Assessment of Quality of Life During Gonadotrophin Treatment for Male Hypogonadotrophic Hypogonadism

Koji Shiraishi; Shintaro Okal Hideyasu Matsuyama


Clin Endocrinol. 2014;81(2):259-265. 

In This Article

Abstract and Introduction


Objective The management of male hypogonadotrophic hypogonadism (MHH) with gonadotrophins is effective in promoting genital development and spermatogenesis. We investigated the changes in SF-36 subscales, including physical, social and psychological QOL, during gonadotrophin or testosterone treatment and analysed the factors that are involved in the outcomes of health-related quality of life (HRQOL) in MHH patients.

Patients and Design Thirty-seven MHH patients (mean age: 26·1 years old) who underwent gonadotrophin (n = 31) or testosterone treatment (n = 6), excluding infertility cases, were asked to respond to a SF-36 questionnaire before and every 6 months during the 2-year treatment period. The changes in SF-36 domains and the associations between improvements and patient factors were examined.

Results The scores in all of the SF-36 domains were lower than in the normal Japanese population. In all eight domains, except for bodily pain and social functioning, the mean scores for physical function (PF), role-physical (RP), general health (GH), vitality (VT), role-emotional (RE) and mental health (MH) significantly increased over the course of treatment in patients with gonadotrophin. These changes were particularly noticeable in the psychological domains; GH, VT, RE and MH exhibited large increases 18 months after treatment. Testosterone treatment increased only PF and RP domains. In patients with sperm in their ejaculate, the improvements in GH, VT, RE and MH were significantly greater than those who did not exhibit sperm.

Conclusion Gonadotrophin treatment for MHH was associated with significant improvements in SF-36 domains. Gonadotrophin treatment could prevent negative physical and psychological sequelae in the management of MHH.


The diagnosis and management of male hypogonadotrophic hypogonadism (MHH) are very important because MHH can be successfully treated in terms of paternity and masculinization using gonadotrophins, including hCG and recombinant human FSH (rhFSH).[1–4] The goals (i.e. masculinization and induction of spermatogenesis) and duration of treatment are often determined based on each patient's needs, and fertility is often an issue in later life.[5] The adverse effects of low testosterone include physical impairment (e.g. reduced muscle strength, osteoporosis, increased visceral fat), psychological disturbances (e.g. depression, anxiety, sleep disturbances) and impairments of reproductive and sexual function (e.g. infertility, decreased libido, erectile and ejaculatory dysfunction). In adolescents with delayed puberty, these symptoms are likely to be exaggerated because of short stature, childlike appearance and the absence of secondary sex characteristics.[6] Treatment results with late-onset hypogonadism (LOH) have suggested that testosterone replacement is beneficial in improving the above parameters and can be expected to improve the health-related quality of life (HRQOL).[7] Decreased HRQOL remains a major matter of concern for MHH patients. However, no studies have investigated the effects of gonadotrophin treatment on patient satisfaction.

To manage MHH patients effectively, defining how their HRQOL improves is essential for understanding their psychological variables and for directing hormonal therapy. The evaluation of HRQOL is a useful tool for understanding these complex phenomena. The SF-36 questionnaire,[8] which has been standardized for the Japanese population,[9] is a validated and broadly used instrument for the self-assessment of different dimensions of HRQOL. Using the SF-36, Aydogan et al.[10] reported that in addition to recovered sexual function, testosterone replacement also improved anxiety and depression scores, as well as QOL.

The aims of this study were to investigate the changes in SF-36 subscales, including physical, social and psychological QOL, during gonadotrophin treatment compared with testosterone treatment and to analyse the factors involved in HRQOL outcomes in MHH patients.