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Hypogonadism; What is it, symptoms and treatment

Hypogonadism; What is it, symptoms and treatment

What is hypogonadism?

Hypogonadism is understood to be when the gonads (testicles in men and ovaries in women) produce low amounts of hormones or none at all or when the hypothalamus is incapable of producing normal levels of the GnRH (gonadotropin-releasing hormone). These hormones are in charge of controlling the development of the secondary sex characteristics, such as the breast, testicle or pubic hair development, so in patients that have hypogonadism, these types of characteristics will not be developed. It is also one of the various factors that can cause infertility.

What types of hypogonadism are there? What are the causes?

There are basically two types of hypogonadism:

Primary hypogonadism

This occurs when there is a problem in the gonads (ovaries or testicles) and they cannot secrete normal levels of hormones. The most common types of primary hypogonadism include the following:

  • Klinefelter Syndrome

The Klinefelter syndrome is a genetic condition that affects men when they have an additional copy of the X chromosome. Often it is not diagnosed until adulthood and it is considered to be a type of hypogonadism that affects testicle growth, lower levels of testosterone are produced, which is why the majority of men who have Klinefelter syndrome produce little or no sperm.

  • Undescended testicles in childhood

Undescended testicles occur when one or both testicles fail to move into the scrotum, this is more common in premature babies. Normally testicles in boys descend from when they are born to when they are 9 months old, when this does not happen it is defined as undescended testicles. This usually corrects itself alone without treatment during the first few years of life, but if it doesn’t, it might cause testicular failure, which affects their function and the production of testosterone.

  • Mumps orchitis

A mumps infection during adolescence or adulthood can affect the testicles and hinder the correct secretion of testosterone.

  • Hemochromatosis

This occurs when the iron levels in the blood are extremely high, which results in testicular failure or a malfunction of the pituitary gland, so the adequate production of testosterone is affected.

  • Testicular lesions

Severe damage in the testicles caused by a blunt trauma, for example, could seriously affect them and lead to hypogonadism. Normally testicle injury does not affect the total production of testosterone, although it might affect it partially.  

  • Cancer treatment: chemotherapy or radiation

The effects of chemotherapy and radiotherapy might affect the normal levels of hormones produced by the testicles and the ovaries, which results in a decline in fertility. The effects of both types of treatment are usually temporary although occasionally infertility might be permanent. That is why patients are advised to preserve their sperm and oocytes before they undergo cancer treatment.

Secondary hypogonadism

This occurs when there is a lack of hormones that stimulate the gonads. These hormones are the gonadotropins: luteinizing hormone or LH and the follicle-stimulating hormone or FSH. It points to a hypothalamic or pituitary gland problem. There are various conditions that can cause secondary hypogonadism, which include the following:

  • Kallmann syndrome

It is a type of secondary hypogonadism that affects both men and women, which involves the abnormal development of the area of the brain that is in charge of controlling the secretion of the pituitary gland hormones.

  • Pituitary disorders

A malfunction in the pituitary gland might affect the hormone level secretion in the testicle, which affects the production of testosterone.

 The most common problem is the development of a tumor, although the majority of them tend to be benign, they might result in the production of high amounts of a certain hormone, which in turns limits the production of others.

  • Inflammatory diseases

Some inflammatory diseases might affect the hypothalamus or the pituitary gland, which therefore affects the normal production of hormones.

  • HIV/AIDS

AIDS might cause hypogonadism as it directly affects the pituitary gland or the hypothalamus, which decreases certain hormone levels such as the testosterone levels.

  • Medication associated with testosterone

The use of certain medication, such as analgesics, might decrease the testosterone levels.

  • Obesity

Excessive weight at any age associated with the existence of hypogonadism.

  • Aging

As we get older the gonad levels gradually decrease.

How is it classified?

Another type of classification for the aforesaid complementary hypogonadism is the following:

  • Constitutional delay of growth and puberty (CDGP)

In this type of hypogonadism delay in the skeletal growth and the height of the child is observed, along with delayed puberty. This condition usually occurs in healthy people and it affects approximately 5% of adolescents aged 14. Although the causes of CDGP are not known possible factors that might be associated with it have been mentioned, such as certain genetic factors or poor nutrition in the first few months of life, among others.

  • Hypogonadotropic hypogonadism

This occurs when there is an inadequate secretion of hormones such as the GnRH, LH and FSH at the hypothalamic-pituitary-gonadal axis level. These hormones are in charge of stimulating the gonadals (also known as secondary hypogonadism).

  • Hypergonadotropic hypogonadism

This occurs when the ovaries or testes do not function properly, which affects hormone secretion (primary hypogonadism).

Symptoms and consequences of hypogonadism

The symptoms of hypogonadism will depend on the age of the patient at the onset of the disorder:

If it occurs during fetal development it might result in the impaired growth of the external sex organs. In puberty it might hamper the growth of body and facial hair, voice deepening, the growth of the penis and testicles, gynecomastia (development of breast tissue in men), among other things. Finally, if the onset of hypogonadism occurs in adulthood, it usually interferes with the normal reproductive function or with certain physical characteristics such as for example erectile dysfunction, infertility, decrease in muscle mass, osteoporosis, gynecomastia, decrease in hair growth on the face and/or body.

Treating hypogonadism

Hypogonadism is treated with specific hormone based medication. In some women tablets or injections can be used to stimulate ovulation. If the hypogonadism is associated with a pituitary or hypothalamus problem, radiotherapy or surgery is often used.

Hypogonadism in women

Female hypogonadism occurs when there is an altered or inadequate function of the ovaries, less oocytes are therefore produced and there are usually low levels of estrogen and progesterone as well.

Hypogonadism and fertility

As aforementioned, one of the possible consequences of hypogonadism is infertility. A lack of gonadals due to the ovaries or testes not working properly can be treated with injections of LH and FSH. However, if there is a problem with the pituitary gland this treatment will not be effective.

How can hypogonadism be prevented?

Certain risk factors have to be dealt with to prevent hypogonadism such as doing regular physical exercise, avoiding obesity and having a healthy diet.

Nerea Díaz, a biologist at Instituto Bernabeu

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