Therapeutic effects of a pulsatile GnRH pump on adult male patients with congenital hypogonadotropic hypogonadism (CHH): a retrospective study

Traditional treatments for congenital hypogonadotropic hypogonadism (CHH) primarily focus on human chorionic gonadotropin (hCG) monotherapy, combined gonadotrophin treatment or Testosterone replacement therapy, which has certain limitations in effectiveness. In recent years, pulsatile gonadotropin-releasing hormone (GnRH) pump treatment, capable of mimicking physiological hormone release patterns, has become a more preferred treatment option. However, there is still a scarcity of medium- and long-term studies in this regard. This study aimed to evaluate the medium- and long-term efficacy of pulsatile GnRH on CHH patients by a microinfusion pump, and to assess the varied effects exhibited in subgroups of CHH patients. We analyzed the clinical data from 54 adult male CHH patients who were treated with pulsatile GnRH pumps. Clinical patient parameters included morphology and size of the external genitalia, sex hormone concentrations, and fertility-evaluated before and at 6, 12, and 24 months of treatment. The mean follow-up time was 15.9 (range, 3-40) months. The mean testicular volume [6.22±1.85 (mean ± standard deviation), 8.90±2.36, 9.73±1.93 mL], serum testosterone level (T) (234±143, 361±117, 381±68 ng/dL), flaccid penile length (4.77±0.68, 5.70±0.69, 6.08±0.52 cm), and stretched penile length (7.87±1.01, 9.44±1.24, 9.63±1.07 cm) of the CHH patients after 0.5, 1, and 2 years of treatment, respectively, were significantly increased compared with the same parameters before treatment (3.19±1.66 mL, 48±47 ng/dL, 3.54±0.92 cm, 5.68±1.27 cm, respectively) (P<0.01). The size of the external genitalia and serum T level of the patients after 1 and 2 years of treatment were further improved when compared with 0.5 year of treatment (P<0.01). Thirty-four of the 45 patients who had over 0.5 year of treatment successfully collected their semen and 27 men produced spermatozoa. CHH patients with normal olfaction, younger patients, and those with initial testicular volumes greater than 4 mL had a faster onset and better outcomes. The use of a GnRH pulsatile pump comprises a strategy with long-term beneficial effects for the treatment of adult male CHH.