Hypogonadism
What is it?
Hypogonadism in men is a condition that results
from the inability of the testes to produce the
sex hormone testosterone, sperm or both. As part
of their reproductive systems, men have external
genital organs called the testes. Oval in shape,
the organs are contained in a pouch of skin
(scrotum) that hangs below the abdomen and behind
the penis. If the testes produce too little
testosterone, then either the growth of the sexual
organs or their function is impaired. This hormone
also plays an important role in the development
and maintenance of typical masculine physical
characteristics.
Who Gets It?
Hypogonadism can affect men of any age, from
fetal development, through puberty and adulthood.
During each of these stages the symptoms of this
condition are very distinct. If you have a family
history of certain conditions such as Kallman's
syndrome, undescended testicles as an infant,
infertility, decreased sex drive, erectile
dysfunction, or hemochromatosis, you may be at
greater risk for developing hypogonadism.
What Causes It?
Hypogonadism is caused by deficient
testosterone secretion by the testes. The two
basic types of male hypogonadism are Primary and
Secondary.
Primary, also known as primary testicular
failure, originates from an abnormality in the
testicles. Common causes of the Primary type of
hypogonadism include Klinefelter's syndrome, a
congenital abnormality of the sex chromosomes X
and Y; undescended testicles; hemochromatosis, a
result of too much iron in the blood; injury to
the testicles, prior hernia surgery, cancer
treatment and normal aging.
The Secondary type of hypogonadism is caused by
defects in the pituitary gland connected to the
brain that controls hormone production. If
chemical messages from the pituitary gland to the
testicles aren't sent, impaired testicular
function occurs. This condition can be a result
from defects in development of the pituitary
gland, certain inflammatory diseases, and the use
of certain drugs used in the treatment of
psychiatric disorders and gastroesophageal reflux
disease.
It is important to establish the cause of
hypogonadism so that appropriate treatment can be
prescribed. This may require a consultation with
an endocrinologist, a physician who specializes in
the hormone-producing (endocrine) glands.
What are the Symptoms?
The effects of hypogonadism primarily are
determined by the stage of life at which they
occur. If the gonads produce too little hormone
during early fetal development, the growth or
functions of the internal and external sex organs
may be impaired. This can cause a condition in
which the sex of the child is not clear by
external examination at birth. During puberty,
symptoms of hypogonadism slow growth and affect
normal development. Physical changes may include
decreased development of muscle mass, lack of
deepening of the voice, impaired growth of the
penis, testicles and body hair, and development of
breast tissue. Other common symptoms include tall
stature and abnormal body proportions. In
adulthood, hypogonadism can result in erectile
dysfunction, infertility, decrease in beard and
body hair growth, increase in body fat,
development of breast tissue and decreases in the
size or firmness of testicles, muscle and bone
mass (osteoporosis).
Mental and emotional changes can also accompany
hypogonadism. As testosterone decreases, some men
may experience signs and symptoms similar to those
of menopause in women. These may include hot
flashes, decreased sex drive, irritability,
depression and fatigue.
How is it diagnosed?
Early detection in boys can help prevent
delayed puberty, and adult men are better
protected against osteoporosis and other related
conditions. Therefore, it is important to be
tested for hypogonadism if symptoms are present.
To evaluate hypogonadism, testing is done early
in the day, because typically testosterone levels
are highest in the morning. If tests confirm low
testosterone levels, further laboratory testing
can be done to find out if a testicular disorder
or a These studies may include hormone testing,
semen analysis, pituitary imaging, genetic studies
and testicular biopsy.
What is the treatment?
Several testosterone delivery methods exist.
These include testosterone injections, patches,
and topical ointments.
Testosterone injections are considered both
safe and effective. Injections are given
approximately every 2 weeks. It is common to
experience fluctuations in symptom relief between
doses.
Another alternative is testosterone patches.
The testosterone may be mixed with the adhesive
with a new patch applied daily to a different
site; this system leaves a sticky residue but
causes little skin irritation. A different patch
uses testosterone in a reservoir system applied to
skin; this system adheres more tightly to the skin
but may cause more skin irritation.
Also available is a topical 1% testosterone
gel. It is applied once daily to clean, dry skin
of the shoulders, upper arms, or abdomen. The
hands should be washed and the application site
allowed to dry for 3-5 minutes before dressing. A
shirt must be worn during contact with women or
children to prevent transfer of testosterone to
them.
Side effects of any testosterone therapy may
include acne, gynecomastia, aggravation of sleep
apnea, and reduced HDL levels.
Self-Care Tips
If hypogonadism occurs during adulthood,
lifestyle and dietary changes should be made to
prevent osteoporosis. Regular exercise in addition
to adequate amounts of calcium and vitamin D to
maintain bone strength are important to reduce the
risks of osteoporosis.
Men diagnosed with hypogonadism may experience
psychological and relationship problems due to
erectile dysfunction or infertility caused by
hypogonadism.
A supportive family that understands the
diagnosis of hypogonadism is important, along with
talking to a doctor about how to reduce the
anxiety and stress that often accompany these
conditions. Support groups can help those with
hypogonadism and related conditions cope with
similar situations and challenges.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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