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Is it possible to mature the HPG axis and induce puberty?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
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Hi,

I went to see growth specialist when 14.5 years old. after wrist xray test, blood test (for hormones?) and testis exam (No access to these records as destroyed in fire!), i was told that good news was there is no disease with me except for delayed growth/puberty. I was offered treatment but refused as we decided to 'wait' for 3 months to see if theres progress in my condition. 3 months later we went back and agreed to start oxandrolone. The physician referred to it as 'growth hormone' as it only fixes growth and DOESNT affect puberty which is partly why i agreed. Now im reading things like it's possible to mature the HPG axis and induce puberty etc.... My areas of concern are as follows:

From the data above, was there any ENDOGONOUS andro activity gonadal or otherwise?

Does a short course 2.5mg once daily oxandrolone induce central puberty or progress of central puberty?
Posted Sun, 13 Jan 2013 in Growth and Development in Children
 
 
Answered by Dr. Hema Yadav 10 hours later
Hello,
Thanks for posting your query.
Answer1. Yes there was most probably some endogenous gonadal androgen production as without which only anabolic steroids ( oxandrolone ) could not induce puberty.

Answer2. Yes a short (3 month) course of oxandrolone can cause increased growth velocity and induce puberty in prepubertal boys.

The hypothalamic–pituitary–gonadal axis is a critical part in the development and regulation of a number of the body's systems, such as the reproductive and immune systems.It is active perinatally , suppressed during childhood and is reactivated by the testosterone produced in gonads which leads to the pubertal changes. In cases of delayed puberty ( mainly constitutional delay of growth and puberty the HPG axis is active during prepuberty but it's activity is suppressed as compared to normal healthy prepubertal males . So doctors do prescribe oxandrolone in CDGP which is not exactly The GH or growth hormone but its beneficial in increasing growth velocity an helping in induction of puberty. This does not mean that the patient could not have attained puberty without it , it would still come but delayed.

Hope I have answered your query.
Kindly accept my answer if you have no further queries.
Wishing you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 25 hours later
please can you advise on following,

In childhood, androgens mature the HPG axis, and this axis further matures and remains so even after cessation of drug.

Can we then say the effects of androgen on this Axis is permanent??


Best Regards
 
 
Answered by Dr. Hema Yadav 7 hours later
Hello,
Thanks for the follow up.
The action of oxandrolone ( or synthetic androgens ) on the HPG axis are not permanent and once the androgens are completely eliminated from the body it is the basal body secretion of the pituitary and sex hormones which keep the axis going .The endogenous hormones are important for the contiinual functioning of the HPG axis even if puberty maturation was induced by exogenous hormones.
The effect of exogenous androgens is significant in terms of growth ( height and weight) and maturation of the gonadal system and yes these effects are not reversible ie permanent but the continuation of the functioning of HPG axis does require endogenous hormones.
I have tried my best to clear your doubt , hope it is helpful.
Please feel free to ask any further queries.
Kindly accept my answer if you have no further queries.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 5 hours later
Thank you Dr XXXXXXX for your advice,


So what about at a cellular level , does the prior exogenous hormone have a permanent imprint or legacy on the HPG axis? Please could you clarify as i need to understand whether the prior exogenous hormones has a legacy at cellular level on the HPG axis. Is this correct or am i misunderstand?

Thanks and Best Regards,
 
 
Answered by Dr. Hema Yadav 29 minutes later
Hello,
Thanks for the follow up.
Yes you could say that at a cellular level the impact of the exogenous androgen which induced puberty does leave a legacy on the HPG axis as the pubertal changes occurring at cellular level ( in gonads , adrenals and related hormonal secretions ) can't be reversed to prepubertal stage. The levels of hormone production may vary ( ie progress or return to original state ) say after six months of the therapy but the pubertal changes or maturity of theHPG axis at cellular level are permanent .
Hope I have answered your query.
Wishing you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 37 minutes later
Thanks Dr XXXXXXX ,

Another doctor, DR Kulbir XXXXXXX suggested that any drug taken for a short course will lose its impact and legacy after 10-15 years after cessation of drug, even at cellular level. So i am confused, which is correct?

Also you make a point that pubertal changes occuring at cellula level cannot be reversed to prepubertal stage. But ABSENCE of continual endogonous androgens also surely must affect the cells?

 
 
Answered by Dr. Hema Yadav 19 minutes later
Hello,
Thanks for the follow up.
Absent hormones is a different case than constitutional delay of growth and puberty. I assume we were discussing about CDGP as your first query suggests.
Yes you are right in your interpretation of what I am trying to say that once the testicular cells have attained pubertal size and maturity ( even though with exogenous help) they don't revert back to prepubertal stage and do progress from that point onwards . Studies show that the basal hormone responses ( LH , FSH etc) may be suppressed or normal following exogenous androgens however after say 6 months or a year the hormones will be secreted as per the original condition of the body if the case was CDGP the hormone levels are not absent or grossly abnormal . However in hypogonadism or any disorder causing absence of gonadal hormones the testicular and adrenal function will definitely be affected gradually .At cellular level , any cell when remains unstimulated or non functioning can atrophy , this doesn't mean that the exogenous hormones did not have a permanent impact , it is a kind of regression due to absence of further stimulation. The time duration ( 5/10/15 yrs ) can't be exactly commented and will vary from case to case.
Hope I have answered your query.
I ll try my best to answer all your doubts in future too.
Regards

Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 1 hour later
Thank you dr XXXXXXX for your XXXXXXX insight.If i may ask,In conclusion is a SLIGHT maturation of HPG axis from oxandrolone therapy still , in a way, partly responsible for current testosterone production?? Is this comment accurate , partly accurate, completely inaccurate? Best regards
 
 
Answered by Dr. Hema Yadav 6 hours later
Hello,
Thanks for the follow up.
Sorry as I have already mentioned this statement would be only partly accurate or it could be termed inaccurate to the best of my knowledge.
The reason as I mentioned before , is that testosterone production in adult males would not be dependant on wether they had received oxandrolone to induce puberty.If the puberty would have been delayed still the HPG axis would have matured though late and slow ( gradually). In such cases too by the time the individual reaches adulthood the endogenous testosterone production would be the same irrespective of past treatment with oxandrolone . I said partly accurate because the oxandrolone does in a way speed up the gonadal maturity which could be helpful in timely attainment of normal testosterone production and puberty changes.
Also please note that current oxandrolone treatment would affect current testosterone levels .
So I have given my honest opinion on the subject to the best of my knowledge.
I hope it has been of some help to you .
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 15 hours later
thank you,

I'd like to ask about long term implication of medications on cells.

I understand in cells that its material composition changes....what are thses changes and how often do they take place?

with Best Regards,
XXXXXXX
 
 
Answered by Dr. Hema Yadav 18 hours later
Hello,
Thanks for the follow up.
Androgens are ligands of the androgen receptor (AR). Androgens bind to the AR to form complexes that bind promoter or enhancer elements of target genes to regulate their transcription. According to the site of action it has varied effects like,
Muscle cell proliferation and hypertrophy, growth hormone stimulation , ,testosterone suppression and testicular atrophy at high doses,etc
During exogenous administration of anabolic androgens, endogenous testosterone release is inhibited through inhibition of pituitary luteinizing hormone (LH). At large doses, spermatogenesis may be suppressed through feedback inhibition of pituitary follicle-stimulating hormone (FSH).
Anabolic steroids have been reported to increase low-density lipoproteins and decrease high-density lipoproteins. These levels revert to normal on discontinuation of treatment.All these effects are dose and duration dependant and one cannot comment how frequent or how long the effects on cells last in general ( without individual specification).
Although oxandrolone is a 17-alpha alkylated steroid, its liver toxicity is very small as well. Studies have showed that a daily dose of 20 mg oxandrolone used in the course of 12 weeks had only a negligible impact on the increase of liver enzymes.
As a DHT derivative, oxandrolone does not aromatize (convert to estrogen, which causes gynecomastia or male breast tissue). It also does not significantly influence the body's normal testosterone production (HPTA axis) at low dosages (20 mg). When dosages are high, the human body reacts by reducing the production of LH (luteinizing hormone), thinking endogenous testosterone production is too high; this in turn eliminates further stimulation of Leydig cells in the testicles, causing testicular atrophy (shrinking).
I would like to know which of the long term effects you are referring to as I have already mentioned that the cellular hypertrophy is not permanent and atrophy is permanent but not possible at usually prescribed low doses .
Kindly mention the specific actions you need to understand as explaining the in general molecular mechanisms are not feasible ( unless you have a medical degree).
I would be glad to be of any further help in clearing your doubts.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 2 days later
Thank you DR XXXXXXX

An endocronoligist suggested that no legacy of old oxandrolone treatment remains as our body renews itself so any impact of ox on hypothalamus is also renewed
 
 
Answered by Dr. Hema Yadav 1 hour later
Hello,
Thanks for the follow up.
Yes , that's true that the oxandrolone you took years ago will not affect your brain or hormonal system now , hence I also mentioned that it's effect on hormones is not permanent however the growth / physical changes it has caused are not reverted in a normal person ie unless any pathological problem exists with the endocrine system.
I hope you have your doubt cleared . However kindly excuse me for my curiosity as I still cannot interpret the exact reason for your doubts and the nature of your worries.
I would be glad if I could help in easing your worries any further .
Wishing you all the best.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 1 hour later
Thank you Dr XXXXXXX

consider this scenario:

At 14.5 years an LH test reveals 2 ui/ml . After commencing oxandrolone treatment for a short period, 3 months after cessation anotheer LH test reveals 3 ui/ml. Thus the oxandrolone matured hpg axis.

Now at 21 years an LH test shows 20 ui/ml.

Should we attribute some of this 20 ui/ml currently produced to the old oxandrolone treatment many years ago...or is this a wrong logic??

Regards
 
 
Answered by Dr. Hema Yadav 7 hours later
Hello,
Thanks for the follow up.
No ,please do not attribute the present LH levels to the past oxandrolone .
So that's why you wanted to know about the legacy of oxandrolone effects!
Anyways I assume you have consulted an endocrinologist for the same .
Wishing you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 39 hours later
Thank you Dr XXXXXXX Yes you are right , thats what i wanted to know.


If you can give me little more explanation regarding advice 'present LH levels not attributable to past oxandrolone'

Can you give me more advice regarding this please?

Kind Regards,
XXXXXXX
 
 
Answered by Dr. Hema Yadav 15 hours later
Hello,
Sorry but there is nothing more to the fact that your present LH levels are not a result of your past oxandrolone and yes I would advise you to follow up for a thorough evaluation and investigation by your endocrinologist for your current situation .
Wishing you good health.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 9 hours later
Thankyou Dr XXXXXXX

I have one last question regarding adrenal androgens if you could advise me,

After adrenarche , do adrenal androgens continue to be regularly produced in boys body?

Regards

 
 
Answered by Dr. Hema Yadav 12 hours later
Hello,
Yes, in a normal male child after adrenarche the adrenals continue to produce the androgens regularly as one of the inherent function of adrenal glands is to produce androgens and other hormones.
Regards
Above answer was peer-reviewed by
 
Follow-up: Is it possible to mature the HPG axis and induce puberty? 12 hours later
Hi Dr XXXXXXX hope youre well,

What stimulates the release of adrenal androgens please?

Best Regards

 
 
Answered by Dr. Hema Yadav 12 hours later
Hello ,
Sorry but it would be difficult to explain the mechanism of action of adrenal gland functions to someone who has not studied medicine.Still I would like to answer your query in short.
Adrenal androgens (AA) are mainly produced by the human adrenal cortex. ACTH is the major regulator of their secretion. However, other factors, such as gonadal sex steroids, insulin, growth hormone, prolactin, hypothalamic peptides and growth factors have been involved in AA regula- tion. More recently, it has become well accepted that, besides systemic factors, AA secretion is under the control of the “sympathoadrenal system” and “immunoadrenal system”.
Kindly accept the answer in case you have no further queries.
Regards
Above answer was peer-reviewed by
 
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