Kallmann syndrome (and other forms of hypogonadotrophic hypogonadism) are not easy conditions to diagnose for a number of reasons.
1. It is not widely known about in the medical profession, especially by primary care physicians and GP's. This leads to people with KS or HH being dismissed as "late developers" at the age of 16 if puberty has not started by then. The constant dismissal of people with this tag "late developer" gets to be very annoying after a while and being told to wait and see well into their late teens.
2. While KS / HH are genetic disorders there is no one genetic test that can detect them. While some gene defects are known to caused KS and some of these can be tested for the majority of KS cases still have an unknown genetic cause.
3. Diagnosis normally only occurs by eliminating other more common conditions.
4. It is difficult, but not impossible, to diagnose KS or HH before the age puberty is due. Still the majority of people are not diagnosed until their late teens or early 20's when puberty still has not started.
Friday, December 17, 2010
Wednesday, December 08, 2010
Not everybody will start puberty at the same age, in any peer group there will always be people who start earlier than others.
However there does come a stage when you end up being the last one to start. By the age of 15 most people, over 95% of them, should have at least started puberty.
By the age of 16 virtually everybody should have started.
Kallmann syndrome is not an easy condition to diagnose mainly because it is so poorly understood, especially by GP's or primary physicians. A lot of people in my position at the age of 15, 16, or 17 are told that they are just a late starter, late bloomer or told they should just go away and wait a few more months.
For some people this may well be true, but for those of us with Kallmann syndrome puberty will never start and you go into your late teens and early 20's thinking there is something very wrong, you are the only person in the world that missed out on puberty and getting a strong mistrust of the medical profession.
At the age of 16 if somebody has not started puberty they should be referred to an endocrinologist for specialist review. They then can determine whether it is a case of "delayed" puberty or a possible case of Kallmann Syndrome or HH.
Some doctors are reluctant to send teenagers for review and tell them all will be OK soon enough. This can be potentially very emotionally damaging to the person involved. Puberty is a very important step both physically and psychologically in any person's development and to fell left behind when the rest of the peer group is advancing can produce effects which last long into the person's life.
In all my conversations and meetings I have with people with Kallmann syndrome one point is made very clear, the people who cope better with this condition are those who are diagnosed and treated early in life, ideally between the ages of 15-17.
However there does come a stage when you end up being the last one to start. By the age of 15 most people, over 95% of them, should have at least started puberty.
By the age of 16 virtually everybody should have started.
Kallmann syndrome is not an easy condition to diagnose mainly because it is so poorly understood, especially by GP's or primary physicians. A lot of people in my position at the age of 15, 16, or 17 are told that they are just a late starter, late bloomer or told they should just go away and wait a few more months.
For some people this may well be true, but for those of us with Kallmann syndrome puberty will never start and you go into your late teens and early 20's thinking there is something very wrong, you are the only person in the world that missed out on puberty and getting a strong mistrust of the medical profession.
At the age of 16 if somebody has not started puberty they should be referred to an endocrinologist for specialist review. They then can determine whether it is a case of "delayed" puberty or a possible case of Kallmann Syndrome or HH.
Some doctors are reluctant to send teenagers for review and tell them all will be OK soon enough. This can be potentially very emotionally damaging to the person involved. Puberty is a very important step both physically and psychologically in any person's development and to fell left behind when the rest of the peer group is advancing can produce effects which last long into the person's life.
In all my conversations and meetings I have with people with Kallmann syndrome one point is made very clear, the people who cope better with this condition are those who are diagnosed and treated early in life, ideally between the ages of 15-17.
Sunday, December 05, 2010
Kallmann Syndrome is not an easy condition for people to understand. Families, partners and friends of people with KS or HH will hopefully help to be understanding, but it is almost impossible for them to know what it is like to have a condition which prevents you from not going through a fundamental stage of development.
One of the big hurdles is the initial diagnosis with most cases of absent / delayed puberty not being taken seriously by primary clinicians. Far too often I hear stories about people who are 16 or older being told to "wait and see", or that they are a "late bloomer". Over 99% of people should have at least started puberty by the time they are 16. Anybody who is 16 with no obvious puberty signs should be referred for an endocrinologist review to determine if they could have KS / HH.
Once diagnosed treatment is fairly straight forward. The 3 monthly injection now available can be stretched to 6 months for some people. Fertility treatments are available and are successful in a lot of cases, both for the men and women.
While on the physical side Kallmann syndrome is a fairly benign condition. It has no shortened life expectancy associated with it and no physical pain. If left untreated the major problem would be the greatly increased risk of osteoporosis or brittle bones due to the low levels of testosterone or oestrogen.
It is the psychological side of Kallmann syndrome that is so poorly understood. I think a lot of it arises from the poor self image a lot of people with KS / HH have. Missing out on such a key developmental step, both physically and emotionally means some people with KS / HH take a long time to catch up with their peer group, if they ever do.
While most people with KS / HH can have normal sex lives, for a lot of people there is a major obstacle of poor self image that they have to overcome. In my own non-professional opinion, but through talking to a lot of guys with KS or HH it is those who have been diagnosed & treated at a later age that have the most trouble forming and keeping relationships.
One of the big hurdles is the initial diagnosis with most cases of absent / delayed puberty not being taken seriously by primary clinicians. Far too often I hear stories about people who are 16 or older being told to "wait and see", or that they are a "late bloomer". Over 99% of people should have at least started puberty by the time they are 16. Anybody who is 16 with no obvious puberty signs should be referred for an endocrinologist review to determine if they could have KS / HH.
Once diagnosed treatment is fairly straight forward. The 3 monthly injection now available can be stretched to 6 months for some people. Fertility treatments are available and are successful in a lot of cases, both for the men and women.
While on the physical side Kallmann syndrome is a fairly benign condition. It has no shortened life expectancy associated with it and no physical pain. If left untreated the major problem would be the greatly increased risk of osteoporosis or brittle bones due to the low levels of testosterone or oestrogen.
It is the psychological side of Kallmann syndrome that is so poorly understood. I think a lot of it arises from the poor self image a lot of people with KS / HH have. Missing out on such a key developmental step, both physically and emotionally means some people with KS / HH take a long time to catch up with their peer group, if they ever do.
While most people with KS / HH can have normal sex lives, for a lot of people there is a major obstacle of poor self image that they have to overcome. In my own non-professional opinion, but through talking to a lot of guys with KS or HH it is those who have been diagnosed & treated at a later age that have the most trouble forming and keeping relationships.
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