Hypogonadism after steroids

Hermanussen and Sippell (1985) reported a presumably X-linked recessive kindred. All carrier females had normal sexual and olfactory function. Hipkin et al. (1990) described male twins who were identical by DNA fingerprinting; one had full-blown manifestations of Kallmann syndrome, whereas the other showed normal sexual development and only hyposmia. In a second family, Hermanussen and Sippell (1985) observed 16-year-old twin sisters of whom one had retarded pubertal development and total anosmia, and the other, proven to be monozygotic by blood grouping and HLA typing, had undergone a normal menarche but showed total anosmia. The authors pointed out that sporadic cases of Kallmann syndrome have appeared only in families in which isolated anosmia (see 301700 , 107200 ) is present. They suggested that there is an acquired hypothalamic GnRH deficiency on the basis of preexisting anosmia.

For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy. [17] This therapy has only been shown helpful for men with secondary hypogonadism. Recent studies have shown it can be safe and effective monotherapy for up to 2 years in patients with intact testicular function and impaired function of the HPTA( http:///ijir/journal/v15/n3/full/ ). Clomifene blocks estrogen from binding to some estrogen receptors in the hypothalamus, thereby causing an increased release gNRH and subsequently LH from the pituitary. Clomifene is a Selective Estrogen Reuptake Modulator (SERM). Generally clomifene does not have adverse effects at the doses used for this purpose. Clomifene at much higher doses is used to induce ovulation and has significant adverse effects in such a setting.

Thomas Perls and David J. Handelsman, in a 2015 editorial in the Journal of the American Geriatrics Society , say that between the ill-defined nature of the diagnosis and the pressure and advertising from drug companies selling testosterone and human growth hormone, as well as dietary supplement companies selling all kinds of "boosters" for aging men, the condition is overdiagnosed and overtreated . [19] Perls and Handelsman note that in the US, "sales of testosterone increased from $324 million in 2002 to $2 billion in 2012, and the number of testosterone doses prescribed climbed from 100 million in 2007 to half a billion in 2012, not including the additional contributions from compounding pharmacies, Internet, and direct-to-patient clinic sales." [19]

Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.  The Merck Manual was first published in 1899 as a service to the community.  The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America.   Learn more about our commitment to Global Medical Knowledge.

A recombinant parathyroid hormone, teriparatide (Forteo), an anabolic agent, has recently been approved for the treatment of osteoporosis in men and postmenopausal women who are at high risk for fracture. In men with primary or hypogonadal osteoporosis, teriparatide in a dosage of 20 mcg per day, administered subcutaneously, increased BMD, with a mean percentage change from baseline to end point of percent at the lumbar spine ( P < ) and percent at the femoral neck ( P < ). 30 Contraindications include hyperparathyroidism, Paget's disease of bone, osteomalacia, end-stage renal disease, primary or metastatic bone cancer, active nephrolithiasis, or unexplained elevation of serum calcium or alkaline phosphatase levels before initiation of therapy. Because the safety and efficacy of teriparatide have not been evaluated beyond two years of treatment, use of the drug for more than two years is not recommended.

Hypogonadism after steroids

hypogonadism after steroids

Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.  The Merck Manual was first published in 1899 as a service to the community.  The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America.   Learn more about our commitment to Global Medical Knowledge.

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