Hypogonadotropic hypogonadism: new identification of testicular blood flow and varicocele after treatment with gonadotropins

ObjectiveTo investigate testicular changes in patients with hypogonadotropic hypogonadism (HH) after treatment with gonadotropins.DesignPatients with HH were investigated and followed before and after treatment.SettingUrology and andrology clinic of a teaching hospital.Patient(s)Consecutive male patients with diagnosed HH.Intervention(s)All patients were treated with gonadotropins during the study period and later.Main Outcome Measure(s)The hormonal status and scrotal color Doppler ultrasound (CDUS) of patients was recorded before and after treatment.Result(s)Twenty-six patients with HH (ages 18-43 years) were followed for 8-29 months. After treatment, serum T and secondary sex characters improved in all and spermatogenesis developed in 61.5% of patients. Before treatment, testicular (intraparenchymal blood flow) was undetectable in all and barely detectable in three patients. This improved significantly to 4.53 ± 5.44 and 4.27 ± 4.97 cm/second, respectively, after treatment. Subcapsular arterial flow and testicular size also improved significantly. Similarly, after treatment, transverse epididymal diameter (TED) increased significantly. At baseline, no patient had detectable varicocele on CDUS. After treatment, varicocele was demonstrable in 23% of patients. This finding was further evaluated retrospectively from our 76 HH patient files. None of them had varicocele before treatment, but after treatment 19.73% were found to have varicocele.Conclusion(s)Patients with HH responded to gonadotropins by improvement in testicular blood flow and increase in TED. In some patients, varicocele was found to develop after treatment.