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[Effects of longterm HCG administration on testicular function in hemodialysis patients (author's transl)]
Insights
Chronic renal failure impairs testicular androgen synthesis, with testosterone levels only normalizing temporarily with human chorionic gonadotropin (HCG) therapy. Dialysis alone does not improve these hormonal imbalances.
Area of Science:
- Endocrinology
- Nephrology
- Reproductive Medicine
Context:
- Chronic renal failure (CRF) significantly impacts male endocrine function.
- Patients undergoing regular dialysis often exhibit low testosterone levels and altered androgen profiles.
- Accumulation of testosterone derivatives in renal failure may affect hormonal feedback mechanisms.
Purpose:
- To investigate the effects of human chorionic gonadotropin (HCG) therapy on androgen levels in male patients with CRF undergoing dialysis.
- To assess the impact of HCG on testosterone, dihydrotestosterone, androstandiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels.
- To evaluate the efficacy of HCG in improving clinical parameters such as body weight, hematocrit, and fertility in CRF patients.
Summary:
- Male patients with CRF on dialysis showed low baseline testosterone and elevated testosterone derivatives (dihydrotestosterone, androstandiol).
- While short-term HCG administration yielded insufficient testosterone increases, prolonged therapy normalized levels, which dropped upon cessation or dose reduction.
- Dialysis alone did not improve androgen synthesis; HCG therapy showed limited benefits beyond temporary testosterone normalization, with no significant improvements in body weight, plasma proteins, hematocrit, or fertility.
Impact:
- CRF severely impairs testicular androgen synthesis, which is not restored by standard dialysis.
- The feedback regulation of testosterone by LH appears insufficient in CRF, potentially due to elevated testosterone derivatives exerting negative feedback.
- HCG therapy offers a temporary solution for low testosterone in CRF but does not address underlying issues or improve overall health outcomes.
Abstract:
Thirtheen male patients with chronic renal failure undergoing regular dialysis treatment (2 X 8-10 hours/week) were treated with gonadotropins (HCG, Primogonyl) primarily 2 X 2,000 IU/week and later 2,000 IU/week. Before HCG administration and during 4-months HCG-therapy testosterone, dihydrotestosterone, Androstandiol, LH and FSH levels were determined by RIA-methods in 7-14 days intervals. Before HCG-application plasma testosterone levels were low and did not increase in the course of regular dialysis treatment. Derivates from testosterone like dihydrotestosterone and Androstandiol were elevated in plasma, presumbably because of accumulation in renal failure. LH-levels were slightly elevated on the average. FSH-levels showed a high individual variation but also seemed to be elevated on the average. HCG stimulation by exogenous HCG administration for short time resulted in a insufficient rise of testosterone levels as compared to normals. During prolonged HCG administration plasma testosterone levels increased to normal but dropped immediatly after cessation of therapy or reduction to less than 2,000 IU HCG twice/week. Body weight, plasma proteins, haematocrite and fertility did not improve significantly. These results indicate that in chronic renal failure androgen synthesis by testicular tissue is seriously impaired and does not improve under usual dialysis treatment. Feedback regulation of testosterone levels by increase of LH levels seems not to be sufficient although pituitary response is found to be normal. This may be explained by elevated levels of testosterone derivates which exert negative feedback effects.