Switch to restoration therapy in a testosterone treated central hypogonadism with erythrocytosis

[摘要] We describe a case of severe erythrocytosis caused by testosterone replacement therapy in a 66-year-old man affectedwith hypogonadotropic hypogonadism (HH) determining osteoporosis, resolved by switching to restoration therapy withclomiphene citrate. The patient complained fatigue, loss of libido and defective erections and a spontaneous vertebralfracture despite bisphosphonate therapy and vitamin D supplementation. The examinations proved isolated HH andhe was therefore treated with testosterone gel with regression of specific manifestations but elevated hemoglobinand hematocrit values. Therefore, it was decided to switch to a restoration therapy with clomiphene citrate 25mg/die, which resulted in the resolution of symptoms without evident side effects. In a couple of months, the patientshowed normalization of testosterone levels and increment of testicular volume. Since secondary hypogonadism isthe consequence of an insufficient stimulation of the gonads by hypothalamic–pituitary axis, therapeutic approachesaimed to restore endogenous testosterone production should be considered in alternative to testosterone replacement,particularly if side effects intervene. Among these strategies, clomiphene citrate seems to have a high efficacy and safetyprofile also in the elderly with isolated HH and no evident pituitary lesion.

[学科分类] 血液学