How to treat hypogonadotropic hypogonadism?

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There is no primary or secondary hypogonadotropic hypogonadism. But hypogonadism can be primary or secondary. In the primary, the defect is in testis with high levels of FSH (follicle stimulating hormone), LH (luteinizing hormone) and there is low testosterone. In secondary, there is a low level of FSH, LH, and testosterone. So you have secondary hypogonadism also called hypogonadotropic hypogonadism.

Do a serum prolactin test. You are taking HMG (Menotropin) and HCG (Human chorionic gonadotrophin). It will gradually increase the testosterone level and testes size, which is small. Since you have zero sperm count, you must wait for at least six months as the testes size is small and the spermatogenic tubules will take time to develop.

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As you are overweight, you should do serum estradiol and fasting blood sugar test along with prolactin test. Try to reduce weight.

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I have gone through the report (attachment removed to protect patient identity). Yes, your FSH, LH, and testosterone levels are still low. But you have more chest hair and sex drive, which means that the testosterone level is working better. Testosterone usually bounds to sex hormone binding globulin and only a part of it will be active. It will be in the form of free testosterone. So you may have your total testosterone low, but the free testosterone can be high. It is working well. So, measure the free testosterone next time. It can tell you the level of active testosterone. Total testosterone is always equal to free testosterone and SHBG (sex hormone binding globulin) bound hormone. You must reduce weight by modifying diet and doing exercise.

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Since your testes are small and your FSH, LH, and testosterone are still low, it may take some time to have spermatogenesis to start. HMG and HCG are fine. There is no need to take extra medicine. Do serum free testosterone test soon. Consult your doctor for taking Metformin. It can help to reduce weight. Weight reduction can also change your hormone status quickly.