title: Hypogonadotropic hypogonadism: new identification of testicular blood flow and varicocele after treatment with gonadotropins.
abstract: OBJECTIVE
  To investigate testicular changes in patients with hypogonadotropic hypogonadism (HH) after treatment with gonadotropins.
  
  
  METHODS
  Patients with HH were investigated and followed before and after treatment.
  
  
  METHODS
  Urology and andrology clinic of a teaching hospital.
  
  
  METHODS
  Consecutive male patients with diagnosed HH.
  
  
  METHODS
  All patients were treated with gonadotropins during the study period and later.
  
  
  METHODS
  The hormonal status and scrotal color Doppler ultrasound (CDUS) of patients was recorded before and after treatment.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan. Electronic address: khaleeqr@hotmail.com.
authors.forename: Khaleeq
authors.initials: K
authors.lastname: ur Rehman
authors.affiliation: Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan.
authors.forename: Khubaib
authors.initials: K
authors.lastname: Shahid
authors.affiliation: Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, Pakistan.
authors.forename: Hina
authors.initials: H
authors.lastname: Humayun
mesh_terms: D000293:Adolescent; D000328:Adult; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D009929:Organ Size / Q000187:drug effects; D012039:Regional Blood Flow / Q000187:drug effects*; D012189:Retrospective Studies; D013091:Spermatogenesis / Q000187:drug effects; D013737:Testis / Q000098:blood supply* / Q000187:drug effects / Q000473:pathology; D014646:Varicocele / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006062:Gonadotropins
keywords: Hypogonadism; hypogonadotropic hypogonadism; scrotal Doppler