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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Cabergoline Improves Orgasms in Two Thirds of Men
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<blockquote data-quote="Nelson Vergel" data-source="post: 187349" data-attributes="member: 3"><p><strong><span style="font-size: 18px">How many men with low testosterone due to high prolactin caused by an adenoma reach normal testosterone when they are treated with cabergoline? (a third of them)</span></strong></p><p><strong><span style="font-size: 18px"></span></strong></p><p> <strong><span style="font-size: 18px"></span></strong></p><p>Abstract</p><p>Context</p><p>Data regarding prevalence, predictors, and mechanisms of persistent hypogonadotropic hypogonadism (HH) in males with a macroprolactinoma who achieve normoprolactinemia on dopamine-agonist therapy is limited. None of the previous studies provide cut-offs to predict the achievement of eugonadism.</p><p></p><p>Objective</p><p>To evaluate the prevalence of persistent HH and its determinants in males with a macroprolactinoma who achieve normoprolactinemia on cabergoline monotherapy</p><p></p><p>Design</p><p>Retrospective study with prospective cross-sectional evaluation.</p><p></p><p>Setting</p><p>Tertiary health care center.</p><p></p><p>Patients</p><p>Males with a macroprolactinoma and baseline HH who achieve normoprolactinemia on cabergoline monotherapy</p><p></p><p>Intervention</p><p>None.</p><p></p><p>Main outcome measures</p><p>Prevalence of persistent HH and its predictors.</p><p></p><p>Results</p><p>Thirty subjects (age: 38.3±10.1 years) with baseline tumor size of 4.08±1.48 cm and median (IQR) prolactin of 2871 (1665-8425) ng/ml were included. Eight of 30 participants achieved eugonadism after a median follow-up of three years. Patients with persistent HH had suppression of LH-testosterone axis with sparing of other anterior pituitary hormonal axes including FSH-Inhibin B. Baseline prolactin (1674 vs. 4120 ng/ml; p=0.008) and maximal tumor diameter (2.55±0.36 vs. 4.64±1.32 cm; p=0.003) were lower in patients who achieved eugonadism. Baseline maximal tumor diameter ≤ 3.2 cm (sensitivity: 75%, specificity: 63.6%) and serum prolactin ≤ 2098 ng/ml (sensitivity: 87.5%, specificity: 77.3%) best predicted reversal of HH.</p><p></p><p>Conclusion</p><p><strong>Recovery of LH-testosterone axis occurred in 26.7% of males with a macroprolactinoma who achieved normoprolactinemia on cabergoline monotherapy. </strong>Higher baseline tumor size and serum prolactin predict persistent HH. Our data favors chronic functional modification of hypothalamic-pituitary-gonadal axis over gonadotroph damage as the cause of persistent HH.</p><p></p><p>[URL unfurl="true"]https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgaa650/5907987?fbclid=IwAR2vRNDMsSfYT8BNP9S4WY76uj18XtKt0N6iJ4hI2MTiuKOkjKGGxA2EIiE#.X2UR77z2390.facebook[/URL]</p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 187349, member: 3"] [B][SIZE=18px]How many men with low testosterone due to high prolactin caused by an adenoma reach normal testosterone when they are treated with cabergoline? (a third of them) [/SIZE][/B] Abstract Context Data regarding prevalence, predictors, and mechanisms of persistent hypogonadotropic hypogonadism (HH) in males with a macroprolactinoma who achieve normoprolactinemia on dopamine-agonist therapy is limited. None of the previous studies provide cut-offs to predict the achievement of eugonadism. Objective To evaluate the prevalence of persistent HH and its determinants in males with a macroprolactinoma who achieve normoprolactinemia on cabergoline monotherapy Design Retrospective study with prospective cross-sectional evaluation. Setting Tertiary health care center. Patients Males with a macroprolactinoma and baseline HH who achieve normoprolactinemia on cabergoline monotherapy Intervention None. Main outcome measures Prevalence of persistent HH and its predictors. Results Thirty subjects (age: 38.3±10.1 years) with baseline tumor size of 4.08±1.48 cm and median (IQR) prolactin of 2871 (1665-8425) ng/ml were included. Eight of 30 participants achieved eugonadism after a median follow-up of three years. Patients with persistent HH had suppression of LH-testosterone axis with sparing of other anterior pituitary hormonal axes including FSH-Inhibin B. Baseline prolactin (1674 vs. 4120 ng/ml; p=0.008) and maximal tumor diameter (2.55±0.36 vs. 4.64±1.32 cm; p=0.003) were lower in patients who achieved eugonadism. Baseline maximal tumor diameter ≤ 3.2 cm (sensitivity: 75%, specificity: 63.6%) and serum prolactin ≤ 2098 ng/ml (sensitivity: 87.5%, specificity: 77.3%) best predicted reversal of HH. Conclusion [B]Recovery of LH-testosterone axis occurred in 26.7% of males with a macroprolactinoma who achieved normoprolactinemia on cabergoline monotherapy. [/B]Higher baseline tumor size and serum prolactin predict persistent HH. Our data favors chronic functional modification of hypothalamic-pituitary-gonadal axis over gonadotroph damage as the cause of persistent HH. [URL unfurl="true"]https://academic.oup.com/jcem/advance-article-abstract/doi/10.1210/clinem/dgaa650/5907987?fbclid=IwAR2vRNDMsSfYT8BNP9S4WY76uj18XtKt0N6iJ4hI2MTiuKOkjKGGxA2EIiE#.X2UR77z2390.facebook[/URL] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Cabergoline Improves Orgasms in Two Thirds of Men
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