Hypogonadism

Hypogonadism at a glance

  • Hypogonadism is a condition in which the sex glands, gonads (testes) in men and ovaries in women, do not produce any hormones or enough of the hormones involved in sexual development and reproduction.
  • Hypogonadism is caused either by malfunction of the glands or malfunction of the part of the brain that controls the glands’ operation.
  • Children may be born with hypogonadism or it may be acquired later in life, usually due to infection or injury.
  • Hypogonadism can cause infertility in both men and women.
  • Boys who have hypogonadism may experience enlarged breasts, less body hair and sex problems. Girls who get hypogonadism do not begin menstruation.
  • Hormone medications are a common treatment for both boys and girls.

What is hypogonadism?

Hypogonadism occurs when the sex glands in men or women do not produce any hormones or enough hormones. Male sex glands are the gonads (testes) and female sex glands are the ovaries. Male hypogonadism can also involve poor production of sperm. Hypogonadism may appear as a birth defect in boys and girls, and may be acquired later in life by men and women through injury or infection.

Because the reproductive system of males and females is heavily dependent on the proper production and distribution of sex hormones, hypogonadism results in sexual and fertility issues for both sexes. Hypogonadism can cause sexual development problems in boys and girls and can cause infertility in men and women. Technically, menopause is a form of hypogonadism.

Hypogonadism also causes physical changes affected by low testosterone in males and low estrogen and progesterone in women. While all men typically experience a reduction of testosterone with age, men with hypogonadism experience a more pronounced drop.

The two types of hypogonadism are classified according to their cause. Primary hypogonadism is caused by malfunctioning ovaries (in women) or testes (in men); and central hypogonadism is caused by faulty performance of the section of the brain that controls the gonads (hypothalamic and pituitary glands).

Causes of central hypogonadism

  • Steroids, opiates and other medications
  • Genetic issues
  • Nutrition problems or eating disorders
  • Tumors
  • Bleeding
  • Surgery
  • Infections

Causes of Primary hypogonadism

  • Autoimmune disorders
  • Genetic problems, such as Turner and Klinefelter syndromes
  • Surgery
  • Radiation
  • Diseases of the liver or kidney
  • Infection

Symptoms of hypogonadism

When tumors are the cause of central hypogonadism, symptoms may include headaches, loss of vision, signs of hormone deficiency and milky discharge from the breasts. Anyone experiencing one of these symptoms should seek prompt medical attention.

Men with hypogonadism usually have a loss of sex drive, and the condition can also result in osteoporosis, erectile dysfunction and infertility. Women may experience the same symptoms as found in menopause (hot flashes, vaginal dryness and mood swings).

Girls with hypogonadism will not begin menstruation, due to the lack of hormones that regulate that cycle. Other symptoms in girls include:

  • Lack of breast development
  • Low sex drive
  • Body hair loss
  • Hot flashes
  • Stunted height.

Boys experience muscle, beard and growth problems. Symptoms for boys include:

  • Muscle loss
  • Sexual performance problems
  • Reduced body hair and beard growth
  • Enlargement of breasts.

Diagnosis of hypogonadism

The urologist will conduct a thorough physical exam and, for children, will pay particular attention to sexual development. Blood tests can detect hormone deficiencies: estrogen for women, testosterone for men, and luteinizing hormone (LH) and follicle stimulating hormone (FSH) in both sexes.

Other tests may be required, including tests for anemia, thyroid hormone level, genetic problems, level of milk hormone in women and sperm count in men. Imaging tests may include a sonogram of the ovaries or MRI or CT scans of the brain if pituitary disease is suspected as a cause of hypogonadism.

Treatment of hypogonadism

The first line of treatment for hypogonadism is hormone-based medication. Men will receive testosterone, delivered by patch, gel, injection or topically at the armpits. Women will receive estrogen and progesterone, which can be delivered by patch or pill. Women with low sex drive may also take testosterone. Other options include:

  • Pituitary hormone injections to help men produce sperm
  • Medication to stimulate ovulation in women
  • Surgical repair and/or radiation therapy in certain cases.

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