Hypogonadism is defined as a condition where a person’s reproductive organs produce very little or completely no sex hormones. The sex organs are also known as the gonads. The gonads are primarily the testes in males and the ovaries in females. Sex hormones mainly control the secondary sexual characteristics in both males and females. Those secondary sexual characteristics include breast development in females, testes in men, and pubic hair growth in both the genders. Sex hormones also play a significant role in the regularization of the menstrual cycle and sperm production. Hypogonadism is also frequently termed as gonad deficiency.
How Common Is Hypogonadism?
Hypogonadism is a condition that affects approximately four to five million men in the United States every year. It can occur in people who belong to any age group. However, it is more common in reproductive-aged adults. Studies have shown that almost 60 % of men above 65 have below-average testosterone levels.
What Are the Types of Hypogonadism?
Hypogonadism has been broadly classified as the primary and central hypogonadism.
1. Primary hypogonadism:
Primary hypogonadism is defined as a condition where the affected individual does not have enough sex hormones in his or her body. This problem is primarily due to any abnormality in the gonads. In this condition, the hypothalamus and pituitary glands’ stimuli are intact, while the gonads fail to act to the received stimulus properly.
2. Central or the secondary hypogonadism:
In central hypogonadism, the primary site of the problem is the affected individual’s brain. In these cases, the hypothalamus and pituitary glands usually designated to control human gonads are not working properly.
What Are the Risk Factors?
Risk factors for hypogonadism can increase the chance of the person to acquire hypogonadism at any stage of his or her lifetime. They are:
What Are the Causes of Hypogonadism?
Primary Hypogonadism -
The following are the common causes of primary hypogonadism:
1. Klinefelter Syndrome:
This condition occurs due to a congenital abnormality of the sex chromosomes, X and Y, where two or more X chromosomes and one Y chromosome are inherited. The additional X chromosome that is seen in Klinefelter syndrome can lead to abnormal development of the testicles. As a result of abnormal testicles, there is an underproduction of testosterone.
2. Undescended Testicles:
This condition is termed as cryptorchidism. Embryologically, the testicles usually develop inside the abdomen and normally descend down step by step into their permanent location at the scrotum. This condition can potentially result in the testicles’ malfunction and a decrease in the production of testosterone.
3. Mumps Orchitis:
A mumps infection which affects the testicles can cause damage to the testicles. This process affects the normal physiological function of the testicles and testosterone production.
Increased iron load in the blood can lead to testicular failure or pituitary gland dysfunction. This can affect testosterone production.
5. Injury to the Testicles.
6. Cancer Treatment:
Cancer treatment that usually involves chemotherapy or radiation therapy can affect normal testosterone and sperm production. Though the effects of both modes of treatments are temporary, it can result in permanent infertility.
The following are the various causes of secondary hypogonadism.
1. Kallmann's Syndrome.
2. Pituitary Disorders: Any abnormality in the pituitary gland can potentially affect the release of hormones from the pituitary gland to the testicles and ovaries. This results in decreased testosterone or estrogen production. A pituitary tumor can also lead to hormone deficiencies.
3. Inflammatory Disease: Inflammatory conditions like sarcoidosis, histiocytosis, or tuberculosis usually involve the hypothalamus and pituitary gland regions. This can also affect testosterone and estrogen production.
4. HIV or AIDS.
5. Opiates: Intake of certain opioid pain medications can affect the normal physiology of the testicles.
7. Normal Aging: As men and women age, there is a progressive decrease in testosterone and estrogen production. In older women, menopause is the most important cause of hypogonadism.
What Are the Symptoms of Hypogonadism?
The symptoms of hypogonadism depend on the following:
The following are the common symptoms that are seen in hypogonadism.
A decrease in sperm count.
Frequent episodes of depressed mood.
Decreased libido (sexual drive).
A significant reduction in muscle mass and strength.
Loss of body hair in the pubic, axillary, and facial regions.
Osteoporosis presents with a decreased bone mineral density.
Enlargement of breasts which is accompanied by discomfort.
Poor concentration in daily activities.
Loss of appetite.
How Is It Diagnosed?
In males, it can be usually diagnosed by measuring the person’s levels of early morning serum testosterone. This test must be repeated if the value seems low. In addition to testosterone, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin should also need to be measured. Suppose the patient’s clinical signs and symptoms strongly suggest hypogonadism, but the serum testosterone level is near to normal. In that case, an assay of serum testosterone should be done with SHBG (sex hormone-binding globin).
In females, a blood test is required to check the follicle-stimulating hormone (FSH) and luteinizing hormone (LH). It is also very important to get the estrogen levels tested in females.
What Are the Treatment Options?
Male hypogonadism can be treated with the help of testosterone replacement therapy. This method is done to return the testosterone levels to normal. The reason behind this is that testosterone can help improve hypogonadal symptoms, which include reduced sexual desire, loss of appetite, decreased facial and body hair, etc. In the females, treatment primarily involves increasing the female sex hormones. Thus, the first line of female hypogonadism management is estrogen therapy. It can be administered either as a skin patch or a pill.
What Are the Complications?
The following are the various complications that can result from untreated hypogonadism.
Hypogonadism can affect both men and women of any age and requires treatment for appropriate development of physical, cognitive and sexual characteristics. The etiology can be different in each case but there is need for more awareness among people and the treating physician regarding such conditions. For more information, you can consult an online doctor.