IDIOPATHIC HYPOGONADOTROPIC HYPOGONADISM IN A MALE RUNNER IS REVERSEDBY CLOMIPHENE CITRATE

Objective: To assess the efficacy of estrogen antagonist therapy on th e function of the hypothalamic-pituitary-testicular axis in a young ma le runner with significant morbidity attributable to idiopathic hypogo nadotropic hypogonadism.Design: An uncontrolled case study. Setting: T he outpatient endocrinology clinic of a university tertiary referral c enter. Patient(s): A 29-year-old male who has run 50 to 90 miles per w eek since 15 years of age and who presented with a pelvic stress fract ure, markedly decreased bone mineral density, and symptomatic hypogona dotropic hypogonadism. Intervention(s): Clomiphene citrate (CC) at dos es up to 50 mg two times per day over a 5-month period. Main Outcome M easure(s): Serum concentrations of LH, FSH, and T before and after CC therapy, as well as clinical indicators of gonadal function. Result(s) : Barely detectable levels of LH and FSH associated with hypogonadal l evels of T were restored to the normal range with CC therapy. The pati ent experienced improved erectile function, increased testicular size and sexual hair growth, and an improved sense of well being. Conclusio n(s): Exercise-induced hypogonadotropic hypogonadism exists as a clini cal entity among male endurance athletes, and CC may provide a safe an d effective treatment option for males with debilitating hypogonadism related to endurance exercise. (C) 1997 by American Society for Reprod uctive Medicine.