The Response to Gonadotropin-Releasing Hormone and hCG in Men with Prior Chronic Androgen Steroid Abuse and Clinical Hypogonadism

Androgens were initially developed to improve anabolism for therapeutic purposes. An observed side effect is a sustained inability to regain normal gonadal function after long-term use. This study was designed to evaluate the response to a standard GnRH (gonadotropin-releasing hormone) test (100g) followed by an hCG (human chorionic gonadotropin) test to evaluate the HPG (hypothalamic-pituitary-gonadal) axis in a subgroup of men with former androgen use (FAU, n=13, mean age 38 +/- 8 years) with secondary hypogonadotropic hypogonadism and total serum testosterone levels below 10nmol/l. For comparison, healthy men (n=8, mean age 41 +/- 5 years) and untreated men with idiopathic hypogonadotropic hypogonadism (IHH, n=5, mean age 26 +/- 8 years) were included. Five of 13 FAU males had an LH (luteinizing hormone) peak after GnRH over 9.6U/l, the 5(th) percentile of normal reference controls. None of the 13 FAU males reached a testosterone response above 16.0nmol/l after the 72-h hCG stimulation test, the lowest recorded value for healthy male controls. The IHH patients responded to GnRH with an LH peak after 45min, while the FAU males and healthy controls had an LH peak after 30min. After hCG stimulation, the IHH patients increased mean testosterone level to 16.8nmol/l (median 15.0nmol/l), significantly higher than the FAU males, p<0.05. Current data support that GnRH and 72-h hCG stimulation tests may be valuable clinical tools to evaluate the HPG axis in adults with previous history of complex androgen abuse, and may provide valuable information in clinical management of these men.