Rainer Quinn, Pai Raghav, Zucker Isaac, Ramasamy Ranjith, Masterson Thomas A
Urology, University of Miami, Miami, USA.
Medicine, Florida International University, Miami, USA.
Cureus. 2022 Jun 10;14(6):e25826. doi: 10.7759/cureus.25826. eCollection 2022 Jun.
Background and objective Human chorionic gonadotropin (hCG) is homologous to luteinizing hormone (LH) and stimulates endogenous testosterone (T) production. Current American Urological Association (AUA) guidelines recommend hCG for T-deficient men who wish to preserve their fertility. However, there is no data available regarding the long-term efficacy and safety of hCG monotherapy in men with a history of exogenous T use. We hypothesized that transitioning to hCG would be a safe and effective option in this population. Methodology We performed a retrospective analysis involving 28 men with previous exogenous T use who were switched to hCG monotherapy and underwent follow-up lab work at least one month later. We evaluated changes in hormones [T, LH, follicle-stimulating hormone (FSH), and estradiol], hematocrit (HCT), glycated hemoglobin (HbA1c), and prostate-specific antigen (PSA). Results Among the entire cohort, we found no significant change in mean hormone levels (including T), HbA1c, or PSA. There was a significant (p<0.05) decrease in HCT (45.27 ±4.06 to 44.16 ±3.48%, n=15). No thromboembolic events were reported. Additionally, among men who had their baseline labs completed outside their previous T therapy therapeutic time window prior to starting hCG monotherapy, there was a statistically significant increase in mean T levels (307.36 ±148.74 to 422.11 ±268.15 ng/dL, n=30 and 31, pre- and post-hCG, respectively) and a statistically significant decrease in mean PSA levels (0.91 ±0.35 to 0.69 ±0.23 ng/mL, n=5). Conclusions These results suggest that hCG is a safe and effective alternative to traditional T therapy for men with a history of exogenous T use and may lead to an advantageous decrease in HCT. hCG may serve as an alternative form of T therapy with a lower risk for secondary erythrocytosis, and further research is warranted to gain deeper insights into the topic.
背景与目的 人绒毛膜促性腺激素（hCG）与促黄体生成素（LH）同源，可刺激内源性睾酮（T）的产生。美国泌尿外科学会（AUA）现行指南推荐，对于希望保留生育能力的睾酮缺乏男性，可使用hCG。然而，目前尚无关于hCG单药治疗有外源性睾酮使用史男性的长期疗效和安全性的数据。我们推测，对于这一人群，转换为hCG治疗将是一种安全有效的选择。方法 我们进行了一项回顾性分析，纳入28例既往有外源性睾酮使用史且转换为hCG单药治疗并至少在1个月后接受随访实验室检查的男性。我们评估了激素水平（睾酮、LH、促卵泡生成素（FSH）和雌二醇）、血细胞比容（HCT）、糖化血红蛋白（HbA1c）和前列腺特异性抗原（PSA）的变化。结果 在整个队列中，我们发现平均激素水平（包括睾酮）、HbA1c或PSA均无显著变化。HCT有显著（p<0.05）下降（从45.27±4.06降至44.16±3.48%，n = 15）。未报告血栓栓塞事件。此外，在开始hCG单药治疗前，其基线实验室检查在既往睾酮治疗治疗时间窗之外完成的男性中，平均睾酮水平有统计学显著升高（分别为307.36±148.74和422.11±268.15 ng/dL，hCG治疗前和治疗后，n = 30和31），平均PSA水平有统计学显著下降（从0.91±0.35降至0.69±0.23 ng/mL，n = 5）。结论 这些结果表明，对于有外源性睾酮使用史的男性，hCG是传统睾酮治疗的一种安全有效的替代方法，可能会使HCT有利地降低。hCG可作为睾酮治疗的一种替代形式，继发性红细胞增多症风险较低，有必要进行进一步研究以更深入地了解该主题。
