Hypogonadism is a form of gonadal deficiency wherein the body’s sex glands produce little or no hormones.  Generally speaking, this condition affects both genders and is largely a problem in the gonads of males (the testes), or in the gonads of women (the ovaries).  However, the term hypogonadism is most often used in its reference to men, and more specifically regarding their inability to produce enough of the male sex hormone testosterone – a hormone integral throughout the stages of male life including:  the masculine development from conception; the maturation stages during puberty; and the proper maintenance of bodily functions throughout adulthood.

There are three basic types of hypogonadism:  1) primary hypogonadism – originates from a problem in the testicles; 2) secondary hypogonadism – originates from a problem in the hypothalamus or the pituitary gland, the two parts of the brain that signal the testicles to produce testosterone; and 3) a source which originates from another internal condition or an external stimulus.  One may be born with this condition, or may develop it later due to a variety of causes among which are illnesses, infections, and injuries.  Both the symptoms and treatment for this condition are contingent upon the determined cause, and the age of the diagnosed male. Most forms of male hypogonadism can be treated with testosterone replacement therapy.

A.D.A.M.

Hypogonadism Causes and Risk Factors

 The causes of hypogonadism are varied, diverse, and usually classified as ‘primary’ and secondary.  In some cases hypogonadism is caused by the malfunction of the testes (or ovaries) themselves.  Such causes are referred to as primary causes and include:

• Certain autoimmune diseases – specific diseases wherein the body’s protective forces, the immune system, misinterprets data and begins to attack body itself. The treatments for all of the autoimmune diseases are similar, because they are all mediated by the immune system.  Such diseases are completely reversible, and many are caused by toxic diets, which is a common factor is celiac disease which can trigger cancer, Addison’s disease, Multiple sclerosis (MS), Amyotrophic lateral sclerosis (ALS), Alzheimer’s, hypoparathyroidism (a rare condition that occurs when the parathyroid glands in the neck do not produce enough parathyroid hormone to regulate the level of calcium and phosphorus in the body), and many others.  Symptoms of fatigue, numbness, and weakness are common to all types of autoimmune diseases.

• Genetic and developmental disorders are often misdiagnosed as primary

hypogonadism.  The most common genetic disorders that cause primary hypogonadism are Turner Syndrome (in women) and Klinefelter syndrome (in men).   However, other notables include Kallmann’s syndrome, Prader-Willi        syndrome, Myotonic dystrophy, and many related genetic disorders can display a variety of hypogonadic symptoms among which are:

• Low testosterone levels
• Reduced facial hair
• Reduced body hair
• Infertility
• Enlarged male breasts
• Small testes
• Inability to produce sperm
• Viral and bacterial infections
• Liver and kidney diseases
• Radiation exposure; intentional as in therapy, and incidental
• Surgery

In secondary hypogonadism, there is a malfunction in the Hypothalamic-Pituitary-Testicular Axis (HPTA) – the relationship between the hypothalamus and pituitary gland and their production of testosterone.  Causes of secondary hypogonadism generally include:

• Infections, including HIV and AIDS
• Internal bleeding
• Significant bodily trauma
• Certain medicines, including opiates and steroids
• Nutritional deficiencies
• Hemochromatosis – too much iron in the body
• Significant and or rapid weight loss
• Tumors, such as prolactinoma – a noncancerous pituitary tumor that causes the production of too much of the hormone prolactin in adults; and craniopharyngioma – benign tumor that develops near the pituitary gland which most commonly affects children (both boys and girls) 5 – 10 years of age. A.D.A.M. 

Hypogonadism Symptoms

The symptoms of hypogonadism may vary depending on age, as children tend to experience fewer and specific symptoms.

GIRLS’ SYMPTOMS

• Delayed menstruation (pre-pubertal symptom)
• Delayed breast development (pre-pubertal symptom)
• Delayed and/or stunted height growth (pre-pubertal symptom)
• Low libido
• Menstruation stops
• Hot flashes
• Loss of body hair 

BOYS’ SYMPTOMS

• Muscle loss
• Sexual problems (erectile dysfunction, low libido, impotence, etc.)
• Breast enlargement
• Decreased beard and body hair 

ADULT SYMPTOMS

• Difficulty conceiving (getting pregnant)
• Weakness
• Increased body fat
• Reduction in muscle and/or bone mass
• Changes in the size of, or lumps in the breasts, testes, scrotum, and penis
• Difficulty sleeping
• Breast discharge
• Impotence
• Depression, anxiety, irritability
• Excessive sweating and night sweats
• Loss of body, facial and pubic hair
• Poor concentration and/or memory
• Loss of body hair
• Loss of menstrual period
• Insulin resistance
• Recent bone fractures; loss of bone mass (osteoporosis)
• Loss of peripheral vision often indicates the presence of a pituitary tumor, which can cause low testosterone levels
• Breast enlargement (men)
• Hot flashes (women) 

BRAIN TUMOR SYMPTOMS (Secondary hypogonadism)

• Symptoms of other hormonal deficiencies
• Headaches and/or vision impairment
• Milky breast discharge (prolactinoma) 

Hypogonadism Tests 

Blood tests are often performed to measure the amounts of ‘free’ (available for function) and ‘bound’ (inactive) testosterone within the bloodstream.  In men, the primary sufferers of hypogonadism, the normal total testosterone levels range from 300 – 1,200 nanograms per deciliter (ng/dl).  Any score close enough to (and definitely below) 300 ng/dL constitutes a diagnosis of low testosterone and warrants investigation of cause and subsequent treatment.  Such investigation may include a diversity of tests in order to locate the culprit some which include:

• Estrogen analysis
• Semen analysis
• Specific blood tests for iron deficiency (anemia)
• Pituitary function testing, if the problem is suspected to occur in the pituitary gland
• Pituitary gland or hypothalamus images may be taken using a computerized tomography (CT scan) which combines a series of X-ray views taken from many different angles and computer processing to create cross-sectional images, and/or magnetic resonance imaging (MRI) which uses a magnetic field and radio waves to create detailed images
• Sonogram of the ovaries
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) testing; LH and FSH are hormones released by the pituitary gland that normally stimulate testosterone production in males
• Chromosome or genetic testing, if a genetic condition is suspected
• Prolactin level testing, as high prolactin levels can cause low testosterone; prolactin is a hormone produced in the pituitary gland, so named because of its central role in lactation (producing breast milk), is a multi-faceted hormone found in males and females that is essential to immune system maintenance 

Hypogonadism Hormone Treatment

Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) are hormone-based medication regimens, which may be prescribed as needed.  TRT for men and boys often involves prescribing and controlling the dosage, frequency, and duration of synthetic testosterone in the form of a transdermal patch or gel, or by intramuscular injection.  Generally speaking, women and girls are prescribed synthetic estrogen and/or progesterone regimens in the form of a pill, or that of a transdermal cream or patch.  Occasionally, women with hypogonadism who also experience low sex drive may be prescribed a low-dose regimen of testosterone. 

Hypogonadism Expectations (prognosis)

Hypogonadism is a very common condition that responds well to treatment, and sufferers of this condition have a very good outlook. 

Prevention

The best thing a person can do to help prevent hypogonadism is maintain a normal body weight, an average to low amount of body fat, and practice healthy eating habits.

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