Hello

I am Dr.Omer and I am here to help you with your query

As you have said that you had constitutional delay in growth and puberty and your doctor prescribed low dose steroids per month for few months?

In constitutional delay in growth and puberty , there is low-normal fsh and Lh from pituitary gland , and hence high gonadotropic releasing hormone ( GnRH) from upper part of pituitary gland known as hypothalamus

This GnRh in CDGP is high-normal, and is abnormal functionally and hence failes to stimulate fsh and lh , and hence low testosterone

These FSH and LH produce testosterone from testes

When you were a teenager , your doctor must had done the FSH , LH , GnRH level and hence must had diagnosed you with this problem CDGP

You must had low libido , low energy , low muscle mass , small testes before the use of low dose testosterone

Then your doctor prescribed testosterone for few months , which stimulated your testes to produce more testosterone and your problems went away in few months .

The testosterone given to you in teenager , made your GnRH functionally better , and your doctor like in most cases , checked your testosterone level and testicular size , and that would had come normal and he stopped your testosterone

You stayed healthy for few years and again having the same problem when you are 31 years

The most probable diagnosis will be that you were a case of Either primay hypogonadism(low GnRH) or secondary hypogonadism(high GnRH) and you were misdiagnosed as CDGP

This mis-diagnosis does happen in most of the patients

The most common cause of reverting back to low GnRH or reverting back of your symptoms , after successful treatment from testosterone would be kallman syndrome or klinefelters syndrome , both of which are due to low GnRH and hence low testosterone

I would suggest to go to your doctor and get your basic tests done like FSh , lh , Gnrh , Prolactin , Tsh , serum iron level and then we can place you in either high fsh , lh causes /// or low fsh , lh causes

Dont worry as most of the causes of infertility are completely treatable , just follow what i said

I hope this explains your query

Take care

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Hello again

Thankyou for understanding

YES, you are 100 percent right that in patients who have no GnRh during their teenager life , they are started on weak dose of testosterone. GnRH starts to rise even when the treatment was stopped (reversibility)

Absent or low GnRH , with delayed puberty and growth is known as HYPOGONADOTROPIC HYPOGONADISM (HH) , MEANING LOW GnRH AND HENCE LOW TESTOSTERONE

In different studies people with HH were successfully treated with testosterone - developed their male sexual characters in teenage life. When they are followed up for 10 years, the result showed that only 10 % of HH people got sustained reversibility (normal GnRH ) for whole life , but 90% showed non sustained reversibility (again low GnRH and hence low testosterone ) with-in 6.5-10 years of last testosterone treatment

Following are the studies, if you wish to read in more detail (there are other studies as well)

1. XXXXXXX R, Cheow HK, Tymms DJ, et al. Kallmann's syndrome: is it always for life? Clin Endocrinol (Oxf) 1999; 50:481.
2. Raivio T, Falardeau J, XXXXXXX A, et al. Reversal of idiopathic hypogonadotropic hypogonadism. N Engl J Med 2007; 357:863.

In those 90% of the patients , retreatment with GnRH + Testosterone made them fertile and reversal of symptoms again , but did not specify their follow up

I hope this supports your idea , happy to know that you know your problem very much

Feel free to ask any questions , what-ever comes into you mind

Your feedback is important for US

Stay happy and healthy

Take care

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Hello again

Thankyou for understanding

As you have said that your doctor did all the tests , but did he do the testosterone+lh+fsh level? ). GnRH test is usually not done as it is very expensive?

A single test like testosterone is useless , untill unless you do lh+fsh , and vice versa

Without these tests(testosterone+fsh+lh) you cant diagnose any thing of puberty


If he did and he labelled you with CDGP , then that means your FSh+lh came low-normal , low testosterone , which is mostly seen in CDGP , and he started the treatment

But as i told you earlier almost all the types of puberty disorder respond to oxandrolone( sister testosterone) in sexual charatcters development in one way or other but more than half will have infertility problem , later in life , as they were mis-diagnosed/over-diagnosed with CDGP

Following occurs in patients with delayed puberty

Constitutional delay of puberty (63 percent of males ).this is the common form , and clinicians go on percentage in treating patients. low fsh+lh+testosterone

Delayed but spontaneous pubertal development (functional hypogonadotropic hypogonadism) occurred in 19 percent.low fsh+lh+testosterone , mimics CDGP

Permanent hypogonadotropic hypogonadism in 12 percent.( imporvement from testosteroen in teenage life but non-fertile) , becomes normal with treatments , shows reversibility , then again appearance of symptoms , herediaty ( kallman syndrome , meaning cant smell things ) , in your case ,you fit in this category , probably

Permanent hypergonadotropic hypogonadism (ie, primary gonadal failure) in 13 percent. ( normal / delayed puberty without treatment , non-fertile) .If you are very tall , with long arms then KLEINFELTERS SYNDROME , high tsh+lh , and low testosterone

Unclassified ( NO REASONS )

Well i dont know if you hadnt took the treatment , would you have grown the spurts , but i can say that a fresh test of testosterone + LH+FSH , at this time will give us a rough idea , that what was you GnRH level before 14.5 years

Well you are a tough customer , and i tried to explains as much , in the easiet way possible , sorry for late response , i am on duty in ER

Take care

If satisfied with the response , kindly write a review

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Hello again

Yes a new test , and its results will be very helpful and we can start a new discussion , by directly asking me the question in specialist group

Waiting for your result , hope that it comes normal

Best of luck

Take care

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Hello again

I know that you have a busy schedule

If your test comes normal , it will be a vary happy news , and it will show that your GnRh was normal but functionally abnormal when you were 14 years old , and your LH , FSH was low , and hence low testosterone , all this will lead to CDGP or HH , and after testosterone your GnRH became functionally normal till now

And if your LH , FSH and testosterone comes subnormal or ZERO this time then you were having HH when you were 14 years old

If GnRH is functionally abnormal , in child hood then your LH , FSh , Testosterone will be low , but not completely absence of these hormones.

And a little bit of stimulation of GnRH when you were 14 years old was there, but not complete stimulation

Hope this explains your query

Feel free to ask any further questions

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