hypogonadism

What is hypogonadism?

Hypogonadism occurs when your sex glands produce little or no sex hormones. The sex glands, also called gonads, are primarily testicles in males and ovaries in females. Sex hormones help control secondary sex characteristics such as breast development in women, testicular development in men, and growth of pubic hair. Sex hormones also play a role in the menstrual cycle and sperm production.

Hypogonadism is also known as gonad deficiency. When it occurs in men it may be called low serum testosterone or andropause.

Most cases of this condition respond well to appropriate medical treatment.

What are the types of hypogonadism?

There are two types of hypogonadism: primary and central.

primary hypogonadism

Primary hypogonadism means you don’t have enough sex hormones in your body because of a problem with your gonads. Your gonads still receive the message from your brain to produce hormones, but they are unable to produce them.

Central (secondary) hypogonadism

In central hypogonadism, the problem is in your brain. Your hypothalamus and pituitary gland, which control your gonads, are not working properly.

What are the causes of hypogonadism?

Causes of primary hypogonadism include:

  • Autoimmune diseases such as Addison’s disease and hypoparathyroidism
  • genetic disorders such as Turner syndrome and Klinefelter syndrome
  • severe infections, especially mumps involving your testicles
  • liver and kidney diseases
  • undescended testicles
  • hemochromatosis, which happens when your body absorbs too much iron
  • radiation exposure
  • surgery of the genitals

Central hypogonadism may be due to:

  • Genetic disorders such as Kallmann syndrome (abnormal hypothalamic development)
  • infections, including HIV
  • pituitary disorders
  • inflammatory diseases such as sarcoidosis, tuberculosis, and histiocytosis
  • obesity
  • rapid weight loss
  • nutritional deficiencies
  • steroid or opioid use
  • brain surgery
  • radiation exposure
  • injury to the pituitary gland or hypothalamus
  • a tumor in or near your pituitary gland

What are the symptoms of hypogonadism?

Symptoms that may occur in women include:

  • menstrual deficiency
  • slow or incomplete breast growth
  • hot flashes
  • shedding of body hair
  • milky discharge from the breasts

Symptoms that may occur in men include:

  • shedding of body hair
  • muscle loss
  • abnormal breast growth
  • decreased growth of the penis and testicles
  • erectile dysfunction
  • osteoporosis
  • low or no sex drive
  • infertility
  • tiredness
  • hot flashes
  • difficulty concentrating

How is hypogonadism diagnosed?

Your doctor will perform a physical examination to confirm that your sexual development is at an appropriate level for your age. They may examine your muscle mass, body hair, and genitals.

Hormone tests

If your doctor thinks you may have hypogonadism, they will first check your sex hormone levels. You will need a blood test to check your follicle stimulating hormone (FSH) and luteinizing hormone levels. Your pituitary gland creates these reproductive hormones.

If you’re a girl, you can get your estrogen levels tested. If you are male, you will have your testosterone level tested. These tests are usually done in the morning when your hormone levels are highest. If you are male, your doctor may also order a semen analysis to check your sperm count. Hypogonadism can lower your sperm count.

Your doctor may order further blood tests to confirm the diagnosis and rule out underlying causes.

Iron levels can affect your sex hormones. Therefore, your doctor can check for high blood iron levels typically seen in hemochromatosis.

Your doctor may also want to measure your prolactin level. Prolactin is a hormone that promotes breast development and breast milk production in women, but is present in both sexes.

Your doctor may also check your thyroid hormone levels. Thyroid problems can cause symptoms similar to hypogonadism.

Imaging tests

Imaging tests can also be useful in diagnosis. An ultrasound uses sound waves to create an image of the ovaries and checks for any problems, including ovarian cysts and polycystic ovarian syndrome.

Your doctor may order MRI or CT scans to check for tumors in your pituitary gland.

What are the treatments for hypogonadism?

Treatment of female hypogonadism

If you are a woman, your treatment will involve increasing your amount of female sex hormones.

If you have a hysterectomy, your first line of treatment will likely be estrogen therapy. Either a patch or pill can apply estrogen to estrogen.

If you have not had a hysterectomy, you will be given a combination of estrogen and progesterone, as increased estrogen levels can increase your risk of endometrial cancer. If you use progesterone, progesterone can lower your risk of endometrial cancer.

Other treatments may target specific symptoms. If the sex drive has decreased, you can take low doses of testosterone. If you have menstrual irregularities or difficulty conceiving, you can take pills containing the human choreogonadotropin hormone, or FSH, to induce ovulation.

Treatment of male hypogonadism

Testosterone is a male sex hormone. Testosterone replacement therapy is a commonly used treatment for hypogonadism in men. You may receive testosterone replacement therapy if:

  • injection
  • patch
  • gel
  • lozenge

Injections of a gonadotropin-releasing hormone can trigger puberty or increase your sperm production.

Treatment of hypogonadism in men and women

If hypogonadism is caused by a tumor in the pituitary gland, treatment in men and women is similar. Treatment to shrink or remove the tumor may include:

  • radiation
  • medicine
  • surgical treatment

What is the long-term outlook?

Unless caused by a treatable condition, hypogonadism is a chronic condition that may require lifelong treatment. If you stop treatment, your sex hormone levels may drop.

Getting support through therapy or support groups can help you before, during and after treatment.

Resources:

Carson CC. (Nd). The frequency, diagnosis and treatment of hypogonadism in primary care practice.

Mayo Clinic Staff. (2016). Male hypogonadism.

What can I expect after treatment? (Nd).

What is low testosterone? (Nd).

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