Gonadotropins

The determination of LH and FSH plays a key role in establishing the diagnosis of hypogonadotropic (i.e. secondary) or hypergonadotropic (i.e. primary) hypo-gonadism. However, during surveillance of testosterone therapy they are of less importance. Negative feedback regulation between hypothalamus, pituitary and testes causes negative correlation between serum testosterone and LH, as well as to some extent to FSH levels in normal men.

In cases with primary hypogonadism (e.g. intact hypothalamic and pituitary function) FSH and in particular LH increase with decreasing testosterone levels and may normalize under testosterone treatment. This is especially the case in patients with acquired anorchia (e.g. due to accidents or iatrogenic castration). However, in the most frequent form of primary hypogonadism, i.e. in patients with Klinefelter syndrome, LH and FSH often do not show significant suppression during testosterone substitution. Moreover, oral or transdermal testosterone may have only little effect on gonadotropins. Therefore LH is not the best indicator of sufficient testosterone replacement therapy.

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