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Male hypogonadism

Definition


Disease: Male hypogonadism Male hypogonadism
Category: Sexual diseases

Disease Definition:

The condition in which the body doesn't produce enough of the hormone testosterone, which is the hormone that plays a key role in masculine growth and development during puberty, is called male hypogonadism.

 

Someone may be born with male hypogonadism, or it may develop later in life from injury or infection. The cause of male hypogonadism and at what point in one's life it occurs are the things that the effects and what one can do about them will depend on. Testosterone replacement therapy can treat some types of male hypogonadism.
 

Work Group:


Symptoms, Causes

Symptoms:

During fetal development, puberty or adulthood, hypogonadism can occur. The signs and symptoms differ depending on when it develops.

 

FETAL DEVELOPMENT:

Impaired growth of the external sex organs may result in case the body doesn't produce enough testosterone during fetal development. A genetically male child may be born with the following depending on how much testosterone is present and when it develops:

 

  • Underdeveloped male genitals
  • Female genitals
  • Ambiguous genitals, which are genitals that are neither clearly male nor clearly female

 

PUBERTY:

Male hypogonadism may affect development and slow growth during puberty; it may cause:

 

  • Impaired growth of the penis and testicles
  • Development of breast tissue (gynecomastia)
  • Lack of deepening of the voice
  • Excessive growth of the arms and legs in relation to the trunk of the body
  • Impaired growth of body hair
  • Decreased development of muscle mass


ADULTHOOD:

Hypogonadism may impair normal reproductive function and alter certain masculine physical characteristics in adult males. It may cause some of these signs and symptoms:

 

  • Erectile dysfunction
  • Infertility
  • Decrease in beard and body hair growth
  • Decrease in muscle mass
  • Development of breast tissue (gynecomastia)
  • Loss of bone mass (osteoporosis)


Mental and emotional changes may be caused by hypogonadism as well. Some men may experience symptoms similar to those of menopause in women as their testosterone decreases. Some of those symptoms may be:

 

  • Hot flashes
  • Difficulty concentrating
  • Fatigue
  • Decreased sex drive

 

If one has any symptoms of male hypogonadism, he should see a doctor. The important first step of getting appropriate treatment is establishing the cause of hypogonadism.
 

Causes:

When the testicles don't produce enough of the male sex hormone testosterone, male hypogonadism occurs. The following are the two basic types of hypogonadism:

Primary:

Also known as primary testicular failure, this type of hypogonadism originates from a problem in the testicles.

Secondary:

This type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland, which are the parts of the brain that signal the testicles to produce testosterone. The hypothalamus produces a gonadotropin-releasing hormone that signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone. Luteinizing hormone then signals the testes to produce testosterone.

 

An inherited (congenital) trait or something that happens later in life (acquired), such as an injury or an infection may cause either type of hypogonadism.

 

PRIMARY HYPOGONADISM:

Primary hypogonadism has got common causes that include:

Undescended testicles:

The testicles develop inside the abdomen and normally move down into their permanent place in the scrotum before birth. In some cases, one or both of the testicles may not be descended at birth. Within the first few years of life, this condition often corrects itself without treatment. However, it may lead to malfunction of the testicles and reduced production of testosterone if not corrected in early childhood.

Hemochromatosis:

Testicular failure or pituitary gland dysfunction affecting testosterone production may be caused by too much iron in the blood.

Klinefelter syndrome:

A congenital abnormality of the sex chromosomes X and Y causes this condition. Normally, a male has one X and one Y chromosome. In addition to one Y chromosome, two or more X chromosomes are present in Klinefelter syndrome. The genetic material that determines the sex of a child and related development is contained in the Y chromosome.  Abnormal development of the testicles is caused by the extra X chromosome that occurs in Klinefelter syndrome, which in turn results in underproduction of testosterone.

Cancer treatment:

The production of testosterone and sperm is hindered by radiation therapy or chemotherapy for the treatment of cancer. Permanent infertility may occur even though the effects of both treatments often are temporary. Preserving sperm before starting cancer therapy is an option that many men consider, although many of them regain their fertility within a few months after treatment ends.

Injury to the testicles:

The testicles are prone to injury because of their location outside the abdomen. Hypogonadism can be caused by damage to normally developed testicles. Testosterone production may not be impaired by a damage to one testicle.

Mumps orchitis:

Long-term testicular damage may occur if a mumps infection involving the testicles in addition to the salivary glands (mumps orchitis) occurs during adolescence or adulthood. This may affect testosterone production and normal testicular function.

Normal aging:

Generally, older men have lower testosterone levels than younger men. There's a slow and continuous decrease in testosterone production as men age. The rate that testosterone declines varies greatly among men. According to some studies, as many as 30% of men older than 75 have a testosterone level that's below normal. It's still a matter of debate whether or not treatment is necessary.

 

SECONDARY HYPOGONADISM:

Due to a problem with the pituitary or hypothalamus, the testicles are normal but function improperly in secondary hypogonadism. Secondary hypogonadism can be caused by a number of conditions that may include:

Medications:

Testosterone production can be affected by the use of certain drugs, such as some hormones and opiate pain medications.

Kallmann syndrome:

Hypogonadism may be caused by abnormal development of the hypothalamus, which is the area of the brain that controls the secretion of pituitary hormones. This abnormality is also associated with anosmia, which is the impaired development of the ability to smell.

Obesity:

At any age, being significantly overweight may be linked to hypogonadism.

Inflammatory disease:

The production of testosterone is affected by certain inflammatory diseases such as tuberculosis, histiocytosis and sarcoidosis which involve the hypothalamus and result in hypogonadism. 

Pituitary disorders:

The release of hormones from the pituitary gland to the testicles may be impaired by an abnormality in the pituitary gland, which ends up affecting the normal production of testosterone. Testosterone or other hormone deficiencies may be caused by a pituitary tumor or other type of brain tumor located near the pituitary gland. Pituitary function may be impaired and hypogonadism may be caused by the treatment for a brain tumor such as surgery or radiation therapy.

HIV/AIDS:

By affecting the testes, the pituitary and the hypothalamus, this virus can cause low levels of testosterone.

 

The following are included in the risk factors for hypogonadism:

 

  • Testicular or pituitary tumors
  • Previous radiation therapy or chemotherapy
  • Undescended testicles as an infant
  • Mumps infection affecting the testicles
  • HIV/AIDS
  • Hemochromatosis
  • Injury to the testicles
  • Kallmann syndrome
  • Klinefelter syndrome

 

A person should tell the doctor if any of these risk factors are in his family because hypogonadism can be inherited.
 

Complications

Complications:

Depending on when hypogonadism first develops; during fetal development, puberty or adulthood, the complications of untreated hypogonadism differ:

Adulthood: 

The possible complications of hypogonadism in adults are osteoporosis, decreased beard and body hair growth, decreased sex drive, erectile dysfunction, fatigue, muscle loss or weakness, infertility and enlarged male breasts (gynecomastia).

Puberty:

A lack of body hair and impaired penis and testicle growth may occur if hypogonadism develops before puberty.

Fetal development:

A baby may be born with ambiguous or abnormal genitalia if hypogonadism begins during fetal development.
 

Treatments:

TREATMENT FOR ADULTS:

The treatment for male hypogonadism depends on the cause and whether the patient is concerned about fertility.

Hormone replacement:

Male hormone replacement (testosterone replacement therapy or TRT) is used for hypogonadism caused by testicular failure. TRT can prevent bone loss and restore sexual function and muscle strength. An increase sense of well-being, sex drive and energy is often experienced by men receiving TRT.

 

Pituitary hormones may stimulate sperm production and restore fertility if a pituitary problem is the cause. If fertility isn't an issue, testosterone replacement therapy can be used. The replacement of other hormones, radiation, medication or surgical removal may be required in the case of a pituitary tumor.

Assisted reproduction:

Assisted reproductive technology may be helpful, even though there's usually no effective treatment to restore fertility in a man with primary hypogonadism. A variety of techniques designed to help couples who have been unsuccessful in achieving conception is covered by this technology.

 

TREATMENT FOR BOYS:

Testosterone replacement therapy (TRT) can stimulate puberty and the development of secondary sex characteristics in boys, such as growth of the penis, increased muscle mass and beard and pubic hair growth. To stimulate testicle growth, pituitary hormones may be used. To avoid adverse effects, an initial low dose of testosterone with gradual increases may help.

 

TYPES OF TESTOSTERONE REPLACEMENT THERAPY:

There are several testosterone delivery methods. Depending on one's preference of the cost, the side effects and a particular delivery system, one can choose a specific therapy. The methods include:

Injection:

It is given in a muscle about every two weeks. Injections of testosterone are safe and effective, and they can be given at home.

Oral:

Taking testosterone orally may increase the risk of heart disease, raise the cholesterol and cause liver problems; because of this, it isn't recommended for long-term hormone replacement.

Patch:

A patch containing testosterone is applied each night to the patient's back, abdomen, upper arm or thigh. To lessen skin reactions, the site of the application is rotated to maintain seven-day intervals between applications to the same site.

Gel:

Testosterone gel is rubbed on the patient's shoulder, upper arm or lower abdomen. The body absorbs testosterone through the skin as the testosterone dries. The gel application of testosterone replacement therapy appears to cause fewer skin reactions than patches do. To make sure the gel gets absorbed, the patient shouldn’t shower or bathe for several hours after a gel application. 

 

The possibility of transferring the medication to the partner or a child is a potential side effect of the gel. A black box warning to these products about this side effect was added by the FDA. The reason behind this is that such transfer has caused increased libido, advanced bone age, inappropriate enlargement of the genitalia and aggressive behavior in young children. Changes in body hair growth and acne and such secondary male sex characteristics may develop in women. People should steps like thoroughly washing the application area with soap and water before any situation in which one expects skin-to-skin contact, covering the application area with clothing once it's dried and washing their hands with soap and water after applying the medication in order to avoid the transfer of the application. 

 

Prognosis:

Not available

Expert's opinion

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