A challenging panhypopituitarism case

Androlog Mail

Dear members,

A 27 years-old male presented at childhood with panhypopituitarism due to
agenesis, has recently decided to try conceiving with his spouse. He has
been taking testosterone for years, enabling him to practice sex, but with
only rare low-volume ejaculates. On physical examination he has a single 4 ml
testis (negative exploration on the contralateral side years ago).
In spite of what seemed to be a very unfavorable prognosis, he insisted on
trying. The patient is determined not to stop treatment, including
microsurgery if no sperm will eventually be found in his future
ejaculate. I am not concerned with his lack of erections at this point, but
he may need to try ICI later.
Upon stopping testosterone and starting Pregnyl (HCG) at 5,000 U every 5 days
he has lost his erections.
After 2 months of treatment with Pregnyl his testosterone is extremely low
at 19ng/dl, and both LH and FSH are below lab detection level. He is about
to start taking FSH as well.

My questions are:
1) Is this patient different from Kallman syndrome / hypo-hypo patients
regarding treatment? How?
2) is there a point for keeping him on hormonal protocol for a year or so?
2) Does anyone have an experience with higher dose Pregnyl protocols? A
protocol of 4,000 U three times weekly for 9 months was another option
mentioned.
3) Any other suggestions?

Thanks,
Shai Shefi
dr.andrology@gmail.com
Received on Mon Feb 2 06:23:17 2009