medwireNews: Treatment with combined human chorionic gonadotrophin (hCG) and recombinant follicle-stimulating hormone (rFSH) achieves testicular growth and fertility, as well as virilisation, in boys with hypogonadotrophic hypogonadism (HH), a study shows.

“This method is effective and reassuring for affected individuals and is likely to reduce the expense, duration and anxiety of late fertility induction”, write the researchers in Clinical Endocrinology.

For the multicentre study, Julia Rohayem (University of Münster, Germany) and team recruited 60 patients with HH, including 34 who were prepubertal or had early arrested puberty. This group of boys, who were aged an average of 15.5 years, received twice-weekly subcutaneous injections of hCG at a dose of 250–500 IU, rising in 250–500 IU increments every 6 months to a maximum of three 2500 IU injections per week.

When the patients attained pubertal serum testosterone levels (>5.2 nmol/L), they also began receiving rFSH injections at a dose of 75–150 IU, given three times weekly.

This achieved virilisation to Tanner stage V, increased bone age, and growth to an appropriate adult height. In addition, average combined testicular volume from both sides increased from 5 to 10 mL during hCG administration and to 34 mL after the addition of rFSH. And sperm were present in 91% of the 23 patients who provided samples.

The researchers concede that the regimen used is considerably more intensive and expensive than the traditional approach of monthly testosterone–enanthate injections during adolescence with fertility induction carried out later, in adulthood.

However, their study also included 26 boys, aged an average of 18.8 years, who had previously undergone full testosterone–enanthate replacement. At baseline, both age groups had quality of life scores “at the lower limit of the normal range”, despite successful puberty induction in the older boys, who in fact had significantly higher depression scores than the younger patients.

This suggests that these boys “have pervasive and persistent concerns with body image and future fertility prospects”, says the team.

The older patients underwent hCG/rFSH treatment at doses used in adults with HH, resulting in combined testicular volumes increasing from 5 to 32 mL and sperm appearing in 95% of the 19 patients who provided samples.

Quality of life scores improved in both age groups after treatment, but while depression scores also improved in the younger patients they remained stable in the older group.

“Previous induction of incomplete puberty by testosterone thus seems to neglect a ‘window of opportunity’ to provide self-assurance and promote confidence for the future”, say Rohayem and team.

By Eleanor McDermid

Clin Endocrinol (Oxf) 2016; Advance online publication

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