Hypogonadism: Causes, Symptoms and Treatment

Hypogonadism is a medical condition in which your gonads i.e. sex glands produce very little or no sex hormones. These gonads, known as testes in males and ovaries in females are paired. The main sex hormone in females is estrogen and, in the male, it is testosterone. These hormones are responsible for the attainment of puberty, reproduction and also control secondary sexual characteristics in both males and females like breast development, pattern hair growth, different distribution of body weight.

Types of Hypogonadism

There are two types of hypogonadism based on the fact that the defect can be either present in the functioning of the brain or in the gonads itself

Primary hypogonadism: The problem lies in the gonads and it means that your gonads don’t produce enough sex hormones despite being signaled by the brain to produce them. It is more common than the other types.

Central hypogonadism: as already mentioned, the problem lies in your brain. Hypothalamus and pituitary are two glands that are part of your brain which controls the functioning of all the major glands of the body including gonads. So defective functioning in the factors secreted by these glands which stimulate the gonads to secrete the sex hormones can lead to this type of hypogonadism. This condition is rare by the way.

Causes of Hypogonadism

There are many causes which are specific to the type of hypogonadism as

Causes of primary hypogonadism

• Genetic disorders like Turner syndrome (females) and Klinefelter syndrome(males) which causes abnormal development of gonads and they are the most common cause of primary hypogonadism in females and males respectively.
• Failure in the descendance of the testes where the testes remain in the abdomen
• Autoimmune disorders like Addison’s disease and hypoparathyroidism
• Severe infection involving the gonads especially mumps in males
• Trauma due to injury or surgery to the gonads
• Radiation exposure
• Liver or kidney disease

Causes of central hypogonadism

• Genetic disorders like Kallmann syndrome which causes abnormal development of hypothalamus.
• Certain pituitary disorders
• Inflammatory diseases like tuberculosis and sarcoidosis
• Infections including HIV
• Injury to the pituitary or hypothalamus gland due to trauma or surgery.

Symptoms of Hypogonadism

As males and females have different reproductive behavior therefore there some symptoms differ as

Major symptoms of females include

• Lack of menstruation or no periods
• No or very slow development of breasts
• Decreased sex drive and infertility
• Signs associated with turner syndrome may be present like short height, webbed neck

Major symptoms in males include

• Abnormal gentiles or testes in abdomen
• Loss of body hair, libido, muscle mass
• Infertility
• Fatigue
• Reduced growth of penis
• Erectile dysfunction

Diagnosis of Hypogonadism

Your doctor will use your medical history, conduct a physical examination and order some tests to establish a diagnosis.

Medical history: basically, your doctor will ask you questions about your symptoms, problems, family history, and past treatment or surgery.

Physical examination: your doctor will examine your body from head to toe to look for

• The abnormalities in the development of the genitals
• The growth and pattern of the body hairs
• The quality of the voice
• Development of breasts in females
• This is done to find out whether your body has sexually developed according to your age or not

Laboratory tests

• Hormone tests: Your blood sample is taken to check for the levels of different hormones in the blood like follicle-stimulating hormone, luteinizing hormone, estrogen(females), testosterone(males), prolactin.
• Sperm count in males
• Karyotyping to look for any chromosomal abnormalities

Imaging tests like ultrasonography can be used to look for the problems in the ovaries and MRI or CT scan to check for the tumors.

Your doctor can order additional tests on the basis of the result of the above tests

Treatment of Hypogonadism

The main goals of the treatment are to develop secondary sexual characteristics, preserving muscle bone mass and to psychologically adjust with the society and it includes

Hormone replacement therapy

For females: these include administration of increasing concentrations of female sex hormones and includes estrogen, progesterone or FSH. Estrogen with progesterone will help in the development of secondary sexual characteristics. Estrogen is given alone increases the risk of endometrial carcinoma. FSH will help in triggering the ovulation

For males: the testosterone is the male sex hormone and it can be given in the form of injection, patches or gel. Suitable hormones can be given to the patient depending upon his condition as GnRH agonists can be given to trigger the puberty

Surgery: it can be used to remove the tumor if that tumor is near to the pituitary gland and causing hypogonadism.

Prognosis of Hypogonadism

Almost all patients have to take hormones for the whole of their lives. The patient suffering from abnormal gonadal development remains unfertile despite being treatment though the secondary sexual characteristics are improved. Many patients have a good outlook.

References:

• Carson CC. (n.d.). Prevalence, diagnosis and treatment of hypogonadism in primary care practice
• Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559. PMID: 20525905
• The American Association of Clinical Endocrinologists