Later in life the patients become responsive to GnRH administration, while they were not so during their childhood; this phenomenon appears to be related to hypothalamic-pituitary-gonadal maturation as found in patients with premature puberty after treatment of virilising disorders. Patients do not respond initially to GnRH agonists. Recently, spironolactone, an antimineralocorticoid and an antiandrogen agent, has been combined with testolactone, an inhibitor of P450 aromatase (a key enzyme in the conversion of androgens to oestrogens) as therapy for testotoxicosis. Alternatively, cyproterone acetate, a powerful antiandrogen that blocks the cytosolic androgen receptor, may be used on its own.
