Absence of effect of recombinant growth hormone to classic gonadotropin treatment on spermatogenesis of patients with severe hypogonadotropic hypogonadism.

Encouraging clinical results have suggested a complimentary or permissive role of growth hormone (GH) to gonadotropin in inducing spermatogenesis in patients with hypogonadotropic hypogonadism, who did not respond to gonadotropin therapy alone. This study evaluates the effects of GH on spermatogenesis in four azoospermic hypogonadic hypogonadotropic (HH) men, treated initially for 6 months with gonadotropins (GN) alone (phase I), followed by a 6 months cotreatment of GH with GN (phase II). Plasma testosterone (T), IGF-1 levels, testicular volume, and spermiogram were evaluated under basal conditions and every 3 months during treatment. GN treatment alone induced a significant increase of T levels and semen volume, whereas testicular volume increased very little; all patients remained azoospermic. The combined GN-GH treatment induced, as expected, an increase in IGF-1 levels and an increase of T levels to values in the normal male range as well as a further, moderate, increase in testicular volume; azoospermia persisted, however, in all patients. The data do not confirm the beneficial effects of combined GN-GH treatment in hypogonadotropic hypogonadal males reported in the literature.