Androlog of the Fertility and Sterility Dialog

follow up for 13 yo with pan-hypopit

Started over 3 years ago

I previously sent this out in the Fall and wanted to give some follow up.  I saw a 13 yr old boy with pan-hypopit.  He also had bilateral cryptorchidism with bilateral orchidopexy at age 6 months.  His exam demonstrates extremely small testes.  I had recommended that they start testosterone when appropriate; however, his mom belongs to some support group and had heard about HCG therapy and wanted to try it.  I started him on 2000 IU 3 times/week.  He had labs done after about 6 weeks of treatment with no response.  Is it worthwhile to continue the HCG, and if so, how much would you increase the dose?  Alternatively, should he just start testosterone, and then re-visit this when he is older?  Thanks.


Hi Jay

Usually in patients with partial or complete HH, hCG treatment may be required for several months to obtain an increase in testosterone levels. Response to treatment is predicted by the initial testes size. To avoid Leydig cell desensitization to hCG, you may administer hCG 2000 IU once every third day. 

Obviously, if testosterone serum level will remain unchanged after 6 months of treatment and the patients and his parents will be concerned about the lack of any pubertal progression, you may switch to testosterone treatment.