or absent sexual maturation, low plasma concentrations of gonadotropins and testosterone, but no other abnormalities. The condition is treated with androgens, and it has always been assumed that lifelong hormone treatment is neededneeded.

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But a new study shows that hormone treatment should be discontinued periodically to see if the hormonal axis has matured and if adult amounts of sex hormones are being produced. The study describes 10 men in whom sustained reversal of hypogonadotropic hypogonadism was noticed after they stopped treatment because of failure to adhere, recruitment into neuroendocrine studies, or increased size of the testes while taking androgens.

Reversal was also seen in five of 50 men in whom hormones were stopped for a mean of six weeks. Testicular volume and concentrations of testosterone, luteinising hormone, and follicle stimulating hormone improved greatly, and spermatogenesis was active in all of the men. Six years later, 13 of the 15 men still had normal adult concentrations of sex hormones and did not need treatment. The mechanism of reversal is unclear.

References

  • N Engl J Med 2007;357:863-73 [PubMed]

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