Hypogonadism Overview
Hypogonadism occurs when the body’s sex glands (gonads) produce little or no hormones.
The sex glands, also called gonads, are primarily the ovaries in females and the testes in males.
The sex hormones help control secondary sex characteristics, such as breast development breast development in females, testicular development in males, and pubic hair growth. Sex hormones also play a role in the menstrual cycle and sperm production.
Hypogonadism is also known as gonadal deficiency. It may be called andropause or low serum testosterone when it occurs in males.
Some people can be born with male hypogonadism, or it can develop later in life, often from injury or infection. The effects, and what you can do about them, depend on the cause and at what point in your life male hypogonadism occurs.
Some types of male hypogonadism can be treated with testosterone replacement therapy.
Types of Hypogonadism
There are three types of hypogonadism: primary, secondary, and eugonadotropic.
Primary Hypogonadism
Primary hypogonadism means that you do not have enough sex hormones in your body due to a problem in your gonads.
Your gonads are still receiving the message to produce hormones from your brain, but they can’t produce the hormones. It’s also known as hypergonadotropic hypogonadism.
Secondary Hypogonadism
In secondary hypogonadism, the issue originates in your brain.
Your hypothalamus or pituitary gland, found in or near the brain, are not working properly. These areas control your gonads. If you have secondary hypogonadism, your gonads aren’t being stimulated.
Secondary hypogonadism is also known as hypogonadotropic or central hypogonadism.
Euogonatropic Hypogonadism
In eugonadotropic hypogonadism, you experience the effects of hypogonadism even though your pituitary gland is functioning as expected.
It’s also known as normogonadotropic hypogonadism. It only affects people AFAB as it is caused by issues affecting the ovaries, such as polycystic ovarian syndrome (PCOS).
Facts on Male Hypogonadism
Following are some key points about male hypogonadism.
- Hypogonadism may occur at any age, and the consequences differ, according to when it starts.
- If hypogonadism occurs before puberty, puberty does not progress. If it occurs after puberty, there may be infertility and sexual dysfunction.
- In adult men, symptoms begin within a few weeks of the onset of testosterone deficiency.
- Hypogonadism may increase the risk for cardiovascular disease, type-2 diabetes, metabolic syndrome, premature death in older men, and Alzheimer’s disease.
Causes of Hypogonadism
Hypogonadism in a male refers to a decrease in either or both of the two major functions of the testes: sperm production and testosterone production.
This can happen for a number of reasons.
The causes of primary hypogonadism include:
- Autoimmune disease such as Addison’s Disease and hyperthyroidism
- Genetic disorders such as Turner syndrome and Klinefelter syndrome
- Inflammation or mumps involving the testicles or ovaries
- Liver and kidney
- Surgery on your sexual organs
- Radiation exposure
- Undescended testes
Secondary hypogonadism may be the result of the following:
- A tumor in or near your pituitary gland
- Brain surgery
- Genetic disorders such as Kallmann syndrome (abnormal hypothalamic development)
- Hemochromatosis, which occurs when your body absorbs too much iron
- Injury to your hypothalamus or pituitary gland
- Infections, including HIV
- Nutritional deficiencies
- Obesity
- Pituitary disorders
- Rapid weight loss
- Inflammatory diseases such as sarcoidosis and tuberculosis
- Radiation exposure
- Use of steroids or opioids
Eugonadotropic hypogonadism may be caused by:
- Delayed menarche
- Hyperprolactinemia, or excess amounts of the hormone prolactin
- Ploycystic ovary syndrome (PCOS)
Signs and Symptoms of Hypogonadism
Symptoms that may affect females include the following:
- Absent or low sex drive
- Hot flashes
- Infertility Lack of menstruation
- Loss of body hair
- Milky discharge from the breasts
- Osteoporosis
- Slow or absent breast growth
Symptoms that may affect people AMAB include:
- Abnormal breast growth
- Erectile dysfunction
- Fatigue
- Difficulty concentrating
- Hot flashes
- Infertility
- Reduced growth of the penis and testicles
- Loss of body hair
- Muscle loss
- Osteoporosis
Diagnosis of Hypogonadism
A doctor will conduct a physical exam to confirm your sexual development is typical for a person your age. They may examine your muscle mass, body hair, and sexual organs.
Laboratory Tests
If the doctor thinks you might have hypogonadism, they’ll first check the levels of your sex hormones.
You’ll need a blood test so that they can check your level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The pituitary gland makes these reproductive hormones, which are also known as gonadotropins.
If you are a female patient, you’ll have your estrogen levels tested. The doctor may also evaluate your egg count by performing a test such as the anti-Mullerian hormone (AMH) test.
For male patients the testosterone levels are tested. Testosterone tests are usually performed in the morning when your hormone levels are highest. The doctor may also order a semen analysis to check your sperm count. Hypogonadism can reduce your sperm count.
In addition, the doctor may order additional blood tests to help confirm a diagnosis and rule out any underlying causes. These include the following:
- Genetic tests: The doctor may perform genetic testing, especially if they suspect you have a chromosomal irregularity such as Turner syndrome.
- Iron tests: Iron levels can affect your sex hormones. For this reason, the doctor may perform an iron test to check for high blood iron levels.
- Prolactin tests: The hormone prolactin promotes breast development and breast milk production in females, but it is present in males as well.
- Thyroid function tests: The doctor may also check your thyroid hormone levels. Thyroid problems can cause symptoms similar to hypogonadism.
Imaging Tests
Imaging tests can also be useful in diagnosis.
An ultrasound can be used to create an image of the ovaries and check for any problems, including ovarian cysts and PCOS.
The doctor may order magnetic resonance imaging (MRI) test or computerized tomography (CT) Scans to check for tumors in or near your pituitary gland.
Treatment of Hypogonadism
Treatment for all genders is similar if the hypogonadism is due to a tumor affecting the pituitary gland. Treatment to shrink or remove the tumor may include medication, radiation, or surgery.
Treatments that are specific to female or male hypogonadism are described below.
Treatment for Female Hypogonadism
The treatment will involve increasing your amount of female sex hormones. Treatments will vary depending on the type of hypogonadism you have and whether you’re trying to conceive.
If the patient have primary hypogonadism and true ovarian failure, you’ll typically need to explore alternative forms of family building. Options include:
- Adoption
- Egg donation
- Using a gestational carrier
Other treatments can target specific symptoms. For eugonadotropic hypogonadism, a doctor will usually treat the underlying cause, such as PCOS.
Treatment of Male Hypogonadism
Injections of a gonadotropin-releasing hormone (GnRH) or gonadotropins (such as hCG or FSH) may trigger puberty or increase sperm production. These treatments are appropriate if you’re interested in conceiving and have primary hypogonadism.
If you have primary hypogonadism, you can explore sperm harvesting and sperm donation as options for conception, as well as intracytoplasmic sperm injection (ICSI).
If fertility isn’t a concern, you may receive testosterone replacement therapy (TRT). Testosterone is available in many forms, including:
- Injections
- Gels
- Lozenges
- Patches Pellets
Outlook of Hypogonadism
Unless a treatable condition causes it, hypogonadism is chronic and may require lifelong treatment. Your levels of sex hormones may decrease if you stop hormone therapy.
Most cases of hypogonadism respond well to appropriate medical treatment, though.
Seeking support through therapy or support groups can help you before, during, and after treatment.
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