Changes in the hypothalamic-pituitary-gonadal axis in men after cadaver kidney transplantation and cyclosporine therapy.

Abstract

A variety of plasma androgens, estradiol, follicle-stimulating hormone, luteinizing hormone, prolactin, cortisol, and thyroid parameters were examined in 10 men followed serially before and after cadaver kidney transplantation. Before transplantation, plasma testosterone levels were below normal in 8 of the 10 men. Free testosterone, follicle-stimulating hormone, and luteinizing hormone were at the lower range of normal values, yet plasma estradiol levels were elevated 3-fold, and prolactin levels were also high. One month after transplantation, all hormones measured were suppressed, probably reflecting high-dose steroids and multiple-drug regimens used in the period following the operation. After 3 months, when other immunosuppressants were reduced and cyclosporine dosage was stabilized, plasma testosterone, androgens, follicle-stimulating hormone, and luteinizing hormone levels were restored toward normal. After 12 months, plasma testosterone levels exceeded pretransplant levels. Plasma estradiol and prolactin levels dramatically decreased after transplantation and remained in the normal range thereafter. These data indicate that abnormalities of plasma estradiol and prolactin levels observed in patients with end-stage renal disease are restored toward normal after cadaver kidney transplantation. Androgen levels that were suppressed in the period immediately after transplantation were restored to normal levels in the succeeding months despite chronic usage of cyclosporine, suggesting that cyclosporine, in currently used doses, does not prevent the restoration of the hypothalamic-pituitary-testicular axis.