2009 Case Study: Hypogonadotropic Hypogonadism treated with GnRH Analog Buserelin (Nasal)

[norgonton]

https://www.fertstert.org/article/S0015-0282(09)01228-X/fulltext

Objective​

To report a patient with hypogonadotropic hypogonadism of hypothalamic origin successfully treated with nasal administration of a low-dose gonadotropin-releasing hormone (GnRH) analogue.

Design​

Case report.

Setting​

A reproductive medical center.

Patient(s)​

A 37-year-old man with anejaculation and infertility.

Intervention(s)​

Nasal administration of a low-dose GnRH analogue, buserelin.

Main Outcome Measure(s)​

Semen analysis and serum levels of gonadotropins and testosterone after nasal buserelin use.

Result(s)​

The patient's laboratory examination showed low serum levels of gonadotropins and testosterone. After being diagnosed with hypogonadotropic hypogonadism, 15 μg of buserelin acetate spray was administrated in each nostril three times a day (total: 90 μg/day). This therapy improved semen parameters and serum gonadotropin and testosterone levels. After approximately 1 year of this treatment, the patient's serum gonadotropin and testosterone levels remained in the normal range and semen analysis showed normozoospermia. The patient and his wife were treated with intracytoplasmic sperm injection, resulting in pregnancy.

Conclusion(s)​

A low-dose buserelin nasal spray appears to be an effective and well-tolerated therapeutic option for patients with hypogonadotropic hypogonadism of hypothalamic origin.

 

[norgonton]

Thoughts?

I know this is n=1, but it is interesting that they had success treating low-T/infertility with a drug that is generally considered a non-starter (instead opting for pulsatile GnRH).

Buserelin is in the same class as Triptorelin, which is much more widely available from peptide vendors. It makes me wonder if a microdose protocol of Triptorelin could have success.

Tagging @Cataceous as before I registered I was very interested in his self-experimentation with GnRH combined with a SERM. Thought this might be interesting to him.

 

[Cataceous]

Thanks for posting. I thought the study sounded familiar, and indeed we did mention it here. It is interesting that when delivered in the right manner an otherwise suppressive drug can continue to stimulate the HPTA. I think two important factors here are the low dose and the relatively short half-life of buserelin compared to other synthetic GnRH analogs. These results may be harder to reproduce with triptorelin, which appears to have a half-life that is 2-3 times longer.