IMPAIRED ANDROGEN PRODUCTION IN FEMALE ADOLESCENTS AND YOUNG-ADULTS AFTER TOTAL-BODY IRRADIATION PRIOR TO BMT IN CHILDHOOD

Pubertal development and androgen production were evaluated 1-10 years after bone marrow transplantation (BMT) in 15 females aged 14-23 (mea n 17) years. Before BMT, these patients had received combination chemo therapy for hematologic malignancy, and all had had a transplant progr am including total body irradiation (TBI). Of the nine patients who we re pre-menarcheal at BMT, two had subsequently experienced spontaneous menarche at 11.5 and 13.3 years of age. Six were post-menarcheal, but became amenorrheic after BMT. Menstruation subsequently started spont aneously in one of them 6 years after BMT. At the time of the study, t hree patients were early to mid-pubertal and 12 late pubertal or post- pubertal. Twelve patients were receiving sex steroid substitution ther apy. Serum concentrations of testosterone, androstenedione, dehydroepi androsterone (DHEA) and DHEA sulfate (DHEAS) were determined. Androgen levels of late pubertal and post-pubertal transplanted patients were compared with 19 post-menarcheal patients aged 14-21 (mean 17) years w ho had been treated for hematologic malignancy with conventional chemo therapy. Testosterone levels of 52 healthy post-menarcheal females age d 14-29 (mean 19) years were measured as controls. Androgen levels of the BMT patients were lower than those of the conventionally treated p atients. Differences in testosterone, androstenedione and DHEA levels were significant. Three spontaneously menstruating BMT patients had no rmal androgen levels. Testosterone levels of the conventionally treate d patients and healthy controls were similar. Subnormal androgen produ ction might be one factor behind the problems in pubertal development and sex life experienced by females after BMT. The use of these hormon e levels for follow-up purposes and the potential value of androgen re placement therapy in females after TBI merit further study.