Hypogonadism is a condition in which the body produces little or no sex hormones. Normally the sex glands known as gonads in the body produce sex hormones, testosterone and estrogen. In men the testes and in women the ovaries are the gonads.
The sex hormones produced by these glands are responsible for the sexual characteristics in men and women. They control testicular development, sperm production, growth of pubic hair and masculine features in men; and pubic hair, breast development, menstruation and feminine features in women. Hypogonadism or gonad deficiency in males results in low production of testosterone. It is also called as andropause.
Types Of Hypogonadism
The gonads produce sex hormones, but these gonads are controlled by the hypothalamus and the pituitary gland in the brain, which send messages to the glands to produce sex hormones. Based on this mechanism, hypogonadism can be mainly classified into:
- Primary Hypogonadism – This occurs when there is improper functioning of the gonad itself, i.e. testes or ovaries and hence the sex hormones are not produced sufficiently. Although the gonads are receiving proper signals from the brain, the hormones are not being produced due to a defect primarily in the gonads.
- Central Hypogonadism – This occurs when the gonads are normal in their structure and function but do not receive proper signals from the brain. The defect, in this case lies within the brain or the center and hence although the gonads are normal, they do not produce sex hormones.
Causes of Hypogonadism
The causes of hypogonadism depend on its types.
Causes Of Primary Hypogonadism
- Genetic and developmental disorders like Klinefelter syndrome in men, Turner syndrome in women
- Some autoimmune disorders like Addison’s disease or autoimmune oophoritis in women
- Premature menopause, polycystic ovarian disease (PCOD), Noonan syndrome in women
- Anorchism and cryptorchidism in men
- Liver and kidney disorders
Causes Of Central Hypogonadism
- Genetic disorders like Kallmann syndrome, congenital adrenal hyperplasia, isolated hormone deficiency
- Congenital malformations especially with craniofacial defects
- Disorders of central nervous system
- Medications like steroids or opiates
- Pituitary glands disorders
- Nutritional deficiencies
- Sudden weight loss
- Radiation therapy
Clinical Features of Hypogonadism
Clinical features may vary with sex and the age when the condition is detected.
In boys, the sexual characters like beard, muscle development and overall growth is affected. Symptoms commonly observed in men include:
- Developmental anomalies of genital system like hypospadias, small penis
- Loss of muscle mass
- Reduced body hair and beard
- Erectile dysfunction
- Reduced sex drive and infertility
- Breast development.
In girls, menstruation is absent and sexual characters like breast development, growth and height is affected. Symptoms of hypogonadism commonly observed in women include:
- Stopping of menstrual cycles
- Loss of body hair
- Low sex drive
- Hot flashes
Some symptoms related to central causes like brain tumors may be seen. For example, headache, vision disturbances or loss, hormone deficiency symptoms, milky discharges from the breast.
Diagnosis of Hypogonadism
The physician would initially perform
Clinical Examination – This helps to detect sexual characters and their development, examine sex organs and breast development, body hair and muscle mass.
Hormone Tests – These are done to detect hormone levels and determine the type and cause of the condition. These include
- Testosterone levels in men
- Estrogen levels in women
- Follicle Stimulating Hormones (FSH) and Luteinizing Hormone (LH) to determine the functioning of pituitary gland in producing these sex hormones.
- Other hormone tests if found relevant.
Other Tests May Include
- Blood tests to detect anemia and iron levels
- Tests to determine bone age
- Thyroid hormone levels
- Prolactin level
- Sperm count
- Genetic tests.
Karyotype Test – this may be helpful in finding any chromosomal defect.
Sometimes testicular tissue testing and testicular biopsy may be considered.
Pelvic Ultrasound – This may be performed to identify any structural abnormality in ovaries or to detect PCOD.
MRI or CT Scan – This may be considered to detect tumors or other abnormality in the brain or pituitary gland.
Treatment of Hypogonadism
The main aim of treatment is to provide the sex hormones that are lacking in the body, treat any other underlying cause and manage the existing symptoms. For boys and girls in the pre-pubertal age, treatment is given for appropriate commencement of puberty. Hormone replacement therapy (HRT) is the mainstay of treatment.
Women are given replacement of estrogen and progesterone in the form of pill, skin patch. The exact treatment and type depends on the age and symptoms of the patient. Menstrual irregularities or infertility are treated with other hormones related to that function, in cases where positive outcomes can be expected.
Men can be given testosterone in the form of skin patch, gel, solution or injection, known as testosterone replacement therapy. Specific hormone treatment may be considered for triggering puberty or increasing sperm production depending on the symptoms.
Any underlying causes are treated appropriately. In case of pituitary gland tumors, medications, radiation therapy or surgery may be considered.
Prevention of Hypogonadism
All patients on HRT should follow the advice of their treating physician and need to be re-evaluated every 6 to 12 months. Lack of sex hormones can lead to other complaints like increased risk of heart disease and osteoporosis, due to thinning of bones. Consider taking vitamin, calcium or vitamin D supplements with medical advice.
For both men and women, it is important to maintain an ideal weight, consume a healthy balanced diet and exercise regularly to remain healthy and active.