Gonadotropin-releasing hormone deficiency in men: diagnosis and treatment with exogenous gonadotropin-releasing hormone.

Abstract

Idiopathic hypogonadotropic hypogonadism in men is the result of absent or abnormal secretion of gonadotropin-releasing hormone, which prevents pubertal development. Isolated gonadotropin-releasing hormone deficiency is clinically and neuroendocrinologically heterogeneous, largely because of variation in the degree of gonadotropin-releasing hormone deficiency. Treatment with pulsatile gonadotropin-releasing hormone results in normal pubertal changes and virilization. Such treatment has been uniformly successful in normalizing release of gonadotropins and secretion of testosterone. Improvement in secondary sex characteristics and induction of spermatogenesis have been achieved in most patients. Eight of nine patients desiring induction of fertility were able to father a child. Use of pulsatile gonadotropin-releasing hormone presents a powerful model in which to examine regulation of gonadotropin secretion and the role of hypothalamic gonadotropin-releasing hormone in control of the male reproductive axis.