A 31-year-old man presenting with an 18-month history of sexual dysfunction resulting from severe adult-onset IHH (LH U/L, FSH U/L, T nmol/L). Initial therapy with 50 mg of clomiphene citrate (CC) three times a day for 7 days, with overnight LH pulse profiling and 9 am T levels evaluated at baseline and on completion. A 2-month washout period, followed by low-dose maintenance therapy (25-50 mg/d) for 4 months.
MAIN OUTCOME MEASURE(S):Baseline and stimulated T levels and LH pulsatility; effect on sexual function.
RESULT(S):Clomiphene therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. CONCLUSION(S):Isolated hypogonadotropic hypogonadism may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. On theoretical grounds, reversal of gonadotropin deficiency with CC might be expected to have a similar biological effect.
After review of the results of the initial blood tests, if the doctor decides that it’s safe and appropriate to start testosterone replacement therapy, a prescription for one month’s testosterone replacement therapy will be authorised. A further blood test will be needed after three weeks to see how you are responding to treatment. All being well, a further five months of treatment will be authorised before another blood test is needed to check your testosterone levels , a year after treatment is initiated, and each year after that, further blood tests will then be needed to ensure that the ideal level of testosterone in your body is maintained and that your continued use of testosterone replacement therapy remains safe. We will be checking for indications of prostate or blood problems that can occur.
In men, low testosterone levels in the body can be supplemented by hormone replacement with testosterone. Testosterone replacement therapy can be prescribed as an intramuscular injection usually given on a biweekly basis; as a patch or gel placed on the skin, or as putty that is applied to the gums of the mouth. Each of the treatments has its risks and benefits. The decision as to which form of testosterone to use depends upon the clinical situation. Discussions between the patient and health care professional often helps decide which medication to use.
In the United States there are currently no preparations that are FDA approved for testosterone replacement for women.