Concomitant testosterone based on HCG treatment resulted in earlier masculinization and no inferior spermatogenesis compared to HCG alone in treatment of IHH patients
The primary goal in treatment of idiopathic hypogonadotropic hypogonadism (IHH) is to induce masculinization and spermatogenesis. Exogeneous testosterone (T) can induce masculinization but not spermatogenesis and rather may be associated with impaired spermatogenesis. This retrospective study aims to determine whether concomitant T based on HCG treatment show significantly harmful impacts on spermatogenesis in IHH patients compared HCG alone.
A total of 107 male IHH patients were recruited and were divided into group A (n=54) and group B (n=53) according to their choices. The study protocol was approved by the ethics committee of Huazhong University of Science and Technology. Group A received intramuscular dose of HCG, while group B received HCG combined with testosterone undecanoate (TU). In both groups, HCG was injected with initial dosage of 2000IU twice weekly. Group B received additional 40mg oral dose of TU twice daily. Patients were regularly followed up and their HCG dosages were adjusted to maintain serum T in the normal range at each visit. SPSS version 23.0 was used to for data analysis and the Tanner stage, testicular volumes, hormone levels, semen parameters and side effects were compared between the two groups.
The median follow-up time was 31.3 months. Significant improvements were seen in Tanner stages, testicular volumes, hormone levels and semen parameters in both groups between pre- and post-treatment period (P < 0.001). Compared to the group A, the median time to achieve Pubic hair Tanner stage III, V and genital Tanner stage III, V was significantly shorter in group B (P < 0.05), and its median time to achieve normal T was also significantly shorter (P < 0.001). But there were no significant differences in terms of testicular volume and sperm concentration. The median time to achieve spermatogenesis, sperm concentration ?15×106/ml and progressive motility rate ? 32% showed no remarkable differences between the two groups. In addition, group B showed no significant side effects, especially in terms of gynecomastia.
Concomitant T based on HCG treatment was associated with earlier masculinization and no adverse effect on spermatogenesis compared to HCG alone, which suggested that it may be a good alternative treatment option for IHH patients, especially promoting development of confidence and build better compliance during initial stage of gonadotropin treatment probably.
Funding: This work was supported by grants from the National Natural Science Foundation of China (NO. 81601270)