Hypogonadism

 

What is Hypogonadism?

Hypogonadism is a condition when the body does not produce sufficient amount of testosterone. Testosterone is a primary male hormone, which plays a major role in the development of masculine features. Hypogonadism may exist from birth or may occur later on at some other phase of a man's life. 

 

What are the symptoms of Hypogonadism?

Symptoms depend on the time hypogonadism occurs (onset during fetal life, before puberty or during adulthood).

During fetal life

If testosterone produced during fetal growth is not sufficient, this may have consequences in the development of external genital organs. As a result, the child that genetically is male may be born with:

  • Female genitalia
  • Ambiguous genitalia (something inbetween male and female genitalia)
  • Residual development of male genitalia

Before puberty

The occurrence of hypogonadism before puberty may cause:

  • Reduced development of muscle mass
  • Decreased hair growth
  • Gynecomastia (enlargement of the breast gland tissue)
  • High-pitched voice

During adulthood

If hypogonadism occurs during adulthood, it may cause:

  • Infertility
  • Erectile dysfunction
  • Gynecomastia
  • Osteoporosis
  • Reduced hair growth
  • Hypoactive (low) sexual desire
  • Attention deficit disorder
  • Hot flashes

What are the causes of Hypogonadism?

Hypogonadism is divided in two main categories, Primary and Secondary Hypogonadism. In Primary Hypogonadism, the problem lies in the testes becasue they cannot produce the normal amount of testosterone that the body needs. In Secondary Hypogonadism, the problem is in the hypothalamus or pituitary gland of the brain. A hormone, Gonadotropine, is normally produced in the hypothalamus stimulating the production of Follicle-Stimulating Hormone (FSH) in the pituitary gland. FSH will transfer the message to the testes for producing testosterone.

 The most common causes of Primary Hypogonadism are: 

  • Cryptorchidism (undescended testicles). When testes do not descend normally to the scrotum, this may lead to testicular dysfunction and reduced testosterone production. 
  • Congential abnormalities (e.g. Klinefelter's syndrome).
  • Mumps. If mumps occurs during adulthood, there is high risk of causing testicular impairment.
  • Testicular injury. This may affect testosterone production only if both testes get impaired.
  • Cancer treatments. Both chemotherapy and radiation therapy (in the testicular region) may affect the production of testosterone and semen. The reduction in testosterone production is usually temporary. 

The most common causes of Secondary Hypogonadism are:

  • Kallmann's syndrome: A genetic condition related to cerebral lesions.
  • Diseases, surgery and radiation therapy of pituitary gland (e.g.in pituitary gland tumor) 
  • Infections (e.g. tuberculosis and AIDS)
  • Pharmaceutical agents
  • Obesity
  • Ageing

How is Hypogonadism diagnosed?

The physician first takes the patient's detailed medical history and then goes on with the clinical examination. Pathological findings related to testicular size, muscle mass and hair growth will raise the suspicion for hypogonadism. The diagnosis will be confirmed with some specific screening tests including:

  • Hormonal blood tests
  • Spermiogram
  • Radiological investigation of pituitary gland
  • Screening for chromosomal abnormalities
  • Testicular biopsy

Not all the above tests are necessary for all patients. The physician individualizes each case and recommends the screening tests that are needed for every patient.

What is the treatment of Hypogonadism?

Treatment for adults

The treatment depends on the causes of hypogonadism and whether there is infertility problem:

  • Hormone Replacement Therapy. If there is a problem in testosterone production due to testicular impairment, a testosterone replacement therapy will be administered.
  • If the problem has to do with the pituitary hormonal production, pituitary hormones will be administered exogenously. In these cases testosterone can be given only if there is infertility issue. In case there is some pituitary tumor, surgical treatment or radiation will be probably required.  
  • Infertility related to hypogonadism, cannot always be resolved with pharmacotherapy. In some cases, In-Vitro Fertilization (IVF) may be an option. 

 Treatment for boys

  • Testosterone supplementation may contribute to the development of masculine features (muscle mass, hair growth)
  • If the problem is detected in the pituitary gland, hormonal supplementation may contribute to the proper development of the testes.