madman
Super Moderator
Hot off the press, Nelson's domain is where it's at!
* TRT patients continue to have pituitary suppression while on HCG after 3 and 6 months of treatment. Certain men may have paradoxical suppression of the HPG axis on HCG which resolves with discontinuation of medication.
'
HPG AXIS RESPONSE TO HCG TREATMENT AFTER TESTOSTERONE INDUCED INFERTILITY (2024)
Brennan Lee, MD,1 Nishit Garg, BS,2 Aaron Bickerstaff,B.S.,3,4 Johnathan Doolittle, MD3 1University of Oklahoma Health, Oklahoma City, OK; 2Oklahoma City, OK; 3University of Oklahoma,Oklahoma City, OK; 4University of Oklahoma, Mustang, OK.
OBJECTIVE
Testosterone use in young adult men is on the rise. As a result, male infertility specialists are seeing an increasing number of men with testosterone replacement therapy (TRT) induced azoospermia. Literature describes the use of human chorionic gonadotropin (HCG) in this population, however, many aspects of HCG treatment have yet to be fully characterized for these men, such as typical hypothalamic-pituitary-gonadal(HPG) axis response to HCG and optimal HCG dose/schedule. We sought to further characterize pituitary response to HCG treatment and associated fertility outcomes of normalization of semen parameters and pregnancy data.
MATERIALS AND METHODS
We retrospectively reviewed charts of male patients with TRT induced infertility who elected to proceed with HCG treatment. Patients with central hypogonadism were excluded. HCG dose, schedule and duration of treatment were recorded. Baseline hormone levels including testosterone, estradiol, luteinizing hormone (LH), and follicle stimulating hormone (FSH) and semen analysis were measured prior to initiation of HCG and at 1, 3 and 6-month time points.
RESULTS
30 patients with TRT induced infertility were treated with doses of HCG ranging from 500 to 3000 IU every MWF. Nine patients were lost to follow up. Median length of follow-up was 4 months (1-10 month range). Average length of TRT use was 3.2 years. Average pre-treatment LH and FSH levels were 1.2 mIU/mL (SD 2.2) and 1.24 mIU/mL (SD 2.9) respectively. 46.7% were started at the 2500 IU dose. The average duration of HCG treatment was 4.7 months (SD 2.8). At 3 months, 71.4% of patients demonstrated continued suppression of LH (<1mIU/mL) and 64.3% demonstrated continued suppression of FSH (<1mIU/mL). Seven patients continued to have pituitary suppression at the time of stopping HCG, with 3/7 patients stopping for continued pituitary suppression at 6 months with associated severe oligospermia or azoospermia. In all 3 cases pituitary hormones normalized the following month. Eight patients had a semen analysis at 3 months, with 5/8 patients demonstrating normal total motile sperm count (TMSC, >16 million motile sperm). At 6 months, 8 patients had return of sperm, with 3 of the 8 having normal TMSC. 8 of 30 men conceived during this study, however one of these was after stopping HCG.
CONCLUSIONS
TRT patients continue to have pituitary suppression while on HCG after 3 and 6 months of treatment. Certain men may have paradoxical suppression of the HPG axis on HCG which resolves with discontinuation of medication. Higher powered, longitudinal studies are required to better characterize the effect of HCG treatment on the HPG axis and fertility outcomes.
IMPACT STATEMENT
This study demonstrates the need to further characterize the recovery of the HPG axis on HCG treatment after TRT cessation. Understanding the optimal use and challenges regarding the use of HCG is of increasing importance as this patient population continues to grow.
* TRT patients continue to have pituitary suppression while on HCG after 3 and 6 months of treatment. Certain men may have paradoxical suppression of the HPG axis on HCG which resolves with discontinuation of medication.
'
HPG AXIS RESPONSE TO HCG TREATMENT AFTER TESTOSTERONE INDUCED INFERTILITY (2024)
Brennan Lee, MD,1 Nishit Garg, BS,2 Aaron Bickerstaff,B.S.,3,4 Johnathan Doolittle, MD3 1University of Oklahoma Health, Oklahoma City, OK; 2Oklahoma City, OK; 3University of Oklahoma,Oklahoma City, OK; 4University of Oklahoma, Mustang, OK.
OBJECTIVE
Testosterone use in young adult men is on the rise. As a result, male infertility specialists are seeing an increasing number of men with testosterone replacement therapy (TRT) induced azoospermia. Literature describes the use of human chorionic gonadotropin (HCG) in this population, however, many aspects of HCG treatment have yet to be fully characterized for these men, such as typical hypothalamic-pituitary-gonadal(HPG) axis response to HCG and optimal HCG dose/schedule. We sought to further characterize pituitary response to HCG treatment and associated fertility outcomes of normalization of semen parameters and pregnancy data.
MATERIALS AND METHODS
We retrospectively reviewed charts of male patients with TRT induced infertility who elected to proceed with HCG treatment. Patients with central hypogonadism were excluded. HCG dose, schedule and duration of treatment were recorded. Baseline hormone levels including testosterone, estradiol, luteinizing hormone (LH), and follicle stimulating hormone (FSH) and semen analysis were measured prior to initiation of HCG and at 1, 3 and 6-month time points.
RESULTS
30 patients with TRT induced infertility were treated with doses of HCG ranging from 500 to 3000 IU every MWF. Nine patients were lost to follow up. Median length of follow-up was 4 months (1-10 month range). Average length of TRT use was 3.2 years. Average pre-treatment LH and FSH levels were 1.2 mIU/mL (SD 2.2) and 1.24 mIU/mL (SD 2.9) respectively. 46.7% were started at the 2500 IU dose. The average duration of HCG treatment was 4.7 months (SD 2.8). At 3 months, 71.4% of patients demonstrated continued suppression of LH (<1mIU/mL) and 64.3% demonstrated continued suppression of FSH (<1mIU/mL). Seven patients continued to have pituitary suppression at the time of stopping HCG, with 3/7 patients stopping for continued pituitary suppression at 6 months with associated severe oligospermia or azoospermia. In all 3 cases pituitary hormones normalized the following month. Eight patients had a semen analysis at 3 months, with 5/8 patients demonstrating normal total motile sperm count (TMSC, >16 million motile sperm). At 6 months, 8 patients had return of sperm, with 3 of the 8 having normal TMSC. 8 of 30 men conceived during this study, however one of these was after stopping HCG.
CONCLUSIONS
TRT patients continue to have pituitary suppression while on HCG after 3 and 6 months of treatment. Certain men may have paradoxical suppression of the HPG axis on HCG which resolves with discontinuation of medication. Higher powered, longitudinal studies are required to better characterize the effect of HCG treatment on the HPG axis and fertility outcomes.
IMPACT STATEMENT
This study demonstrates the need to further characterize the recovery of the HPG axis on HCG treatment after TRT cessation. Understanding the optimal use and challenges regarding the use of HCG is of increasing importance as this patient population continues to grow.
