Mastrogiacomo I, Motta R G, Bonanni G, Ziliotto D
Istituto di Semeiotica Medica, Università di Padova.
Minerva Endocrinol. 1990 Jan-Mar;15(1):61-72.
Males affected by hypogonadotropic hypogonadism can be treated with androgen replacement therapy, if they do not wish fertility. In order to limit or avoid androgen toxicity on the liver, it is possible to use testosterone undecanoate (which is absorbed in the gut by lymphatic system) at the dose of 160-240 mg/die or testosterone esters administered intramuscolarly at the dose of 250 mg/month. Estradiol and DHT derived from testosterone catabolism can be in excess therefore they can be provoke toxic phenomena, even if slight, such as gynecomastia or prostatic diseases. If patients wish fertility, they must be treated with gonadotropins or pulsatile LHRH. Therapeutic effects are very different depending on the different origin of the hypogonadism. In postpubertal onset hypogonadotropic hypogonadism, the response is constant and rapid; sperm count normalization can be reached within 6 months with the only hCG. Prepubertal onset hypogonadotropic hypogonadal men need hu-FSH too and longer treatment (18-24 months); sperm count normalization can be reached in less than half case. Nevertheless fertility can be reached even in oligozoospermic stage. Negative prognostic factors are: pan-hypopituitarism, cryptorchidism, how old are the patients at the beginning of the treatment and small testis volume. It is not yet clear if pulsatile LHRH therapy is profitable in terms of therapeutic results.
患有低促性腺激素性性腺功能减退的男性，如果不想要生育能力，可采用雄激素替代疗法进行治疗。为了限制或避免雄激素对肝脏的毒性，可以使用十一酸睾酮（通过淋巴系统在肠道吸收），剂量为160 - 240毫克/天，或者肌肉注射睾酮酯，剂量为250毫克/月。睾酮分解代谢产生的雌二醇和双氢睾酮可能会过量，因此即使是轻微的，也可能引发毒性现象，如男性乳房发育或前列腺疾病。如果患者想要生育能力，则必须用促性腺激素或脉冲式促性腺激素释放激素（LHRH）进行治疗。治疗效果因性腺功能减退的不同病因差异很大。在青春期后发病的低促性腺激素性性腺功能减退中，反应持续且迅速；仅使用人绒毛膜促性腺激素（hCG），6个月内精子计数即可恢复正常。青春期前发病的低促性腺激素性性腺功能减退男性还需要人促卵泡生成素（hu - FSH），且治疗时间更长（18 - 24个月）；不到一半的病例能使精子计数恢复正常。然而，即使在少精子症阶段也可实现生育。不良预后因素包括：全垂体功能减退、隐睾、治疗开始时患者的年龄以及睾丸体积小。目前尚不清楚脉冲式LHRH疗法在治疗效果方面是否有益。
