Hypogonadism

Hypogonadism is a condition in which male and female sex organs or gonads fail to produce enough quantities of sex hormones. In males, the sex hormone is testosterone, produced by the testes. Testosterone is required in males for normal masculine growth as well as for the development of sperms. In females, estrogen is produced by the ovaries and is responsible for developing secondary sexual characteristics and menstrual cycles.  

Primary hypogonadism is caused because the sex organs are affected due to:

Genetic diseases: Genetic conditions such as Klinefelter’s syndrome in males and Turner’s syndrome in females cause hypogonadism.

Autoimmune diseases: In Addison’s disease, cortisol levels are lowered, which in turn causes levels of sex hormones to fall.

Undescended testes: Hypogonadism occurs if the testes don’t descend in the fetal life and remain within the abdomen after birth.

Mumps orchitis: Infection of the testes, which occurs after puberty, can cause hypogonadism.

Hemochromatosis: This is the condition in which the body absorbs excess iron, which doesn’t let sex hormones work properly.

Surgery: Procedures that involve the sex organs can cause levels of sex hormones to fall.

Central hypogonadism can be caused by:

Kallmann syndrome: It is a genetic disorder in which the hypothalamus abnormally grows as a result of which certain hormones are not produced which help produce sex hormones.

Pituitary gland disturbances: Hormones released from the pituitary gland act on the sex glands, and if their release is disturbed, sex hormones are also not released.

AIDS: Human Immunodeficiency Virus (HIV) can involve the pituitary gland and hypothalamus and cause low testosterone levels.

Obesity: Our body weight also plays a role in maintaining sex hormones.

Aging: With increasing age, sex hormones are lowered, as in menopause in females.

Liver and Kidney diseases: They may also impact the production of sex hormones.

Hypogonadism may be primary or central based on the cause;

●     Primary Hypogonadism:

In primary hypogonadism, the production of sex hormones is affected because the sex organs are unable to produce them even after receiving messages from the hypothalamus.

●     Central Hypogonadism:

Central hypogonadism, also known as secondary hypogonadism, is caused due to lack of the growth factors produced by the hypothalamus or pituitary gland. These growth factors are responsible for acting on sex glands producing sex hormones.

Risk factors for hypogonadism can be;

●     Obesity

●     HIV

●     Exposure to radiation or surgery

●     Increasing age

Hypogonadism is diagnosed in about 4 to 5 million men in the United States, affecting men of almost all age groups, whereas low testosterone levels are more common in older men.

Depending on the age at which hypogonadism occurs and its cause, different signs and symptoms can be seen, such as;

1. If the male fetus testes or the female fetus ovaries are non-functional, a lack of testosterone or estrogen results in the absence of male and female characteristics. In both cases, female sex organs are formed.
2. If hypogonadism develops before puberty in males, they continue to have the male sex organs and characteristics. Although the bones are quite thin, the voice is child-like, and there is no masculine hair growth on the face or elsewhere.
3. If hypogonadism occurs because a man is castrated after puberty, there is a loss of masculine hair production and a loss of thick bones. His sexual desires also decrease but are not lost. Erectile dysfunction and infertility will occur. Similar changes would occur in females if both ovaries of a fully developed woman were removed.
4. If hypogonadism occurs due to the genetic inability of the hypothalamus to secrete normal hormone-releasing factors, then an abnormality in the feeding center of the hypothalamus is associated, which causes the person to overeat greatly, and obesity occurs. The condition is called Adiposogenital syndrome.
5. If, in females, gonads are secreting small amounts of estrogen, the ovarian cycle does not occur normally. Menstrual cycles are prolonged or may completely cease, i.e., Amenorrhea.

To diagnose hypogonadism, your doctor may run several tests, which may include;

●     Hormonal tests

A blood test is ordered to check the levels of sex hormones. Sex hormones checked, in this case, are by ordering FSH (follicle-stimulating hormone), LH (luteinizing hormone), prolactin, and serum testosterone levels.

●     Imaging tests

By ordering an ultrasound, your doctor can look at your ovaries and diagnose many diseases such as PCOS (polycystic ovarian syndrome) and ovarian cysts, which cause hypogonadism.

Other diseases which cause infertility and delayed puberty are conditions such as;

●     Klinefelter’s syndrome

●     Cryptorchidism

●     Kallmann’s syndrome

Whereas, in females, the conditions which affect fertility can be;

• PCOS (poly-cystic ovarian syndrome)
• Endometriosis

For males

In the case of males, to treat the low level of sex hormones, testosterone replacement therapy is used. Testosterone is administered by various methods such as in the form of solutions, as an injection, pumped into nostrils, in the form of a patch, or as an implant after every 3 to 6 months.

For females

Estrogen therapy is used in females with hysterectomy. Otherwise, estrogen and progesterone are used to lower the chances of endometrial cancer. If the woman has trouble conceiving, she is also given follicle-stimulating hormone pills and human choriogonadotropin.

Medications

●     Intramuscular injections used are testosterone cypionate and testosterone enanthate.

●     Gels used are Androgel 1% and 1.62%, Testim 1%, Axiron 2%, and Fortesta 2%.

●     The patches used are Androderm.

●     Implants are testopel.

Hypogonadism is a chronic condition; if the hormonal replacement therapy is stopped, its symptoms may return.

Maintaining a healthy diet, losing weight, exercising, and quitting smoking may help improve the lifestyle of people with hypogonadism and increase sexuality.