Primary gonadal failure in men selectively amplifies the mass of follicle stimulating hormone (FSH) secreted per burst and increases the disorderliness of FSH release patterns: reversibility with testosterone replacement
Authors: VELDHUIS J. D. , IRANMANESH A. , URBAN R. J. 
Published: November 2003

The neuroendocrine mechanisms by which primary gonadal failure in men increases mean serum FSH concentrations (castration‐like response) are not known. To investigate the testosterone‐dependent mechanisms of the FSH castration response: (i) blood was sampled at 10‐min intervals for 24 h for later FSH assay in seven normal middle‐aged men and in six patients with primary testicular failure, during testosterone withdrawal and after 6 weeks of parenteral testosterone replacement; (ii) using a specific two‐site IRMA, serum FSH concentrations were measured, since this assay correlates well with an in‐vitro Sertoli cell bioassay; (iii) multiparameter deconvolution analysis was then applied to estimate the frequency, amplitude, duration, and mass of underlying FSH secretory bursts, and the half‐life of endogenous FSH, and (iv) approximate entropy was calculated to quantify the relative orderliness of FSH release over 24 h. Mean (± SEM) 24‐h serum FSH concentrations were 3.9 ± 0.8 IU/L in control subjects and 39 ± 10 IU/L in unreplaced hypogonadal patients (p=0.034). Deconvolution analysis revealed similar estimated mean FSH half‐lives of 346 ± 40 min (control) and 321 ± 47 min (untreated patients), and indistinguishable FSH secretory burst frequencies, namely, 20 ± 0.95 (normal) and 21 ± 1.3 (patients) pulses per 24 h. In contrast, the daily production rate of FSH was markedly increased in testosterone‐withdrawn hypogonadal men at 117 ± 25 vs. 9.3 ± 1.8 IU/L/day (control) ( p < 0.01). This was due to a 10‐fold higher calculated maximal rate (amplitude) of FSH secretion achieved within each FSH release episode (normal 0.078 ± 0.02 vs. gonadal failure 0.74 ± 0.087 IU/L/min, p < 0.01), yielding a 10‐fold increase in the mass of FSH secreted per burst (control 0.53 ± 0.06 vs. patients 5.3 ± 0.81 IU/L, p < 0.01). In contrast, the mean half‐duration of FSH secretory bursts was unaltered in unreplaced hypogonadal men at 8.2 ± 2.2 min (control) vs. 7.0 ± 1.0 min (patients). Approximate entropy (ApEn), a scale‐ and model‐independent statistic designed to quantify the orderliness or regularity of hormone release, revealed greater irregularity of serum FSH concentrations in the hypoandrogenic state: ApEn=1.8 ± 0.025 (testosterone‐withdrawn) vs. 1.6 ± 0.037 (control) ( p < 0.05). Parenteral testosterone replacement for 6 weeks significantly decreased mean serum FSH concentrations by reducing the daily FSH secretion rate and FSH secretory burst amplitude and mass, and concomitantly restored the orderliness of FSH release patterns. Testosterone treatment did not change FSH secretory burst half‐duration, number, interburst interval, or half‐life.It is concluded that primary gonadal failure in men evokes FSH hypersecretion which is marked by more disorderly FSH release patterns and a selectively amplified mass of FSH secreted per burst. These hypergonadotrophic mechanisms are, to a significant extent, testosterone‐suppressible.