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Sir,

Chow and Payne [1] published a comprehensive review of an uncommon disorder that can severely affect the quality of life of young males. A similar review was published that also includes the efficacy of the treatments in one andrology unit, where it was found that antiandrogens, e.g. cyproterone acetate, are the most effective treatment [2]. However, as these patients are frequently adolescents with sickle-cell disease, the effects on spermatogenesis and hormonal function limits the use in this age group as a first-line treatment option. Therefore alternative therapies are advised before contemplating antiandrogens.

I would also advise caution when using the algorithm in Fig. 1, as gabapentin and baclofen have only been reported in a few patients, including those with spinal cord injury, where the aetiology of the stuttering episodes might differ. The use of hydralazine has also been reported but again it is not widely used [3]. In the acute phase, ice-packs and attempted ejaculation can also be advised. There has also been a recent report of the successful control of stuttering episodes using ketoconazole.

Although Chow and Payne suggest randomized controlled trials, the number of patients presenting with this condition is currently far too low to gain any meaningful data. Unless a trial is implemented as either a coordinated multi-centre trial, or patients are referred directly to a few selected units nationally, treatments will continue to be based primarily on anecdotal reports.