Hypogonadism in thalassemia major patients

• Hypogonadism is a common problem in patients with thalassemia major.
• The cause of hypogonadism is usually iron deposition in pituitary gonadotropic cells.
• Pituitary MRI is useful for early detection of pituitary iron deposition.
• Ovarian failure can often occur after bone marrow transplantation.
• Fertility, using reproductive techniques, is possible and depends on gonadal reserve.

Despite recent advances in iron chelation therapy, excess iron deposition in pituitary gonadotropic cells remains one of the major problems in thalassemic patients. Hypogonadism, mostly hypogonadotropic hypogonadism, is usually detected during puberty. Early diagnosis and treatment are crucial for normal pubertal development and to reduce the complications of hypogonadism. The risks and benefits of hormonal replacement therapy, especially regarding the thromboembolic event, remain a challenge for providers caring for thalassemic patients.