Should I Insist on HCG for Hypogonadotropic Hypogonadism Treatment?

Q: Should I Insist on HCG for Hypogonadotropic Hypogonadism Treatment?

Response： If the goal is to maintain male characteristics and sexual function, using testosterone patches is sufficient; however, if fertility is a consideration for the future, it is advisable to continue using HCG, as testosterone may inhibit the processes related to spermatoge

Pituitary gland dysfunction syndrome

I am a patient with hypogonadotropic hypogonadism.
After being discharged from military training at Cheng Kung University, I was referred to Chang Gung Memorial Hospital, where I underwent MRI and chromosome testing, both of which showed no issues.
I have been using HCG, starting from 4500 IU to 8000 IU per week, for two years, and I have made significant progress; my voice has changed, and body hair has developed.
Later, I went abroad for studies but continued to have the medication shipped from Taiwan.
Eventually, I felt it was too much of a burden for my family, so I sought treatment here.
However, the doctor switched my medication to Testoderm 5 mg/day transdermal patches, citing reasons of cost-effectiveness and convenience.
The doctor mentioned that the effects would be similar to using HCG and that I would only need to combine it with FSH when I plan to marry and have children, which still has a high chance of success.
Currently, the use of male hormones is sufficient for developing secondary sexual characteristics.
The only downside is that my testes will not continue to grow.
Since I am not a doctor, I did not argue for the necessity of HCG.
I have been on the patches for six months, but I have not seen much improvement.
There is only one endocrinologist in the area, and I have not been able to switch back to my original medication (HCG).
In January of this year, I applied to university and saw a new doctor, but he continued the previous treatment approach.
When I was in Taiwan, I read the medication pamphlet, which stated that HCG is the most natural way to obtain male hormones, and I believe that producing what I need is essential.
Should I insist on using HCG this time?

Kevin Huang, 20~29 year old female. Ask Date: 2000/11/15

Dr. Huang Yingzhe reply Neurology

Response: If the goal is to maintain male characteristics and sexual function, using testosterone patches is sufficient; however, if fertility is a consideration for the future, it is advisable to continue using HCG, as testosterone may inhibit the processes related to spermatogenesis through negative feedback.
Dr.
Chao Wei-Shih, Attending Physician, Department of Metabolism, Tainan Hospital, Department of Health.

Reply Date: 2000/11/15

More Info

When considering treatment options for Hypogonadotropic Hypogonadism (HH), it's essential to weigh the benefits and drawbacks of the medications available, particularly HCG (Human Chorionic Gonadotropin) and testosterone replacement therapies like Testoderm. Your experience with HCG has shown positive results, including changes in voice and body hair growth, which are indicative of the development of secondary sexual characteristics. This is a crucial aspect of treatment for HH, as it directly impacts your quality of life and psychological well-being.

HCG is a hormone that mimics luteinizing hormone (LH), stimulating the testes to produce testosterone and support spermatogenesis. This is particularly important if you are considering future fertility, as HCG can help maintain testicular size and function, which testosterone replacement therapy alone may not achieve. Testosterone replacement, such as with Testoderm, can effectively manage symptoms related to low testosterone levels, but it does not stimulate the testes to produce testosterone or sperm. This could lead to testicular atrophy over time and may complicate future attempts at fathering children.

Your current physician's rationale for switching to Testoderm may be based on convenience and cost-effectiveness, but it is crucial to consider your long-term goals. If you are planning to have children in the future, maintaining testicular function through HCG is advisable. The concern about the negative feedback loop is valid; exogenous testosterone can suppress the hypothalamic-pituitary-gonadal (HPG) axis, potentially leading to reduced endogenous testosterone production and sperm count.

If you have not seen significant improvements while on Testoderm for six months, it may be worth discussing your concerns with your healthcare provider. It is essential to advocate for your health and treatment preferences, especially when you have previously experienced positive outcomes with HCG. If your current doctor is not receptive to your concerns, seeking a second opinion from an endocrinologist or a specialist in reproductive medicine may provide you with more tailored options.

In summary, if your primary goal is to maintain secondary sexual characteristics and you are not currently focused on fertility, Testoderm may suffice in the short term. However, if you are considering future family planning, insisting on HCG treatment is advisable. It is essential to have open communication with your healthcare provider about your treatment goals and to explore all available options to ensure that your treatment plan aligns with your long-term health and fertility aspirations.

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