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Impact of Long-Term Gonadotropin Replacement Treatment on Sleep in Men with Idiopathic Hypogonadotropic Hypogonadism


Murat Aksu, MD, Professor, Department of Neurology, Erciyes University Medical School, TR 38039 Kayseri, Turkey. Tel: +90 533 3638980; Fax: +90 352 2257910; E-mail:


Introduction.  Concern has been expressed in recently published literature that gonadotropin replacement therapy (GnRT) in hypogonadism may alter sleep architecture and induce, or worsen, obstructive sleep apnea (OSA).

Aim.  To investigate the sleep stages and sleep-breathing parameters in young men with idiopathic hypogonadotropic hypogonadism (IHH)—a treatable form of male infertility and sexual dysfunction—before and 12 months following GnRT.

Methods.  Sixteen male patients with IHH (mean age 27.5 ± 10.5 years, range 17–48 years) and 16 individually age-matched healthy men were included in the study. Human chorionic gonadotropin (HCG) was administered 1,500 U intramuscularly three times/week for 6 months, and then 75 U twice/week, recombinant follicle stimulating hormone (FSH) was added to HCG for the following 6 months. Polysomnography (PSG) recordings were performed at baseline in all and following the GnRT in the patient group.

Main Outcome Measures.  Sleep stages and sleep-breathing parameters on PSG.

Results.  Patients with IHH had a higher percentage of slow-wave-sleep (SWS) (22.3 ± 6.3%) compared to that in the healthy controls (14.5 ± 9.5%; P = 0.009). Four patients and one control subject had OSA (Apnea-Hypopnea Index [AHI] > 5-h) at baseline (not significant). Following the GnRT in the patient group, there was a slight decrease in SWS (18.6 ± 6.4%; P = 0.05) without any significant changes regarding the sleep-breathing parameters in the whole patient group. However, of the four patients with OSA at baseline, the GnRT was associated with worsening of the AHI in three of them.

Conclusions.  IHH in men is associated with a higher percentage of SWS. One-year GnRT slightly decreases SWS and does not induce OSA. However, in patients with OSA at baseline long-term GnRT should be exercised with caution. Ismailogullari S, Korkmaz C, Peker Y, Bayram F, Karaca Z, and Aksu M. Impact of long-term gonadotropin replacement treatment on sleep in men with idiopathic hypogonadotropic hypogonadism. J Sex Med 2011;8:2090–2097.