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Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator?

DOCTOR OF THE MONTH - Feb 2013
Feb 2013
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Hi, what impact does short course of low dose oxandrolone have on boy in mid-childhood , especially on his gnrh pulse generator?

I was told that even at this stage of life, Gnrh pulses exist along with baseline hormone levels, as hypothalamic centers are being expressed....is this true?

Regards
XXXXXX
Posted Mon, 24 Jun 2013 in Child Health
 
 
Answered by Dr. E Venkata Ramana 28 minutes later
Hi,

Thank you for your query on Healthcare Magic.

Before answering this question I want to know the exact age of this boy.

Gonadotrophin Releasing Hormone (GnRH) pulse generator is under suppression till the age of puberty.

It is suppressed by many body neural inhibitory mechanisms.

At the start of puberty, these inhibitory mechanisms will be lost, and GnRH secretion will occur in pulsatile manner.

So the impact of a short course of low dose oxandrolone on a boy in his mid-childhood is negligible.

The GnRH pulses start at the start of puberty and actually the start of these hormone pulses decides and determines the onset of puberty.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 10 minutes later
Thanks. Age would be around 9.5 years old but with diagnosis slow delayed puberty. I dont know if clinically his puberty had started or not (4ml testes volume)
You mentioned gnrh pulses decides and determines puberty, but before this, can anabolic steroids such as oxandrolone augment gnrh pulses at 9.5?

Best Regards
XXXXXX
 
 
Answered by Dr. E Venkata Ramana 18 minutes later
Hi,

Thank you for getting back.

In boys, the growth of testes (>3 ml in volume or 2.5 cm in longest diameter) and thinning of scrotum are the first signs of puberty.

As you told the testes volume is 4 ml it is suggestive of the onset of puberty.

Low dose oxandralone for shorter periods usually doesn't have significant effect on Hypothalamus Pituitary Testicular (HTPA) axis and hence it may not have an effect on GnRH pulse generator.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 15 minutes later
Thank you Dr Venkata.

what is testes was below 3ml ? Does oxandrolone have a facilitatory effect on hypothalamic centers to produce Gnrh? I got this info from elsewhere but i'd like your expert opinion please

Secondly, in a early and mid childhood, i understand baseline hormone levels in a boy are necessary for normal male organ growth....would it be considered normal to have same size male organ from birth upto time of puberty? Is this considered ok in a healthy boy?

Best Regards,
 
 
Answered by Dr. E Venkata Ramana 1 hour later
Hi,

Thank you for getting back.

If testes are small (< 3cm) it is suggestive of prepubertal testes.

As the child attains puberty, the testes size increase gradually reaching 9-10 ml.

Oxandrolone in larger doses causes inhibition of luteinizing hormone (LH), which in turn leads to suppression of testosterone production because of testicular atrophy.

As a negative feedback mechanism GnRH will increase as a response to decreased production of LH, but this increase will not help as the final target organ for all these hormonal changes is testes which become atrophied as a result of large dose of Oxandrolone.

As I told, in small doses Oxandrolone will not cause significant changes in testosterone production.

Yes in early and mid childhood, there are baseline levels of hormones present in the body and from mid childhood these hormone levels rise progressively through out the middle childhood without dramatic effect.

Rapid pubertal changes begin with increased sensitivity of pituitary gland to GnRH; pulsatile release of GnRH, LH, and FSH during sleep; and corresponding increase in gonadal hormones.

The male organ usually grows in size from birth to till the onset, but the growth is small and it is a part of generalized body growth which is caused by somatotrophic hormones like growth hormone.

The dramatic growth in male organ starts from the onset of puberty because of increased androgen production by the testes as a part of pubertal process.

So there should be a proportionate growth in male organ even before puberty because of growth hormone effect, but the dramatic growth occurs after puberty.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 31 minutes later
I'll be XXXXXXX with you. I want to know if baseline levels or pulses for Gnrh, lh and testosterone during mid childhood years. I want to ask , does weak androgen s treatment have ability to augment Gnrh pulses? If yes , does the augmented secretion persist after cessation of treatment?

Regards
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 1 hour later
Dear Dr.

Please find following link

WWW.WWWW.WW

This suggests that in midchildhood , as you kindly suggested, gnrh and other hormones do exist.

But why should it apply to me?? Please make me understand

Best Regards,
XXXXXX
 
 
Answered by Dr. E Venkata Ramana 1 hour later
Hi XXXXXX,

Thank you for getting back.

And I appreciate your deep knowledge and interest in the hormonal pattern in the regulation of puberty and the factors causing effects on this pattern.

Frankly speaking the hormonal changes that occur around the age of puberty are very much complex and the exact cause which initiates the hormonal changes leading to onset of puberty is still not well understood.

As Oxandrolone is a weak androgen, in its lower doses it will not augment the pulses of GnRH significantly.

I went through the link which you have suggested.

In middle childhood the gonadotropins will be present at base levels and rise gradually from there onwards.

At the onset of Puberty, the sensitivity of pituitary gland will increase to the effects of GnRH which in turn there will be increased release of LH and FSH which causes the production of testosterone by stimulating the testes.

The increased testosterone will lead to the physical and mental changes associated with the puberty.

The GnRH pulse generator will be present, but it will be silent in early and mid childhood. But what makes it to become active at the onset of puberty is less understood, but it may involve ongoing neuronal development throughout the middle childhood and adolescence.

So as the neuronal maturation progresses, at one point the inhibitory effect on silent GnRH pulse generator is withdrawn leading to the activation of GnRH pulse generator.

Hope I have tried my level best to make you understand this process of hormonal effects around the puberty.

If you have any clarification please feel free to get back.

Regards.
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Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 2 hours later
Ok thanks Dr Venkata for great in depth advice. Another dr mentioned that growth of male organ during stage from birth to onset of puberty was down to testosterone baseline levels , whereas you're suggesting somatic growth hormone is responsible .....I don't know what to think now.

My concern is 0 HPG activity level was present before my oxandrolone treatment at 14.5 years old, and this treatment activated the HPG to enter a prepubertal phase. And subsequently i experienced onset of puberty . i dont know Please help
 
 
Answered by Dr. E Venkata Ramana 11 hours later
Hi XXXXXX,

Thank you for getting back.

The growth of male organ from birth to the onset is resulted from the collective action of somatotrophic hormones collectively and we can't attribute its growth to a single hormone exclusively.

The onset of puberty in boys varies between early at 9.5 years to 15 years of age and it is closely related to bone maturation rather than chronological age.

What for Oxandrolone is prescribed to you?

It is very difficult to tell whether your HPG activity is activated spontaneously during the maturational process with the age or it is activated by Oxandrolone.

But I advise you to consult a Pediatric Endocrinologist to discuss your concerns about the effects of Oxandrolone on HPG axis in relation to the onset of puberty.

Oxandrolone in significantly high doses suppresses the action of gonadotropins like LH and FSH.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 8 hours later
Thank you for the indepth advice.

It was prescribed for 'growth boost' as I remember dr saying my hormones are lazy . I think she said this oxandrolon will kickstart my hormones...I dont know if she was referring to my growth hormones or sex hormones. I think I may have been in puberty but in beginning stages, but not sure
 
 
Answered by Dr. E Venkata Ramana 1 hour later
Hi XXXXXX,

Thank you for getting back.

Oxandrolone is an anabolic steroid, so it is usually prescribe to build the growth of tissue as a booster to growth.

To know your stage of puberty, be in regular follow up with your doctor/endocrinologist for the regular assessment of the XXXXXXX SMR (sexual maturation rate) staging.

Hope I have answered your query, and if you don't have any clarification you can close the discussion and I request you to kindly rate my answer to improve myself to address the queries in a better way.

And thank you very much for contacting me on Healthcare Magic.

Wish you good health.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 1 hour later
Ok just for final clarification.

Earlier you mentioned gnrh and other hormones are present in mid childhood.....and then increase as onset of puberty approaches. How is this known? Is there scientific reasoning explanation for this to be present ? Or is it info from studies?



 
 
Answered by Dr. E Venkata Ramana 44 minutes later
Hi XXXXXX,

Thank you for getting back.

The presence of these hormones is known by doing blood investigations for this hormones.

This is known by the measurement of gonadotropins in serially obtained serum samples or timed urine collection samples.

The tests are done for baseline levels, the peak levels after stimulating with an agonist, and the interpretation of the hormonal pattern with diurnal variation.

And many studies were done on primates and humans to know the physiology of puberty.

Hope this explanation answers your final clarification, and if you have any doubt you can revert back.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 1 hour later
Thank you Dr Venkata .

Final clarification. Is gnrh ALWAYS present throughout life? And in prepubertal phase, where HPG hasn't been established, can steroids start/augment gnrh pulses?



Thanks and Regards,
XXXXXX
 
 
Answered by Dr. E Venkata Ramana 10 hours later
Hi XXXXXX,

Thank you for getting back.

GnRH is present in undetectable levels in the serum before mid childhood.

At the onset of puberty, because of removal of inhibitory control over GnRH pulse generator, the level of GnRH will increase in the serum.

Steroid usually doesn't start or augment GnRH pulses in the prepubertal age.

And the gonadotropins levels are affected by the androgenic potency and the dosage of that particular hormone.

Hope I have answered your query. If you don't have any further clarifications you can close the session and I request you to rate my answer.

Best regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 2 hours later
Thank you for all the expert advice Dr Venkata.

Just before I leave, if I may, some final query.

Before midchildhood, how do we know gnrh is present if undetectable?

Only asking as you have best answers ?

Wishing you all the best

 
 
Answered by Dr. E Venkata Ramana 23 minutes later
Hi XXXXXX,

Thank you for getting back.

Direct estimation of GnRH level in hypophysial portal plasma is unpractical in human beings.

Detailed comparison of spontaneous fluctuations in FSH and LH with gonadotropin responses induced by a known concentration of exogenous synthetic GnRH will provide reasonable estimates of GnRH pulse amplitude.

Before mid childhood, the presence of GnRH in undetectable levels is know by measuring the timed out urine collection samples and studying the gonadotropin levels pattern after administering the synthetic GnRH.

Hope I have answered your query, if you have further queries please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Impact of low dose oxandrolone on childhood, specially on gnrh pulse generator? 1 hour later
Thank you Dr Venkata.

I request more clarification on following:

'Before mid childhood, the presence of GnRH in undetectable levels is know by measuring the timed out urine collection samples and studying the gonadotropin levels pattern after administering the synthetic GnRH.'

Forgive me if i misunderstood, but how can endogonous Gnrh be known, if we administer exogonous synthetic Gnrh?

Kind Regards,
XXXXXX

 
 
Answered by Dr. E Venkata Ramana 54 minutes later
Hi XXXXXX,

Thank you for getting back.

Your in depth interest in this aspect of puberty and hormones made me to go through my subject books extensively to reach your level of expectation.

What I meant is GnRH is measured in two ways.

1. Direct method : In this this hormone is measured in sampling blood from the
pituitary portal blood. This type of test is unpractical in human beings.

2.Indirect method : In this method the GnRH effect is measured in the form of
LH surge. In this method synthetic GnRH is given, and the levels of LH, FSH,
and sex hormones are measured at a prefixed regular intervals.

So the raise in these hormone levels is interpreted and the raise is an indirect evidence of GnRH activity.

By administering exogenous GnRH, we will know the effects of GnRH in the form of raised hormones, so that the effects and actions of endogenous GnRH.

In this way we can come to a conclusion in the evaluation of abnormalities of puberty like delayed and precocious puberty.

Hope I am able to clarify your queries.

But still what I can say is the mechanism of hormonal changes and the process puberty is a complex subject till the date and I tried to tell you the things what I knew as per level of knowledge.

Still if you need more clarification, I advise you to consult a Pediatric endocrinologist directly so that he can explain these changes in more precised way.

And thank you very much for your time and making me enlightened.

Best Regards.
Above answer was peer-reviewed by
 
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