TRT vs. GnRH pulsitile therapy

[galapagos]

medpagetoday.com/Endocrinolo … gy/tb/6538

“Exogenous therapy with pulsatile GnRH or gonadotropin therapy usually restores normal pubertal development and fertility, whereas androgen therapy only induces virilization.”

I suppose such “gonadotropin therapy” would be analagous to SERM therapy in its mechanism and purpose…

I realize this source has as its focus therapeutic initiation of puberty, which, wonder, may perhaps be similar in mechanism to what we know and care about as “jumpstarting the HPTA?”

But the point is, if there are differences in pulsatile GnRH therapy and androgen therapy, as far as treatment is concerned, which one should really be preferred?

It makes sense to me that by keeping gonadotropins going, one might be in a better position to perhaps eventually restore HPTA function, as they do for restoring puberty.

[Hypo-is-here]

galapagos wrote:

http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/tb/6538

“Exogenous therapy with pulsatile GnRH or gonadotropin therapy usually restores normal pubertal development and fertility, whereas androgen therapy only induces virilization.”

That study is quite specific in the setting in which GnRH is used.

galapagos wrote:

I suppose such “gonadotropin therapy” would be analagous to SERM therapy in its mechanism and purpose…

It is used to jump start the HPTA in the specific setting that is stated.

galapagos wrote:

I realize this source has as its focus therapeutic initiation of puberty, which, wonder, may perhaps be similar in mechanism to what we know and care about as “jumpstarting the HPTA?”

Speculation. The therapy is to jump start the HPTA and in that regard might work in a man with hpogondotropic hypogondism as a result of finasteride use, then again the mechanism of action of finasteride might mean that it does not work. We would need studies or cases to know.

galapagos wrote:

But the point is, if there are differences in pulsatile GnRH therapy and androgen therapy, as far as treatment is concerned, which one should really be preferred?

It is a largely irrelevant question the reasons for which are as follows;

A) You wont get on GnRH therapy due to the medical position on its use and the prohibitive cost.
B) You would need to have it injected via an infusion pump every two hours or so, which makes it impractical in most situations.

galapagos wrote:

It makes sense to me that by keeping gonadotropins going, one might be in a better position to perhaps eventually restore HPTA function, as they do for restoring puberty.

That potentially might be true, nevertheless it will not be used for the reasons above, I would be amazed to hear of anyone managing to get on GnRH therapy at present for anything other than the stated reasons of use such as delayed puberty.

P.S

There is nothing wrong with your thinking on this one though, good logic and reasoning.