Hypogonadotrophic hypogonadism New identification of testicular blood flow and varicocele after treatment with gonadotropins

Capsule:
In our study, patients with hypogonadotropic hypogonadism responded to gonadotropins by an increase in testicular size, blood flow, and transverse epididymal diameter. In some patients, varicocele developed after treatment.

Authors:
Khaleeq Ur Rehman, M.B.B.S., M.S., F.E.C.S.M., Khubaib Shahid, M.B.B.S., F.C.P.S., Hina Humayun, M.B.B.S.

Volume 102, Issue 3, Pages 700-704

Abstract:

Objective:
To investigate testicular changes in patients with hypogonadotropic hypogonadism (HH) after treatment with gonadotropins.

Design:
Patients with HH were investigated and followed before and after treatment.

Setting:
T Urology and andrology clinic of a teaching hospital.

Patient(s):
Consecutive male patients with diagnosed HH.

Intervention(s):
All patients were treated with gonadotropins during the study period and later.

Main Outcome Measure(s):
The hormonal status and scrotal color Doppler ultrasound (CDUS) of patients was recorded before and after treatment.

Result(s):
Twenty-six patients with HH (ages 18–43 years) were followed for 8–29 months. After treatment, serum T and secondary sex characters improved in all and spermatogenesis developed in 61.5% of patients. Before treatment, testicular (intraparenchymal blood flow) was undetectable in all and barely detectable in three patients. This improved significantly to 4.53 ± 5.44 and 4.27 ± 4.97 cm/second, respectively, after treatment. Subcapsular arterial flow and testicular size also improved significantly. Similarly, after treatment, transverse epididymal diameter (TED) increased significantly. At baseline, no patient had detectable varicocele on CDUS. After treatment, varicocele was demonstrable in 23% of patients. This finding was further evaluated retrospectively from our 76 HH patient files. None of them had varicocele before treatment, but after treatment 19.73% were found to have varicocele.

Conclusion(s):
Patients with HH responded to gonadotropins by improvement in testicular blood flow and increase in TED. In some patients, varicocele was found to develop after treatment.

  • Agree with Dr. Samplaski. Would like to know if change in testicular/epididymal size was correlated with sperm production. How long were these patients treated for before 1st noticing sperm production? And what levels did their testosterone levels, FSH, and LH get to with therapy? Was a higher testosterone level associated with better testicular blood flow?

    It would be nice to have these correlations to be able to maybe give patients undergoing treatment some reassurances during treatment. Also, did any patients need titration of therapy for HCG or HMG beyond your treatment doses to get the same improvements?

  • msamplaski

    These results are interesting, but not necessarily reassuring. When the authors say that “spermatogenesis developed in 61.5% of patients”, are they saying that a large portion of these men were azoospermia to start? How many of these men developed a clinical varicocele? I would be most interested to know if the men that developed changes in testicular blood flow were the same men who had an improvement in sperm concentration (motility, morphology, volume). Finally, what was the timeline for changes on US and in semen parameters?

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