Exp Clin Endocrinol Diabetes 2005; 113 - V7_60
DOI: 10.1055/s-2005-862844

High prevalence of hypogonadism in male adults after allogeneic bone marrow transplantation

M Stadler 1, E Dammann 1, H Dietrich 1, M Eder 1, B Hertenstein 1, E Leifke 2, G Brabant 2, C Schöfl 2
  • 1Medizinische Hochschule Hannover, Hämatologie, Hämostaseologie und Onkologie, Hannover
  • 2Medizinische Hochschule Hannover, Gastroenterologie, Hepatologie und Endokrinologie, Hannover

Severe germ cell injury causing infertility occurs in most male adults receiving allogeneic bone marrow transplantation (BMT). By contrast, Leydig cell insufficiency causing hypergonadotropic hypogonadism has been reported to be rare in these patients. As allogeneic BMT is the treatment of choice for many hematological diseases and prolonged survival is increasingly common, we evaluated the endocrine testicular function in a large cohort of male adults after BMT.

Methods: 86 male patients (median age 41 y (range 17–64 y) who received allogeneic BMT for a variety of hematological disorders were included. LH, FSH, and total testosterone were measured 196 days (range 89–1568d) after BMT by routine methods. Hypogonadism was diagnosed, if total testosterone was 2SD below the age-adjusted mean of healthy men (Leifke et al. 2000).

Results: 43 of 86 patients (50%) had hypogonadism according to our criteria (total testosterone 2.09±0,08 ng/ml). 43 of 86 patients (50%) had total testosterone values within the age-adjusted normal range (4.82±0,18 ng/ml, p<0.001). LH was 9.68±0.73 U/l in the hypogonadal and 9.72±0.68 U/l in the eugonadal patients, which indicates more complex dysregulation of the gonadal axis rather than just primary testicular failure. Hypogonadism appears to develop early after or even during BMT, since the percentage of hypogonadal man did not increase over time (47% after 6 months, 45% after 24 months). Hypogonadism was not associated with acute or chronic GvHD. Consistent with germ cell injury FSH was elevated (≥10 U/l) in 92% of the patients.

Conclusion: In male adults hypogonadism is much more common after BMT than hitherto reported affecting 50% of the patients. Our data further indicate that gonadal dysfunction may not only occur at the testicular level but may also involve hypothalamic-pituitary dysregulation. As the rate of endocrine gonadal dysfunction is high, screening of male adults for hypogonadism appears to be warranted.