A less common approach, but one that can be effective is the use of the hypothalamic hormone GnRH - gonadotrophin releasing hormone (sometimes called LHRH - luteinising hormone releasing hormone instead. This form of treatment appears to be far more popular in the USA than in the UK where it is more readily available.

GnRH is released by the hypothalamus and acts on the pituitary gland to release its own hormones - LH and FSH.

GnRH is released in a pulsatile manner by the hypothalamus throughout the day in order to stimulate the pituitary gland.

For GnRH treatment to be effective it has to be given in a manner that mimics its normal release as much as possible. In order to do this a pump is normally used that allows for timed release of a set dose of GnRH through out the day. The pump only works for short periods throughout the day, usually at 90 to 120 minute intervals.

A very fine needle is inserted into the abdomen and attached to a pump which is worn for most of the day. The pump can be worn around the waist of leg.

Care is needed in changing the needle regularly and cleaning the injection site to prevent the risk of infection. Ampoules of GnRH are replaced in the pump every 10 days or so.

GnRH pump.

This may be not be the easiest method of delivery but it is one of the most effective and a high success rate has been achieved using this method, usually after 6 months. If effective it will induce near normal levels or sperm production and testosterone by the testes so conception can be achieved naturally.

A small percentage of HH patients will not respond to this treatment due a problem with the hypothalamus being able to recognise GnRH. Your doctor will probably carry out a very simple GnRH stimulation test first to tell if you are able to respond to this type of treatment.

Other examples of GnRH, sometimes called GnRH agonists are used in female fertility treatments in injectable form along side FSH to control egg production and release.

Common trade names:

Gondorelin
Factrel
Lutrepulse