Hormonal replacement therapy with HCG and HU-FSH in thalassaemic patients affected by hypogonadotropic hypogonadism

Gonadotropin (Gn) replacement therapy using HCG plus HU-FSH was administere d to 24 patients affected by beta-thalassaemia major with hypogonadotropic hypogonadism aged 18-40 years (25.2 +/- 5.4 yr, m +/- SEM). The age range a t the start of treatment was 14.5-24.5 years (16.7 +/- 2.6 yr); the mean du ration of Gn treatment was 8.6 +/- 3.9 years (range 1-15.2 yr), Gn therapy was begun with HCG alone, the dosage being initially 500 TCT twice a week a nd then increased to a maximum of 3000 IU twice a week, according to the in dividual serum testosterone levels obtained. HU-FSH (75 IU twice a week) wa s added to initiate spermatogenesis in all cases when the HCG-induced testo sterone serum levels normalized. The duration of HU-FSH treatment ranged fr om 1-2 years and then therapy was continued with HCG alone. In nine patient s Gn therapy was discontinued after 6-14 years and was replaced by testoste rone' depot therapy, 75-100 mg i.m. twice a month, for a period ranging fro m 1-1.5 years. Using Gn therapy, the testosterone levels normalized, The co mpliant patients obtained good virilization and normal sexual function; tes ticular volume increased within the normal adult range and spermatogenesis was achieved. When Gn therapy was replaced by testosterone-depot therapy, a marked decrease in testicular volume and sperm count was observed, but the patients complied better and showed a slight increase in coarse hair, In c onclusion gonadotropins are an effective replacement therapy for male hypog onadism in thalassaemic patients. If we consider the advantages and disadva ntages of this therapy, the former seem to outweigh the latter, Finally, it should be emphasized that physicians caring for these patients must foster compliance during frequent check-ups and examinations.