How Long Does Hcg Take To Work
Chonnam Med J. 2011 Apr; 47(one): 39–42.
Penile Growth in Response to Homo Chorionic Gonadotropin (hCG) Treatment in Patients with Idiopathic Hypogonadotrophic Hypogonadism
Lord's day-Ouck Kim
Department of Urology, Chonnam National University Medical School, Sexual Medicine Enquiry Center, Chonnam National University, Gwangju, Korea.
Kwang Ho Ryu
Section of Urology, Chonnam National University Medical Schoolhouse, Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea.
In Sang Hwang
Department of Urology, Chonnam National University Medical School, Sexual Medicine Enquiry Center, Chonnam National University, Gwangju, Korea.
Seung Il Jung
Department of Urology, Chonnam National University Medical School, Sexual Medicine Enquiry Center, Chonnam National University, Gwangju, Korea.
Kyung Jin Oh
Department of Urology, Chonnam National University Medical School, Sexual Medicine Enquiry Center, Chonnam National University, Gwangju, Korea.
Kwangsung Park
Department of Urology, Chonnam National University Medical School, Sexual Medicine Research Center, Chonnam National University, Gwangju, Korea.
Received 2011 Mar xvi; Accepted 2011 Mar 31.
Abstract
Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory consequence on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male person idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-ii,000 IU) was administrated intramuscularly, 3 times per week, for viii weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks afterwards hCG treatment. The patients' mean age was 18.nine years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, four, 12, and 24 weeks: 0.90±one.35 ng/ml, one.77±ane.31 ng/ml, 3.74±2.24 ng/ml, 5.49±i.lxx ng/ml, and five.58±1.75 ng/ml, respectively; p<0.05). Hateful penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39±1.03 cm to 5.fourteen±ane.39 cm; stretched length: from 5.41±1.43 cm to seven.45±1.70 cm; p<0.001). Mean testicular volumes increased significantly likewise (left: from v.45 cc to half-dozen.83 cc; right: from v.53 cc to seven.03 cc). There were no remarkable agin effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG handling has a beneficial effect on gonadal role and penile growth in patients with IHH presenting with micropenis.
Keywords: Human chorionic gonadotropin, Micropenis, Testosterone
INTRODUCTION
Idiopathic hypogonadotrophic hypogonadism (IHH) is associated with deficient pituitary gonadotropin secretion due to dumb secretion of GnRH from the hypothalamus. The deficiency may be isolated or may occur in conjunction with other disorders.1 Men with IHH present clinically with delayed sexual maturation and may accept associated midline defects such as Kallman's syndrome.1 The main goal of treatment in adolescent or young men is to restore serum androgen to normal levels by hormonal awarding such as testosterone or human chorionic gonadotropin (hCG), thus allowing virilization, penile growth, and puberty to be achieved, and finally, inducing fertility when appropriate. Normal testosterone levels may be achieved with exogenous testosterone administration. Alternatively, endogenous testosterone secretion can exist stimulated past using hCG.ii Penile growth is under androgenic command, but hCG likewise has a stimulatory effect on testicular steroidogenesis and penile growth. One study reported that the last testicular volume in patients with IHH treated with hCG was substantially greater than that in patients treated with testosterone.three
Micropenis refers to an extremely minor penis with a stretched penile length of less than 2.v SD below the mean for historic period or stage of sexual evolution.4 Micropenis is one of the presenting symptoms of IHH; nevertheless, few studies have evaluated the response to hCG therapy in boyish or adult men with IHH in terms of micropenis. The purpose of this report was therefore to decide the outcome of hCG therapy on the gonadal response and penile growth in men with IHH who presented with micropenis.
MATERIALS AND METHODS
1. Patients
A total of 20 male patients with IHH who met the criteria for micropenis were included in this study. The results were analyzed retrospectively by nautical chart review and were approved by an institutional review board and ethics committee. Patients with cryptorchidism or its absenteeism according to the imaging studies conducted at the initial presentation were excluded. The hCG stimulation examination was performed in all patients to exclude chief testicular insufficiency. Additionally, all men had normal basal thyroid and adrenal function. A pituitary mass lesion or a suprasellar tumor was excluded past skull 10-ray and by cranial computed tomography.
2. Diagnosis of IHH
The diagnosis of IHH was made on the basis of low or normal serum LH and FSH concentrations associated with low serum testosterone, otherwise normal anterior pituitary part, and no demonstrable lesion on a high-resolution CT scan or MRI of the hypothalamic-pituitary area.
3. Methods
i) Clinical and laboratory assessment
Testis book was assessed by using the Prader orchidometer. Gonadotrophin (LH, FSH) levels were measured by immunoradiometric assays. Serum testosterone was measured following organic solvent extraction by radioimmunoassay. Basic laboratory and endocrine assessments were performed (including serum testosterone, LH, and FSH levels) and penis length (flaccid and stretched) and testicular book were measured before and after hCG treatment.
2) Hormonal therapy
The patients were treated past using a standard protocol of 1,500 IU to two,000 IU hCG administrated intramuscularly, 3 times per week, for 8 weeks.
three) Penile length measurement
Penile length was measured by one doctor (K. Park). A wooden spatula was pressed against the pubic ramus depressing the suprapubic pad of fat as completely as possible to ensure that the part of the penis that is buried in the subcutaneous fat was measured. Measurement was made forth the back of the penis to the tip of the glans penis. The length of foreskin was not included.
4. Statistical analysis
The information are given as the mean±SD unless otherwise indicated. Comparisons of data within a patient were evaluated by Student's t test; comparisons of data from unlike subsets were evaluated by unpaired t test. Multiple means were compared by ANOVA.
RESULTS
The clinical features of the patients are shown in Table 1. The patients' hateful age was xviii.9 years (range, 12 to 24 years). The mean testicular volume of the patients was less than 6 ml (measured by Prader orchidometer) at the time of assessment. The basal serum LH (mIU/ml), FSH (mIU/ml), and prolactin (ng/ml) levels were 0.72±0.53 (reference range, ane.3-thirteen.0), 0.23±0.fourteen (reference range, 0.9-15.0), and 11.39±1.75 (reference range, two.0-15.0), respectively (Table 1). There were no remarkable adverse events related to the hCG treatment.
TABLE 1
The basal characteristics of the patients before hCG treatment
1. Increase in serum testosterone later on hCG treatment
The mean serum testosterone level was significantly increased subsequently hCG treatment. The serum testosterone levels at baseline and afterward 2, 4, 12, and 24 weeks of hCG handling were 0.90±1.35 ng/ml, one.77±1.31 ng/ml, 3.74±2.24 ng/ml, 5.49±1.70 ng/ml, and 5.58±1.75 ng/ml, respectively (p<0.05) (Fig. i).
Change in the mean serum testosterone level later on hCG treatment. *: p<0.05 vs baseline.
2. Increase in penile length later on hCG treatment
Penile length was measured with the penis flaccid and fully stretched. The mean penile length as well increased significantly after hCG handling. The flaccid and stretched length after hCG handling increased from 3.39±1.03 cm to 5.14±1.39 cm and from 5.41±ane.43 cm to vii.45±1.70 cm, respectively (p<0.001) (Table 2).
TABLE two
Testosterone levels, penile length, and testis volume earlier and afterward hCG treatment
three. Increase in testicular volume after hCG treatment
The hateful testicular volume measured by orchidometer increased significantly as well later on hCG treatment. Testis book increased from v.45 cc to 6.83 cc on the left side and from 5.53 cc to 7.03 cc on the right side (p<0.005) (Table 2).
DISCUSSION
In this study, patients with isolated IHH had a good response to hCG therapy in terms of penile growth, testicular growth, and elevation of serum testosterone. Although the present study included relatively severe cases whose initial mean testicular volume was less than 6 mL, the bulk of patients accomplished a good response. The hCG handling increased serum concentrations of testosterone, testicular volume, and penile length. Therefore, our results advise that patients with IHH volition have a proficient response to hCG therapy in terms of testicular growth, improvement in serum testosterone, and increased penile growth, even patients with severe forms of hypogonadotropic hypogonadism.
IHH is a congenital disorder with deficient pituitary gonadal secretion that may occur in conjunction with other disorders.1 The central defect in most men with IHH is the loss of pulsatile secretion of GnRH from the hypothalamus.5-8 The objectives of therapy in adolescent and young adult males are to restore normal serum androgen levels to induce penile growth and puberty, and finally, to induce fertility. Although penile growth is dependent on androgenic command, hCG is also known to have a stimulatory effect on testicular steroidogenesis and penile growth.
Micropenis, a presenting symptom of IHH, refers to an extremely pocket-size penis with a stretched penile length of less than 2.5 SD below the mean for age or stage of sexual evolution.4 The most important concern in a patient with micropenis is whether the patient will accept sufficient penile growth to allow sexual office as an developed. It is well known that micropenis results from a lack of adequate androgen action during early fetal life that hinders full masculinization of the external ballocks and induces inadequate androgen stimulation for normal penile growth. Among the suggested etiologic factors of micropenis, the well-nigh common cause of micropenis is failure of the hypothalamus to secrete gonadotropins or hypophysial dysfunction.9 When treating patients with anterior pituitary or hypothalamic dysfunction, hCG can be used to induce puberty instead of testosterone, which has the additional advantage of producing testicular enlargement and initiating spermatogenesis.x Few studies, however, have evaluated penile growth in response to hCG therapy in boyish patients with IHH. In cases of idiopathic IHH combined with micropenis, hCG alone has been reported to increase penile length.2 In the current written report, we studied the effect of hCG therapy on the gonadal response and penile growth in male person patients with IHH presenting with micropenis. Our results show that hCG treatment can successfully improve penile length in IHH patients.
Normal testosterone levels may be achieved with exogenous testosterone administration. Alternatively, endogenous testosterone secretion tin can exist stimulated past using hCG. Additionally, the final testicular volumes in patients with IHH treated with hCG are substantially greater than in patients treated with testosterone.3 Previously, many other studies reported a proficient response to gonadotropin therapy in males with IHH. Schopohl et al11 reported that gonadotropin therapy with 3×2,500 IU hCG equally a weekly intramuscular injection restored endocrine and exocrine testicular function to the normal range in male person patients with IHH. They showed that the serum level of testosterone, positive sperm count, and testicular volume were increased significantly in the gonadotropin-injected grouping. Burris et al12 investigated the effect of exogenous hCG solitary in IHH men in terms of serum testosterone, spermatogenesis, and testicular growth. They reported that hCG treatment increased the testicular book from v.five (pretreatment) to 10.viii mL (maximum) during handling and that all men attained normal serum testosterone levels after hCG handling. During hCG treatment, xiv of the 22 men had positive sperm appearance in their semen. Ley and Leonard13 also reported that hCG handling is sufficient to both initiate and maintain spermatogenesis. Although the studies mentioned above reported the effect of gonadotropin therapy in males with IHH, all studied heterogeneous groups of males with complete or partial gonadotropin deficiency, which may be one reason for the good response to the hCG handling.
The spectrum of gonadotropin deficiency is manifested past the men'due south initial testis volume.14 The initial testicular volume of men with IHH is highly correlated with maximum testicular book and sperm production.12 A testicular book of less than 4 mL is considered to betoken consummate gonadotropin deficiency, whereas a testicular volume of at least 4 mL is considered to point some caste of gonadotropin stimulation.15,sixteen In this study, we included patients with mean testicular volumes less than vi mL at the initial diagnosis, and the patients showed a good response to hCG therapy. Therefore, we suggest that hCG handling may accept a beneficial consequence on gonadal function in patients with a small testicular volume and on penile growth in patients presenting with micropenis.
A limitation of our report is that we could non mensurate semen parameters before and after surgery, because nigh of our patients were of an adolescent age and did not agree to provide a semen sample. Some other limitation is the small sample size and the absence of a command group treated with combined human menopausal gonadotropin (hMG) or testosterone. The advisable timing and dosage of hCG therapy and its mode of activity has not been conclusively determined, and controversy currently exists in the literature. Furthermore, our report population was mixed with both adolescent and adult patients, and nosotros could not evaluate the outcomes separately for these different age groups of prepubertal and postpubertal patients. It is uncertain whether the initial gain in penile length will be maintained into adulthood. Further written report is needed with a prospective blueprint, large sample size, long-term follow-up in terms of penile growth, and a command group of patients with some other treatment modality.
In decision, hCG treatment seemed to exist effective in IHH, considering information technology successfully increased the serum testosterone level and testicular book and stimulated penile growth. Our data also imply that hCG treatment for patients with IHH presenting with micropenis results in a satisfactory proceeds in penile length.
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Articles from Chonnam Medical Journal are provided hither courtesy of Chonnam National University Medical Schoolhouse and Chonnman National University Inquiry Institute of Medical Sciences
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214853/
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