19
inhibition and reversal due to AAS administration are critical in determining the
correct dose, duration, and form of treatment that is optimal without causing
permanent damage. When the need for long-term androgen use presents, using
moderately supraphysiologic doses of androgens as suggested by Strawford and
colleagues (1999) coupled with post-treatment HPGA restoration as
demonstrated here, may be a more effective means over high-dose protocols
used to offset negative alterations in lean body mass. Unfortunately current
studies have yet to adequately address a standard of patient care post-androgen
therapy. Because of the negative impact of the hypogonadal state on physical
and mental well- being, pharmacotherapy that restores HPGA function more
rapidly than current modalities would greatly benefit men with hypogonadotropic
hypogonadism.
While we believe that the treatment protocol was effective in returning
normal hormonal function to these men, the lack of randomization or a control
group leaves room for speculation. Although cases of spontaneous return to
eugonadism with no medicinal intervention have been published, these reports
documented durations anywhere from 6-18 months before normal hormone
status was achieved (Gazvani et al, 1997; Wu et al, 1996). If the alternative
treatment modality described herein can reverse suppressed gonadotropin
production and AAS associated side effects much sooner than non-treatment,
further evaluation of this therapy should continue.
20
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ABBREVIATIONS
AAS Anabolic-Androgenic Steroids
AIDS Acquired Immunodeficiency Virus
ALT Alanine aminotransferase
AST Aspartate aminotransferase
BMI Body Mass Index
dL deciliter
FSH Follicle Stimulating Hormone
GGT Gamma-glutamyl transferase
GnRH Gonadotropin Releasing Hormone
HCG Human Chorionic Gonadotropin
HIV Human Immunodeficiency Virus
HPGA Hypothalamic Pituitary Gonadal Axis
kg kilogram
LH Luteinizing Hormone
mg milligram
mIU mili International Units
mL milliliter
ng nanogram
PSA Prostate Specific Antigen
T3 Triiodothyronine
T4 Thyroxine
TSH Thyroid Stimulating Hormone