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Journal of Endocrinological Investigation

, Volume 32, Issue 11, pp 934–938 | Cite as

Epidemiology; diagnosis, and treatment of male hypogonadotropic hypogonadism

  • A. Lenzi
  • G. Balercia
  • A. Bellastella
  • A. Colao
  • A. Fabbri
  • C. Foresta
  • M. Galdiero
  • L. Gandini
  • C. Krausz
  • G. Lombardi
  • F. Lombardo
  • M. Maggi
  • A. Radicioni
  • R. Selice
  • A. A. Sinisi
  • G. Forti
Comment

Abstract

Hypogonadotropic hypogonadism (HH), or secondary hypogonadism, is a clinical condition due to an impairment of the pituitary function, characterized by low testosterone plasma levels associated with normal or low FSH and LH plasma levels. An impairment of gonadotropin secretion and, therefore, a reduced efficiency of spermatogenesis was reported to be frequently associated to conditions different from the classical causes of secondary hypogonadism. These conditions (metabolic, endocrine and eating disorders, physical exercise etc.) have been associated with a non-classical form of HH that could be called “functional” HH (FHH). FHH differs from the classical one by the evidence that gonadotropin levels are in the low-normal range, but are inadequate for the testosterone levels, that often are also in the low-normal range. This commentary aims at reviewing knowledge on the forms of male HH in order to indicate and discuss clinical context, diagnostic and therapeutic approach in the less known non-classical form, i.e. FHH.

Keywords

FSH functional hypogonadotropic hypogonadism hypogonadotropic hypogonadism male infertility testosterone 

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References

  1. 1.
    Petak SM, Nankin HR, Spark RF, Swerdloff RS, Rodriguez-Rigau LJ; American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patient—2002 update. Endocr Pract 8: 440–56.Google Scholar
  2. 2.
    Klibanski A, Beitins IZ, Badger T, Little R, McArthur JW. Reproductive function during fasting in men. J Clin Endocrinol Metab 1981, 53: 258–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Corona G, Mannucci E, Forti G, Maggi M. Hypogonadism, ED, metabolic sindrome and obesity: a pathological link supporting cardiovascular diseases. Int J Androl 2009, 32: 587–98.PubMedCrossRefGoogle Scholar
  4. 4.
    Dandona P, Dhindsa S, Chaudhuri A, et al. Hypogonadotrophic hypogonadism in type 2 diabetes, obesity and the metabolic syndrome. Curr Mol Med 2008, 8: 816–28.PubMedCrossRefGoogle Scholar
  5. 5.
    Trarbach EB, Silveira LG, Latronico AC. Gentic insights into human isolated gonadotropin deficiency. Pituitary 2007,10: 381–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Lofrano-Porto A, Barra GB, Giacomini LA, et al. Luteinizing hormone beta-mutation and hypogonadism in man and woman. N Eng J Med 2007, 357: 897–904.CrossRefGoogle Scholar
  7. 7.
    Falardeau J, Chung WC, Beenken A, et al. Decreased FGF8 signaling causes deficiency of gonadotropin-releasing hormone in humans and mice. J Clin Invest 2008, 118: 2822–31.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Behan LA, Agha A. Endocrine consequences of adult traumatic brain injury. Horm Res 2007, 68 (Suppl 5): 18–21.PubMedCrossRefGoogle Scholar
  9. 9.
    Kelberman D, Dattani MT. Hypopituitarism oddities: congenital causes. Horm Res 2007, 68 (Suppl 5): 138–44.PubMedCrossRefGoogle Scholar
  10. 10.
    World Health Organization Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. 4th ed. Cambridge University Press Cambridge, 1999.Google Scholar
  11. 11.
    Isidori AM, Caprio M, Strollo F, et al. Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels. J Clin Endocrinol Metab 1999, 84: 3673–80.PubMedGoogle Scholar
  12. 12.
    Isidori AM, Giannetta E, Lenzi A. Male hypogonadism. Pituitary 2008, 11: 171–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Yalti S, Gürbüz B, Fiçcioglu C. Serum levels of inhibin B in men and their relationship with gonadal hormones, testicular volume, testicular biopsy results and sperm parameters. J Obstet Gynaecol 2002, 22: 649–54.PubMedCrossRefGoogle Scholar
  14. 14.
    Anawalt BD, Bebb RA, Matsumoto AM, et al. Serum inhibin B levels reflect sertoli cell function in normal men and men with testicular dysfunction. J Clin Endocrinol Metab 1996, 81: 3341–5.PubMedGoogle Scholar
  15. 15.
    Anderson RA, Sharpe RM. Regulation of inhibin production in the human male and its clinical applications. Int J Androl 2000, 23: 136–44.PubMedCrossRefGoogle Scholar
  16. 16.
    Fujisawa M, Yamasaki T, Okada H, Kamidono S. The significance of anti-Müllerian hormone concentration in seminal plasma for spermatogenesis. Hum Reprod 2002, 17: 968–78.PubMedCrossRefGoogle Scholar
  17. 17.
    Behre HM, Greb RR, Mempel A, et al. Significance of a common single nucleotide polymorphism in exon 10 of the follicle-stimulating hormone (FSH) receptor gene for the ovarian response to FSH: a pharmacogenetic approach to controlled ovarian hyper-stimulation. Pharmacogenet Genomics 2005, 15: 451–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Ahda Y, Gromoll J, Wunsch A, et al. Follicle-stimulating hormone receptor gene haplotype distribution in normozoospermic and azoospermic men. J Androl 2005, 26: 494–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Pengo M, Ferlin A, Arredi B, et al. FSH receptor gene polymorphisms in fertile and infertile Italian men. Reprod Biomed Online 2006, 13: 795–800.PubMedCrossRefGoogle Scholar
  20. 20.
    Matsumoto AM. Hormonal therapy of male hypogonadism. Endocrinol Metab Clin North Am 1994, 23: 857–75.PubMedGoogle Scholar
  21. 21.
    Warne DW, Decosterd G, Okada H, Yano Y, Koide N, Howles CM. A combined analysis of data to identify predictive factors for spermatogenesis in men with hypogonadotropic hypogonadism treated with recombinant human follicle-stimulating hormone and human chorionic gonadotropin. Fertil Steril 2009, 92: 594–604.PubMedCrossRefGoogle Scholar
  22. 22.
    Sinisi AA, Esposito D, Maione L, et al. Seminal anti-Müllerian hormone level is a marker of spermatogenic response during longterm gonadotropin therapy in male hypogonadotropic hypogonadism. Hum Reprod 2008, 23: 1029–34.PubMedCrossRefGoogle Scholar
  23. 23.
    Liu PY, Gebski VJ, Turner L, Conway AJ, Wishart SM, Handelsman DJ. Predicting pregnancy and spermatogenesis by survival analysis during gonadotrophin treatment of gonadotrophin-deficient infertile men. Hum Reprod 2002, 17: 625–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Burris AS, Clark RV, Vantman DJ, Sherins RJ. A low sperm concentration does not preclude fertility in men with isolated hypogonadotropic hypogonadism after gonadotropin therapy. Fertil Steril 1988, 50: 343–7.PubMedGoogle Scholar
  25. 25.
    Dohle GR, Jungwirth A, Kopa Z, et al. Guidelines on male infertility. European Association of Urology 2007 Update.Google Scholar
  26. 26.
    Kamischke A, Behre HM, Bergmann M, Simoni M, Schäfer T, Nieschlag E. Recombinant human follicle stimulating hormone for treatment of male idiopathic infertility: a randomized, double-blind, placebo-controlled, clinical trial. Hum Reprod 1998, 13: 596–603.PubMedCrossRefGoogle Scholar
  27. 27.
    Foresta C, Selice R, Ferlin A, Garolla A. Recombinant FSH in the treatment of oligozoospermia. Expert Opin Biol Ther 2009, 9: 659–66.PubMedCrossRefGoogle Scholar
  28. 28.
    Isidori AM, Pozza C, Gianfrilli D, Isidori A. Medical treatment to improve sperm quality. Reprod Biomed Online 2006, 12: 704–14.PubMedCrossRefGoogle Scholar
  29. 29.
    Attia AM, Al-Inany HG, Proctor ML. Gonadotrophins for idiopathic male factor subfertility. Cochrane Database Syst Rev 2006, 1: CD005071.Google Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2009

Authors and Affiliations

  • A. Lenzi
    • 1
  • G. Balercia
    • 2
  • A. Bellastella
    • 3
  • A. Colao
    • 4
  • A. Fabbri
    • 5
  • C. Foresta
    • 6
  • M. Galdiero
    • 4
  • L. Gandini
    • 1
  • C. Krausz
    • 7
  • G. Lombardi
    • 4
  • F. Lombardo
    • 1
  • M. Maggi
    • 7
  • A. Radicioni
    • 1
  • R. Selice
    • 6
  • A. A. Sinisi
    • 3
  • G. Forti
    • 7
  1. 1.Department of Medical PhysiopathologyUniversity of Rome “La Sapienza”Rome
  2. 2.Andrology and Endocrinology Unit, Department of Clinical Medicine and Applied BiotechnologiesPolytechnic University of Marche, Umberto I HospitalAncona
  3. 3.Endocrinology and Medical Andrology Section, Department of Clinical and Experimental Medicine and SurgerySecond University of NaplesItaly
  4. 4.Department of Molecular and Clinical Endocrinology and OncologyUniversity “Federico II” of Naples, University of NaplesNaplesItaly
  5. 5.Endocrinology and Diabetes Unit, Department of Internal MedicineSt. Eugenio and CTO A. Alesini Hospital, University of Rome Tor VergataRome
  6. 6.Section of Clinical Pathology, Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology and Medical BiotechnologiesUniversity of PaduaPadua
  7. 7.Endocrinology and Andrology Unit, Department of Clinical PhysiopathologyUniversity of FlorenceFlorenceItaly

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