good read on NEJM

  1. bigironkiller's Avatar
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    good read on NEJM


    here is the url:

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    sorry the url didnt work. if you have a subscription to nejm the article title is: Reversal of Idiopathic Hypogonadotropic Hypogonadism. just go to the collections page and go to endocrinology and it will be 10th article down.
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    http://content.nejm.org/cgi/content/abstract/357/9/863

    ABSTRACT

    Background Idiopathic hypogonadotropic hypogonadism, which may be associated with anosmia (the Kallmann syndrome) or with a normal sense of smell, is a treatable form of male infertility caused by a congenital defect in the secretion or action of gonadotropin-releasing hormone (GnRH). Patients have absent or incomplete sexual maturation by the age of 18. Idiopathic hypogonadotropic hypogonadism was previously thought to require lifelong therapy. We describe 15 men in whom reversal of idiopathic hypogonadotropic hypogonadism was sustained after discontinuation of hormonal therapy.

    Methods We defined the sustained reversal of idiopathic hypogonadotropic hypogonadism as the presence of normal adult testosterone levels after hormonal therapy was discontinued.

    Results Ten sustained reversals were identified retrospectively. Five sustained reversals were identified prospectively among 50 men with idiopathic hypogonadotropic hypogonadism after a mean (±SD) duration of treatment interruption of 6±3 weeks. Of the 15 men who had a sustained reversal, 4 had anosmia. At initial evaluation, 6 men had absent puberty, 9 had partial puberty, and all had abnormal secretion of GnRH-induced luteinizing hormone. All 15 men had received previous hormonal therapy to induce virilization, fertility, or both. Among those whose hypogonadism was reversed, the mean serum level of endogenous testosterone increased from 55±29 ng per deciliter (1.9±1.0 nmol per liter) to 386±91 ng per deciliter (13.4±3.2 nmol per liter, P<0.001), the luteinizing hormone level increased from 2.7±2.0 to 8.5±4.6 IU per liter (P<0.001), the level of follicle-stimulating hormone increased from 2.5±1.7 to 9.5±12.2 IU per liter (P<0.01), and testicular volume increased from 8±5 to 16±7 ml (P<0.001). Pulsatile luteinizing hormone secretion and spermatogenesis were documented.

    Conclusions Sustained reversal of normosmic idiopathic hypogonadotropic hypogonadism and the Kallmann syndrome was noted after discontinuation of treatment in about 10% of patients with either absent or partial puberty. Therefore, brief discontinuation of hormonal therapy to assess reversibility of hypogonadotropic hypogonadism is reasonable. (ClinicalTrials.gov number, NCT00392756 [ClinicalTrials.gov] .)
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    i found the part about using GnHR to stimulate the reversal hypogonadism as a possibility. i would love to do away with the shots for the rest of my life. im also looking forward for neibdo in summer 08' to cut down on my injection frequency. heard for some though it only keeps levels in mid to upper range for 5-7 wks. would it be beneficial to add HCG those last 3-4 weeks till next neibdo shot??
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    Interesting article. But--- Look more closely. It's not that simple.


    The article deals with people who developed acquired eunuch syndrome at a generally younger age and in a different matter due to delayed puberty, etc.

    Still-- the article gives some hope. Got a kick out of the last doctor listed in the study, Dr. Pitteloud. I saw her last year before I started with Dr. Shippen.
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    ive posted about this before, but im still a little worried im not on the proper treatment. i would love to try a restart while im still pretty new to trt. only been on for around two years and id like to give my body a chance to function normally.
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    Quote Originally Posted by JanSz View Post
    Conclusions Sustained reversal of normosmic idiopathic hypogonadotropic hypogonadism and the Kallmann syndrome was noted after discontinuation of treatment in about 10% of patients with either absent or partial puberty. Therefore, brief discontinuation of hormonal therapy to assess reversibility of hypogonadotropic hypogonadism is reasonable. (ClinicalTrials.gov number, NCT00392756 [ClinicalTrials.gov] .)
    This deals with people with partial puberty. That is helpful, but does not mean it will apply equally to those whose HPTA declined afterwards.

    It shows improvement in 10% of patients. Maybe it's worth the cost and time of therapy for a 10% chance. I'm not sure.

    Lastly, I read this article some time ago and did not re-read now, but I recall that the people who "recovered", got into the normal range, but low-normal..

    Mark
  

  
 

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