Plasma testosterone in prepubertal cryptorchid boys under long-term HCG therapy

Human chorionic gonadotropin (hCG) treatment in cryptorchidism

One hundred twenty-eight prepubertal boys, ages 1-12 years, were referred to our institute because of uni- or bilateral cryptorchidism. Patients with mobile (retractile) testes were not included in the study. They were treated with human chorionic gonadotrophin (hCG, Pregnyl-Teva) twice weekly for five consecutive weeks by the following doses; 1-4 years (n = 53) - 250 U X 10; 4-7 years (n = 51) - 500 U X 10; 7-12 years (n = 24) - 1000 U X 10;i.m. Plasma testosterone (T) levels were measured before and once weekly during the treatment period. A good clinical response (a complete descent of the testes into the scrotum) was obtained in 32 (25%), a partial response (a distal movement of the testes towards the scrotum) - in 41 (32%) of the boys. The basal plasma T levels were within the normal range for prepuberty in all the patients (18 +/- 9 ng/dl) and a significant increase during hCG treatment was found in all (peak of 344 +/- 185 to 640 +/- 288 ng/dl). These values were not significantly different between the "responders", "partial responders". The result of these studies, indicate the use of hCG for the initial treatment of boys with cryptorchidism, the minimal effective dose being 500 U twice weekly for five consecutive weeks.

Effect of intranasal LHRH therapy on plasma LH, FSH and testosterone, and relation to clinical results in prepubertal boys with cryptorchidism

Synthetic LHRH (HOE 471) administered intranasally over a period of 4 weeks for treatment of uni- or bilateral cryptorchidism in nineteen otherwise healthy prepubertal boys led to increased basal and peak LH values and to markedly decreased peak FSH values in the i.v. LHRH test. Basal testosterone remained unchanged. Sixteen cryptorchid boys treated with placebo served as a control group. The reduced FSH response to i.v. LHRH could be due to induction of a gonadal feedback mechanism rather than pituitary depletion of FSH, in view of the favourable therapeutic effect and the increased LH secretion seen in some of our patients. Pretreatment LHRH tests were available in twenty successfully and in twenty-eight unsuccessfully treated boys. LH values were similar in both groups, whereas FSH peak values were significantly higher in boys who responded successfully to subsequent therapy. Testicular descent occurred most readily in boys with a large pool of easily releasable FSH and without a significant rise in testosterone (in contrast to HCG treatment). We suggest that FSH induces changes that potentiate the local action of testosterone.