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Minerva Pediatrics 2021 Jul 26

DOI: 10.23736/S2724-5276.21.06534-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Hypogonadism in male and female: which is the best treatment?

Enrica BERTELLI 1, Marianna DI FRENNA 2, Marco CAPPA 3, Mariacarolina SALERNO 4, Malgorzata WASNIEWSKA 5, Carla BIZZARRI 3, Luisa DE SANCTIS 6

1 Pediatric and Pediatric Emergency Unit, Children’s Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy; 2 Pediatric Department, V. Buzzi Children's Hospital, ASST Fatebenefratelli - SACCO, University of Milan, Milan, Italy; 3 Unit of Endocrinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy; 4 Paediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; 5 Department of Human Pathology in Adulthood and Childhood, University of Messina, Messina, Italy; 6 Pediatric Endocrinology Unit, Department of Public Health and Pediatric Sciences, Regina Margherita Children Hospital, University of Turin, Turin, Italy


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BACKGROUND: Subjects with hypo-or hypergonadotropic hypogonadism need hormone replacement therapy (HRT) to initiate puberty and maintain it with a normal hormonal status. While general recommendations for the management of HRT in adults have been published, no systematic suggestions focused on adolescents and young adults. The focus of this review is the HRT in males and females with hypogonadism, from puberty to late reproductive age, covering the different management options, encompassing sex steroid or gonadotropin therapy, with discussion of benefits, limitations and specific considerations of the different treatments.
METHODS: We conducted an extensive search in the 3 major scientific databases (PubMed, EMBASE and Google Scholar) using the keywords “hormonal replacement therapy”, “hypogonadism”, “bone mineral density”, “estradiol/testosterone”, “puberty induction”, “delayed puberty”. Case-control studies, case series, reviews and meta-analysis published in English from 1990 to date were included.
RESULTS: By considering the available opportunities for fertility induction and preservation, we hereby present the proposals of practical schemes to induce puberty, and a decisional algorithm to approach HRT in post-pubertal adolescents.
CONCLUSIONS: A condition of hypogonadism can underlie different etiologies involving the hypothalamic-pituitary-gonadal axis at different levels. Since the long-terms effects of hypogonadism may vary and include not only physical outcomes related to sex hormone deficiencies, but also psychological problems and implications on fertility, the initiation, maintenance and consolidation of puberty with different pharmaceutical options is of utmost importance and beside pubertal development, optimal uterine and testicular growth and adequate bone health should consider also the psychosocial wellbeing and the potential fertility.


KEY WORDS: Hypogonadism; Hormonal replacement therapy; Oestrogen; Testosterone; Gonadotropins; Puberty induction; Delayed puberty; Fertility

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