Q: I am 28 years old having a few endocrine problems. My testosterone, LH and FSH hormone levels are very low. My problems are absent puberty, small testis and penis. I first consulted an endocrinologist last year. He suggested me to take testosterone injections (Sustanon 250) every 10 days. I started taking Sustanon 250 every 10-12 days. I took 15-16 injections. The pubertal signs have appeared but then one of my family doctors suggested that I should not take these injections and treatment should be done so that my body can start producing hormones on its own. He gave me clomiphene citrate for 20 days and waited for 20 days and once again gave clomiphene citrate for next 20 days. But this too did not help much. Can I achieve puberty? Can penile and testicular size be normal and can I lead a normal married life? Should I go for HRT or wait and see the results with clomiphene citrate?

A:You have what is called as hypogonadism. As your LH and FSH are low, the problem lies at the level of hypothalamus-pituitary level. This condition is called as hypogonadotropic hypogonadism. You need to get a MRI scan for pituitary region to have a look at hypothalamus and pituitary gland. Fortunately good treatment is available which can make you sexually fit to lead a married life and even chances of getting child are almost 60-70% if proper treatment is taken. Specific answers are as follows: 1. Puberty can be achieved easily with Testosterone injections once in 2-3 weeks. These are quite safe. Alternately you can take HCG injection from beginning which will increase the size of testes but as it is very costly I usually prefer to use Sustanon till one is looking for children after marriage. 2. Your penile size will increase with Testosterone and testicular size with HCG. 3. You can lead a normal married life. 4. Go for HRT now and HCG after marriage.