Research study in America.

Dr. Angela Delaney sent a message using the contact form at
http://kallmanns.org/contact.

I am trying to get the word out about a research study we are conducting at
the National Institutes of Health (federally funded, not for profit), which
I think may be of interest to some of the patients and families in your
network.  Please let me know if you can post this message somewhere, or if
there is any other assistance you may be willing to provide.  Thank you
very much for your consideration. The message is below:

I am a pediatric endocrinologist and a researcher at the National
Institutes of Health (NIH).  We are conducting several related studies on
disorders of puberty and reproduction. Our goal is to learn more about what
regulates pubertal development and reproduction by studying people who have
an abnormality of certain hormone levels, resulting in abnormal puberty or
fertility. 

Anyone diagnosed with Kallmann syndrome (KS) or idiopathic hypogonadotropic
hypogonadism IHH (also known as congenital, or isolated, GnRH deficiency)
is eligible. Patients who may meet these criteria and have a family history
of any related issues are especially encouraged to participate. 

We are currently in search of female patients who also have abnormal
development of the uterus, including a uterine septum, uterine agenesis
(including, but not limited to Meyer-Rokitansky-Kuster-Hauser syndrome),
bicornuate, didelphys, or similar anomaly AND a history of delayed pubertal
development, KS or IHH.

Participation may include a full clinical evaluation, in addition to
genetic testing, all at no cost to you.  Travel and accommodations may be
provided within the US, or if you can't or don't wish to travel to the
Washington, DC area, you can participate from a distance.  Additional
information can be found on our website: http://ird.nichd.nih.gov.  
The studies are conducted by the Unit on Genetics of Puberty and
Reproduction at the Eunice Kennedy Shriver National Institute of Child
Health and Human Development, in collaboration with the Reproductive
Endocrine Unit at the Massachusetts General Hospital. 

Please feel free to forward this information to any families or individuals
who may be interested and willing to participate in our studies.

Interested individuals and families may contact the research team at UGPR@mail.nih.gov, or 301-827-4221 to determine eligibility or receive more information. Please feel free to contact us with any questions.

KS online study

I am forwarding a e-mail from a research team based at Pennsylvania State University in the USA. They are working with the KS team at Boston with a survey of KS / CHH patients. They hope to see if there are any common factors patients with KS / CHH experience with their diagnosis and treatment.

The survey is open to everybody, even families of patients with KS / CHH. This hopefully will build on and complement the survey done last year.

The questionnaire is totally anonymous and will take about 45 mins to complete on line. It is a very personal and intense set of questions. There is also a series of visual and audio questions. I think it is a  well designed survey. While some of the questions are deeply personal they cover a lot of topics that come up in discussions I have with fellow patients.

If you wish to participate or wish to know more information you can e-mail Lauramarie on the e-mail address below.

======================================================

We are currently seeking research participants who have been diagnosed with idiopathic hypogonadotropic hypogonadism (IHH), including Kallmann Syndrome (KS), for an online study regarding hormone replacement therapy and psychological well-being.

To participate, you must be 18 to 65 years old. Although you may wish to participate out of a desire to promote this research, you will also be compensated for your participation (about 45 minutes online) with $25.

We would also like relatives of IHH participants (siblings or first cousins) to participate in the study. If you have IHH (including KS) and have a relative who might also be interested in participating, please pass this information on to them.

You may still participate even if you do not have a relative who is willing to participate in this study.

For more information about participating in this study, or to sign up, please contact Lauramarie at lep161@psu.edu

If you have any general questions about this project or our overall research goals, please contact Dr. David Puts at dap27@psu.edu or visitwww.putslab.psu.edu/research.html.

Identifying the unmet health needs of patients with congenital hypogonadotropic hypogonadism using a web-based needs assessment: implications for online interventions and peer-to-peer support.

http://www.ojrd.com/content/9/1/83

http://www.ncbi.nlm.nih.gov/pubmed/24915927

This paper was written by Andrew Dwyer of CHUV in Switzerland. Through an on line survey and three patient meetings he interviewed a number of Kallmann and CHH patients to gauge their feelings and attitudes about their diagnosis and treatment.

One clear idea from the paper is that since KS / CHH is such a rare condition there is an onus on the patient to take a lead in finding out information for themselves as they can often be treated by health professionals who themselves have not come across a patient with KS / CHH before. Internet sources and patient groups can play a big part in this.

Having KS / CHH can be a very isolating condition, especially if not diagnosed, so being able to connect to and communicate with fellow patients can be very helpful to some patients. A lot of patients will not feel the need to actively partake in groups but are happy enough just to know that there are other patients out there that they could talk to if they wanted.

Some patients might only need the support of groups at specific times such as getting the original diagnosis, starting relationships or trying to achieve fertility.

It is clear that some patients with KS / CHH are content with their diagnosis and are happy just to get on with their lives. However it is important to identify the patients that might need extra help and ensure that they have access both to patient support groups and expert medical opinion if they need it.

Rare Connect Kallmann Syndrome Community.

https://www.rareconnect.org/en/community/kallmann-syndrome

Rare Connect is a joint venture by EURODIS (European organisation that runs support groups and communities for rare disorders) and NORD (USA based National Organisation for Rare Disorders).  

Rare Connect provides a framework for patient support groups for rare condition to publish information on the internet and help patients connect and communicate with each other.

There is a community group for Kallmann syndrome.

They also allow groups to have on line web seminars via video link so patients can talk to other patients and medical experts in real time. It is a form of on line video conferencing. Once the group has been established and has enough members it is hoped we can organise one for Kallmann syndrome.

There are patients meetings occasionally but having video conferencing will allow patients who can not attend these meetings to talk to other patients and medical experts on Kallmann syndrome and CHH.

We already have groups on Facebook and Yahoo but this is a network totally separate from any social network groups and allows fellow patients to communicate in privacy.

FDA approve use of long acting testosterone injection - Aveed (Nebido).

http://online.wsj.com/article/PR-CO-20140306-906700.html


Nebido is a long-lasting testosterone injection that can be effective in the restoration of testosterone levels in patients with Kallmann syndrome and congenital hypogonadotropic hypogonadism.

The testosterone undecanoate injection is given as a deep muscular depot injection. After the initial two injections between 4 and 6 weeks apart as a loading dose injections are subsequently given every 10 to 12 weeks depend on the response.

Nebido has been in use in most parts of the world for a number of years (Reandron in Aus & NZ).
After being refused a licence in the past the FDA has now approved its use under the trade name of Aveed.

This injection gives patients another alternative to their testosterone delivery and the longer period between injections might be more convenient for some patients.

UK Patient meetings 2014.

There are patient meetings planned for January 2014.

18th Jan. Royal Victoria Infirmary, Newcastle-upon-Tyne.

25th Jan. Royal Free Hospital, London.


The meetings will be a combination of a chance to ask KS experts questions and the chance to meet and talk to fellow patients.

Further details to follow or e-mail neilsmith38@hotmail.com for more information.

US Kallmann syndrome meeting 2013. Notes taken. Part 3.

USA Patient Meeting 2013. Notes taken. Part 3.

Obtaining medications with health insurance.

There are companies that can provide basic testosterone medication free of charge without insurance in the USA as long as you have a valid prescription. There is a post in the Facebook groups listing these companies.

Gaining hCG and hMG medications on health insurance is possible but it is a time consuming and lengthy process. One key point is emphasise the point that the hCG / hMG medications are required for testosterone production only and not for fertility. Insurance companies are very unlikely to approve medication for fertility use. However in patients with KS / CHH the primary reason is testosterone production and osteoporosis prevention. If you leave a message in the Facebook groups somebody who has had a lot of experience in dealing with insurance companies will be able to help and advice you.

 

Genetics.

The understanding of the genetics of KS / CHH is changing all the time and it is difficult to give many clear cut answers.

So far over 20 different genes have been implicated in causing cases of KS / CHH.

With puberty being such a defining point in human development it is not surprising there are many different genes involved in its control. No one single gene is responsible for the initiation of puberty so a defect in one gene does not always mean puberty is delayed or is absent.

KS / CHH is primarily a two or more gene defect condition, which accounts for its rarity. One gene defect on its own might cause visible symptoms such as hearing loss, dental problems, cleft lip, and delayed puberty. However it is only when this gene defect is combined with another that you get a case of KS / CHH with the full range of symptoms. It is clear by looking at families with KS / CHH that the range and severity of symptoms is not consistent, even within siblings. This makes the prediction of inheritance and the genetic screening for KS / CHH very problematic.

Over 50% of KS / CHH cases still show an unknown genetic origin. You can screen blood for the currently known genes but any negative result just means it is negative for the genes discovered so far. Research centres in Boston & Augusta in the USA or in Switzerland will test blood samples for current gene defects and then store the samples for re-testing once new gene defects are discovered.

The only exception to this is the KAL-1 mutation on the x-chromosome. KAL-1 is termed a high penetrance gene. A mutation in the KAL-1 gene can cause a case of KS on its own with no other gene defect present. Any small defect in the KAL-1 gene gives rise to a high probability of having Kallmann syndrome. The KAL-1 mutation is the one associated with the additional symptoms of anosmia, mirror movements of the hands, absence of one kidney and hearing loss.

KAL-1 causes x-linked KS, so is only found in males (there is a theoretical chance of a female having x-linked KS but has never been proved yet). X-linked KS accounts for less than 10% of all KS / CHH cases but is the one that is most easily tested for.

US Kallmann syndrome meeting 2013. Notes taken. Part 2.

USA Patient Meeting 2013. Notes taken. Part 2.

 

Growth spurt.

The growth spurt seen in late puberty in both males and females is controlled primarily by testosterone and oestrogen levels under the influence of growth hormone. Normally height will increase until the pre-determined height is reached and then the end plates of the long bones fuse & harden preventing any further growth.

In KS / CHH where there is a lack of testosterone & oestrogen no growth spurt occurs but instead there is a linear height increase under the influence of growth hormone. This can lead to patients with KS / CHH being of above average height unless they start hormone treatment at the appropriate time.

The lack of oestrogen or oestrogen in KS / CHH patients can lead to early onset osteoporosis which should be checked for by the use of DEXA / bone density scan.

No puberty v partial puberty.

In patients with KS / CHH it is estimated that 60% of cases will show no pubertal development at all while the remaining 40% will show partial pubertal development.

Use of hCG in males.

hCG is human chorionic gonadotropin, it is normally derived from human placentas and has the same activity as luteinising hormone (LH). In males hCG can be given instead of testosterone preparations in order for the testes to produce their own testosterone. Pregnyl is a common trade name for hCG.

hCG acts on the Leydig cells in the testes in the same way as LH, with the production of testosterone. Normal levels of testosterone can be achieved within two months of starting treatment. Injections are given sub-cutaneously and the dose and frequency given is dependent on the testosterone levels achieved.

There is normally no increase in size in the testes when on hCG injections.

There was a bit of debate at the meeting about the possibility of achieving sperm production while on hCG alone. It is certainly possible for some patients with KS / CHH to achieve a low level of sperm production while on hCG injections alone but normally this tends to be the patients who have had some form of gonadotropin treatment in the past or who have partial testicular development already.

Patients with KS / CHH can sometimes achieving fertility with sperm counts a lot lower than those seen in other men. The theory is that fertility is based on the quality of sperm produced and not just the number produced.

There is no evidence of any long term adverse risk in males using hCG injections.

Use of FSH injections in fertility treatments in males.

Follicle stimulation hormone (FSH) acts on the Sertoli cells in the testes in order to induce sperm production. It is the increase in the Sertoli cells that gives the testes their size. Normally testes need to be 4ml or bigger in order to produce enough sperm for natural conception.

In most males, but not all, with KS / CHH FSH type medication is required to induce fertility. It is thought that giving FSH on its own for a few months before the addition of hCG increases the chances of sperm production and can speed up production.

In the past hCG has been given on its own first but new evidence suggests that pre-treatment with FSH can be more effective.

FSH can be given in its pure form or combined with LH in the form of human menopausal gonadotropin (hMG or menotropin).

FSH and hMG injections are expensive and not always easy to get hold of but can provide an effective form of fertility treatment for me along with the psychological benefit of testicular development.

 

 

 

 

 

US Kallmann syndrome meeting 2013. Notes taken. Part 1.

USA Patient Meeting 2013. Notes taken. Part 1.

Gender difference between males & females.

It used to be thought that there were about five times more cases of KS / CHH in males than in females. This has never been fully explained by genetics.

One school of thought is that there is actually no gender imbalance in reality. The disproportion in diagnosed cases might well be due to the lack of correct diagnosis of KS / CHH in females. It is not easy to correctly diagnose KS in females, especially if the oral contraceptive pill is used in treatment.

Un-published work done in Boston took the numbers of 600 patients in known KS / CHH families and came out with a ratio of 1 : 1.3 male to female cases.

Definition of a “rare disease”.

A rare disease is defined as one that is found in 1 in 2,000 of the general population. With KS / CHH being at around the 1 in 20,000 mark roughly it falls neatly in this category. About 8% of the general population of the USA could be classified as having a rare disease.

Start of puberty.

The age of onset of puberty has a range of 10 to 15 years in females with a mean of 12 years old. In males the range is 12 to 16 with a mean of 13 years old. Typically puberty takes 5 years to fully complete.

The age puberty starts in males is not easy to distinguish in boys whereas in girls it is marked by the first menstrual bleed.

2% of the population will show a constitutional delay of puberty. This group will start puberty naturally at some stage but early hormonal treatment might be given in appropriate cases.

Any delay of puberty by the age of 15 in females and 16 in males should be investigated by a reproductive endocrinologist or a paediatric endocrinologist.

Un-descended testes at birth.

Occurs in 2% of the male population but in up to 40% of boys with Kallmann syndrome.

GnRH and sexual differentiation.

Sexual differentiation into the male and female physical forms occurs in the first few weeks of life and is controlled by the hCG derived from the placenta. This is normally unaffected in people with KS / CHH so they are born physically male or female.

Normally there is a GnRH surge from the hypothalamus in the developing baby in the final trimester and into the first 6 months of life. This is a “mini-puberty” and can give rise to detectable levels of LH / FSH / testosterone or oestrogen. This mini-puberty is missing in patients with KS / CHH. This can be used as a diagnostic tool for babies where there is a likelihood of KS / CHH being passed on. This test is more sensitive in male infants than female infants.

The presence of micro-penis and un-descended testes at birth seen in some boys with KS / CHH is related to the lack of testosterone in boys in this mini-puberty.

Kallmann Syndrome Information page on Facebook.

I am in the process of creating a new information page on Facebook for Kallmann Syndrome and Hypogonadotropic Hypogonadism.

It is work in process at the moment but I hope to be able to post information that might be helpful to fellow patients and news of any upcoming meetings or recent medical papers.

Facebook Information page for Kallmann Syndrome.

Kallmann syndrome & anosmia.

Anosmia or the lack of sense of smell is an important symptom in Kallmann syndrome as it is the one symptom that can be noticed well before the age puberty is due.

Anosmia accompanied by pubertal delay should alert doctors to the potential of a case of Kallmann syndrome.

Anosmia is only found in patients with Kallmann syndrome.

An absence of puberty and no sense of smell might not seem related at first. They are linked because the part of the brain that controls smell (olfactory bulb) and the part of the brain that controls the initiation of puberty (hypothalamus) are located very close together. During the very early development of the foetal brain any problem in the development of the structure of the olfactory bulb can prevent a the part of the hypothalamus that controls puberty from working correctly later in life.

Around 50% of cases of congenital hypogonadotropic hypogonadism (CHH) occur with a normal sense of smell. The other 50% of cases have anosmia or hyposmia (reduced sense of smell), it is these cases that can also be termed Kallmann syndrome.

Since patients with Kallmann syndrome have had no sense of smell all their lives some patients do not realise how important the sense of smell can be.

There are issues such as fire & gas safety, food wastage, personal hygiene & body odour that can be easily overlooked, especially if a person lives by themselves.

There is an excellent support group for people with all forms of anosmia, called Fifth Sense. Here is a link to their website:

Fifth Sense Website.

USA Patient Meeting. 26th October 2013.

There will be a patient meeting for patients with Kallmann syndrome / CHH .

It will be held at the Saddleback Memorial Hospital,  Laguna Hills, California, USA on 26th October 2013

Attending the meeting will be top KS experts Professor. Nelly Pitteloud and Andrew Dwyer.

The meeting will be a mixture of medical information and a social event. It will be a good chance for patients and their families to meet other patients.

More information can be obtained by e-mailing:

kschh2013@hotmail.com

Early blood test for KS / CHH - from birth to 6 months of age.

In both males and females there is a "miny puberty" which lasts from birth until 6 months of age. It is more apparent in males than females. In males it sets the body up ready for normal puberty to start at around 11 or 12 years of age.

In this short period of time from birth to six months of age there would be detectable levels of FSH and LH in the blood and detectable testosterone levels in males.

In males and females with Kallmann syndrome or CHH this miny puberty does not occur.
It works better in boys than girls but if there is a delectable level of FSH, LH, testosterone / oestrogen it would strongly suggest that it is not a case of KS / CHH.

The lack of detectable levels would not confirm a KS / CHH diagnosis but would be a big clue towards the correct diagnosis. Conversely if you do find the hormones present at that age it can be very reassuring that CHH / KS is not present.

If a blood test reveals no detectable levels of testosterone at 6 months of age and there has been either micro-penis or undescended testicles it would give doctors a very good indication that KS / CHH is a distinct possibility.

I have added here a one page link to a web site which also confirms the possibility of testing up to the age of 6 months.

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=EN&Expert=174590

New website

A clinical research team at CHUV, Switzerland is leading European wide consortium that aims to bring together all the research on Kallmann syndrome / CHH into one place. Part of the project is to host a website for clinicians, researchers and patients to use to obtain the latest information on the genetics, diagnosis & treatment of Kallmann syndrome and other GnRH deficient conditions that cause a disruption of puberty.

The website is live now with the start up information. Patient orientated information will be added in the next couple of months followed in time with clinical guidelines for the diagnosis & treatment of Kallmann syndrome.

http://www.gnrhnetwork.eu/

USA Patient Meeting - 26th October 2013

There will be a patient meeting for patients with Kallmann Syndrome or CHH in America on 26th October 2013.

It will be held at Saddleback Memorial Hospital, Laguna Hills, Orange County, California.

The meeting will be for patients and families of patients. The meeting will be a mixture of presentations by experts in KS / CHH, a chance to ask the experts questions and more importantly the chance to meet with fellow patients in a relaxed atmosphere.

It will be a relaxed, informal meeting with plenty of time to socialise & talk with other patients.

More details will be provided soon, or please contact:


kschh2013@hotmail.com

or

neilsmith38@hotmail.com

Programme on CBC in America on Kallmann Syndrome.

Hopefully attached are links to three videos on AOL from an episode of "Doctors" on CBC in America where a 27 year old gets his first diagnosis of Kallmann syndrome.

They explain the basics on Kallmann syndrome very well and Brandon does an excellent job of explaining his condition.


http://www.aol.com/video/brandons-delayed-puberty/517683899/?icid=maing-grid7%7Cmaing6%7Cdl4%7Csec3_lnk1%26pLid%3D275735

http://www.aol.com/video/mri-to-examine-pituitary-gland/517683902/

http://www.aol.com/video/delayed-puberty-explained/517683901/

Nebido Injection

Nebido is a long lasting testosterone injection that is effective for treating patients with Kallmann syndrome and CHH.

It was first developed and produced by the Bayer health group and is licenced and distributed under the trade name Reandron 1000 in Australia, Reandron in Spain and Nebid in Italy.

It is a 4ml injection of testosterone undecanoate that is given as a deep muscular injection.

Two loading injections are first taken 6 weeks apart then injections are normally given at 10 to 13 week intervals depending on the response. Some patients enjoy the convenience of only having to have an injection every 3 months; it is not unknown for some patients to go 6 months in-between injections and still achieve normal testosterone levels.

Most patients achieve steady normal physiological levels of testosterone while using Nebido, without the peaks and troughs seen with shorter lasting injections.

It is a large volume to inject and sometimes there can be some short lasting localised pain at the injection site but this can be avoided by warming the vial in hot water for 5 minutes before injecting to allow the solution to become more viscous.

The injection is widely available throughout the world apart from the USA where under the trade name Aveed but it has yet to be licenced.

http://www.nebido.com

British Medical Journal article. Patient Journey - Kallmann syndrome._


The British Medical Journal todays posted an article, wrtitten by me about my story of having Kallmann syndrome.

I was diagnosed with Kallmann syndrome at the age of 22 after spending my teenage years and early adulthood being labelled as a “late developer” or “late bloomer”.

Kallmann syndrome is a form of hypogonadotrophic hypogonadism with the associated symptom of anosmia. It affects both men and women but is at least five times more common in men. It is a congenital condition with currently nine known gene defects linked to its cause which combined still only account for less than 40% of cases. Patients are left with poorly developed or no secondary sexual characteristics, are infertile and at increased risk of osteoporosis.

 Childhood years:

My early childhood was fairly uneventful medically apart from 70% hearing loss in one ear and no sense of smell. I reached the normal pre-puberty Tanner stages and up to the age of twelve nothing seemed to be amiss. Going through the early teenage years it was a case of waking up each day and hoping something was going to start to develop. I knew I was getting late to start puberty but I assumed it would all start soon enough. Eventually I was the only one in my year group not to show any development and was certainly noticed by the rest of the year group.

A routine health inspection by the school nurse as part of the health screen for the permit to work on a newspaper delivery round led to a referring to a GP at the age of 15. At that stage the GP said I was just late starting and I should wait and see and was sent on my way.

Teenage years:

Up to the age of 14 I was a normal enough school boy I think, I was in the Scouts and was involved in my local cricket club. I gradually got left out of social events as I lacked the confidence to go and had no sexual drive at all. I knew the basics from a purely physical point of view but had no libido or interest in any sort of teenage activities. I made up excuses not to go to social events and eventually I stopped being invited.

By the age of 17 it was clear nothing was starting so I was referred to a general medical consultant and then an urologist at Derifford hospital in Plymouth. I was put on low dose Sustanon monthly but with no follow up assessment, it was just assumed it would all start naturally.

By the time I went to University it was obvious something was wrong but I did not have the drive to do anything about it. I even stopped taking the Sustanon for a time at University as it seemed to having no effect on me at all. Looking back now there were opportunities for me at University but without the drive and the knowledge of the condition I did not have the interest or confidence to notice them, let alone follow up on them.

Diagnosis:

The first time I actually saw an endocrinologist was when I started my first job as a Biomedical Scientist at the Royal Free Hospital in North London. I had studied endocrinology and haematology as part of my biomedical science degree and had a bit of an understanding on how puberty was supposed to work. When I started work at the Royal Free I was determined to talk to and endocrinologist even though my GP still had not referred me. Under my own volition I contacted Dr Richard Quinton, at the time a specialist registrar in endocrinology under Prof. Pierre-Marc Bouloux. One of the first questions he asked was “did I have a sense of smell”. It was the first time any doctor had asked me that question.

From there the correct diagnosis came soon after and I was put on a suitable dose of testosterone, first in the form of Testogel and then later Nebido. The delay from the age of 16 to 22 meant I went six years with a very low testosterone level with the subsequent delay in secondary sexual development and bone strength.

Blood tests then confirmed the low levels of FSH and LH which, combined with the anosmia confirmed the diagnosis. A subsequent MRI showed the absence of the olfactory bulbs. A DEXA scan showed osteopenia and I was prescribed Fosamax at the time, which has now been replaced with high dose Vitamin D therapy. At the time of diagnosis I probably looked 10 years younger than I was and never shaved.

Delay of Diagnosis.

On a physical level the late diagnosis has left me with osteopenia which is still present but at least not deteriorating. The lack of gonadotrophins and hence androgens in my teenage years also resulted in a delay in the development of secondary sexual characteristics. The lack of testicular development will always be present in Kallmann syndrome but the lack of penile growth will always leave the question of what would have happened if testosterone treatment had been started earlier and at the correct dose.

It is on the psychological level that the late diagnosis has the biggest impact in my view. Judging by my own experiences and those of fellow patients I meet and talk to now this is an area which is very frequently overlooked.

With puberty and adolescence being so closely linked if a patient does not enter puberty at almost the same stage as his peer group he risks being left behind socially and emotionally as well as physically. I feel that this emotional development of social interaction is difficult to catch up on and is often a result of feeling socially isolated when puberty fails to start.

In my experience with fellow patients it is those who are diagnosed early and treated early who cope with the condition better. For a lot of people I talk to the very fact they can put a name to the condition and realise that they are not the only person in the world not going through puberty is a big step in being able to cope with the condition.

Treatments available:

Referral to a reproductive endocrinologist allows for the possibility for fertility treatments. Even though there is a reported good success rate with gonadotrophin therapy for both men and women with KS there is not universal availability of treatments across the country probably due to the high cost FSH treatments.

I feel there is a good argument for FSH treatment to be available to younger men with KS even if fertility is not the ultimate goal. The testicular development achieved while on FSH can help with self confidence and emotional development.

Pregnyl / hCG can be used in isolation just for testosterone production and is useful indicator for the effectiveness of FSH treatment.

The type of hormonal replacement therapy used is also important for both men and women. The Nebido injection for men may be more suitable than the Sustanon injection due its length of action, while for some the gel, capsules or deep muscular implants may be more beneficial.

The most important treatment is possibly the diagnosis itself. Being labelled as a “late starter” or “late bloomer” when in your early twenties can be very self destructive. The ability to put a label on the condition and the knowledge that it is a recognised condition is the first step in coming to terms with a condition that is difficult to describe to others. The use of patient support groups on Yahoo and Facebook also play a big part in people being able to talk about the condition but this can only be achieved once they have got the correct diagnosis.

What are hormones?

In a general sense hormones are the body’s messenger service. There are over 40 known hormones that act within the body. They are each released by a specific endocrine gland (such as the pituitary gland, adrenal glands, pancreas or testes / ovaries) in response to a specific stimulus, possibly another hormone. A hormone is released to generate a specific result. In normal circumstances the hormonal system works on a negative feedback mechanism.

A stimulus causes the endocrine gland to release a hormone -> The hormone causes the stimulus to be stopped or reduced -> The endocrine gland stops producing the hormone

The classic example is the role of insulin in the role of maintaining the blood sugar levels. Insulin is only released in response to an increase in sugar levels, as soon as blood sugar levels falls; the production of insulin is stopped. The breakdown in this regulation causes the most common hormonal diseases – diabetes mellitus.

In normal puberty the pathway is:

Hypothalamus gland produces GnRH (gonadotrophin releasing hormone)

Which causes the

Pituitary gland to produce LH & FSH (luteinsing hormone / follicle stimulating hormone)

Which cause the

Testes to produce testosterone & sperm

Or

Ovaries to produce progesterone and oestrogen & allow ovulation to occur

The sex hormones also have other effects around the body, not just linked to puberty and fertility.

In KS or HH either the pituitary gland does not receive the GnRH, or it is unable to respond to the GnRH. Without the first signal the pituitary will not produce its hormones (LH and FSH) that in turn will prevent the testes or ovaries producing their own hormones at the required time to cause puberty. For some people with KS / HH there is no physical problem with the testes or ovaries, they just have not had correct signal from the pituitary gland in order to function correctly.

The treatments people get with KS / HH will be replacing one of the hormones missing in the chain. Normally this is either testosterone or oestrogen / progesterone. However it is also possible to be given FSH / LH or GnRH in certain circumstances, especially if fertility is desired.

Can a person with KS or HH become fertile?

Yes, possibly, but only with specialist treatment and if other circumstances are favourable. There have been many cases of people with KS / HH having children, sometimes through a form of IVF or other assisted fertilisation programmes. As with any type of fertility treatment there are many other factors to consider and it can take many months of treatment and there is no guarantee as with any form of fertility treatment. It has been noted that fertility can be achieved with Kallmann’s women more quickly than with other patients.

Is there any effect on expected lifespan?

There is no reliable evidence that KS or HH has any effect on the life span on an individual. It is worth point bearing in mind though that there are some rare symptoms that can occur with KS and HH that may have an effect on life span. These other symptoms may be connected to KS or HH or may have arisen regardless.

Are there any risks if KS or HH is left untreated?

Yes there can be. The major problem with a person with untreated KS or HH is the increased risk of osteoporosis or ‘brittle bone disease’. The greatly reduced levels of sex hormones seen with KS and HH have a detrimental effect on the strength of the bones. This can be easily treated with the appropriate drugs that will reduce the risk of osteoporosis to that seen in the rest of the population. It is advised that a person with KS or HH should have a bone scan (DEXA) at least every 5 years to assess their bone age and to assess the risk of osteoporosis. There is increasing evidence that Vitamin D levels play a vital role general health, not just bone strength. It is not unknown for people with KS / HH to have their Vitamin D levels monitored and prescribed tablets if the level is too low.