Evaluation of gonadotrophin analyses in male hypogonadism

Urinary total hypophyseal gonadotrophin (HG) analyses in 56 healthy men and 282 patients with a great variety of forms of male hypogonadism showed that in some clinical conditions HG is decreased, in others increased while in some others the HG level is normal.

It has been shown, however, that primary damage of the germinal epithelium per se causes an increase of the HG level. It is necessary, therefore, to take the functional state of the germinal epithelium into account when HG excretion is used as a parameter of function and responsiveness of the hypophysis.

By the testicular biopsy score count method described by the author, a figure (mean score, MS) is obtained which expresses the spermatogenetic state. Analysis of 284 patients with primary testicular disorders established a correlation between the log gonadotrophin value (log HG) and MS. It was found that the HG level in the control group of apparently healthy men was considerably higher than that corresponding to perfect spermatogenesis. The question whether »ideal« men with perfect spermatogenesis or »average healthy« men should be used as controls in gonadotrophin assays is a dilemma.

By using the regression equation between log HG and MS the influence of various spermatogenetic states on the HG level was eliminated by transforming, in each patient, the log HG value to the value corresponding to a fixed mean score of 1.0. These transformed log HG values were then evaluated in the various disorders. Decreased values were found in hypopituitarism, infantilism, eunuchoidism, adiposogenital dystrophy (in adults) and hypogonadism secondary to metabolic disease. In all other conditions, the HG level corresponded to the spermatogenetic state. No extra-tubular factors seem to influence the HG level and no case of primary overproduction of gonadotrophins was found.

The value of transforming gonadotrophin values to a defined spermatogenetic state in clinical and experimental studies is discussed.