Hypogonadism is a complication in males with thalassemia major. Mahwi et al reported risk factors for development of hypogonadism in patients who are transfusion dependent. The authors are from Shar Hospital in Sulaymaniyah, Iraq.
Patient selection: transfusion-dependent thalassemia major
The serum testosterone is reduced in affected males.
A patient with hypogonadism may have other endocrinopathies (diabetes, hypothyroidism, hypoparathyroidism).
The serum ferritin in patients with hypogonadism is about 2 times that of a person without hypogonadism (mean serum ferritin 2,326 ng/mL vs 1,220 ng/mL).
Many patients have involvement of the hypothalamic-pituitary-gonadal axis with low LH and FSH (hypogonadotropic hypogonadism). This is ascribed to hemosiderosis of the anterior pituitary gland.
Some patients develop interstitial fibrosis in the testis with a loss of Leydig cells.
The chronic anemia may contribute to the hypogonadism.
Proper use of chelating agents can be effective in reducing the hemosiderosis and may avoid the endocrinopathy.
