Hypogonadism is a condition of absence of or reduction in sex hormone secretion by the sex glands i.e. gonads, which in males are the testes, and it can affect development of sex characteristics. It is classified into two types- primary hypogonadism and central hypogonadism. Primary hypogonadism more often than note occurs sometimes by surgical removal, disorder, or failure of the testes (may be from a chromosomal abnormaility. Central (secondary) hypogonadism is caused by problems with the pituitary gland or the hypothalamus, which then leads to the underproduction of hormones that stimulate functioning of the testes. At times, the two types can happen together or simultaneously.
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Prevalence
- Hypogonadism incidences increase with age in men and is quite high. There appears to be no consistent evidence that its prevalence is differently distributed between racial and ethnic groups. It can develop and manifest at any age.
- According to the Hypogonadism In Males study, 38.7% of males 45 years or older have it. Hypogonadism can be correlated with low testosterone levels, and in a study in Baltimore, the percentage of men with low testosterone levels from 12% to 49% from men in the 50s to over 80 years old, respectively. It is estimated that only 5-35% of males with hypogonadism receive treatment for it.
Causes
Primary Hypogonadism
Primary hypogonadism is where the testes do not function properly.
- Genetic disorders/abnormality: Klinefelter syndrome (two X chromosomes as well as a Y chromosome, resulting in abnormal development of sexual characteristics and leads to poor development of the testicles and ovaries, thus underproduction of sex hormones)
- Undescended testicles is when one or both of the testicles do not descend at birth (they develop inside the abdomen and are supposed to move down permanently in their place at the scrotum). It often corrects itself during the first few years of life, but if not it could lead to testicle malfunction and reduced testosterone production
- Mumps infection involving the testicles and salivary glands during adolescence or adulthood can result in long-term testicle damage
- Autoimmune disorders
- Surgery, either getting testes removed or complications after surgery such as...
- Infections and disorders that affect the liver, adrenal glands, and thyroid glands, as well as type 1 diabetes
- Trauma caused by injury such as in sports that impairs testicular function
- Cancer treatments like radiation and chemotherapy can lead to production of testosterone and sperm
- Aging for men also means lower testosterone production and atrophy of the testis, increasing chances of hypogonadism
- Too high iron levels in the blood can cause testicular failure and affecting testosterone production (Hemochromatosis)
- Use of certain drugs like opiates or hormones have been found to affect testosterone levels, resulting in hypogonadism
Central (Secondary) Hypogonadism
Secondary Hypogonadism is where brain areas the control sex glands don't function properly, resulting in altered secretion of testosterone (pituitary gland and/or the hypothalamus). The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then signals the testes to produce testosterone.
- Abnormalities in hypothalamus development or the pituitary gland (which controls hormones secreted by pituitary gland), notably the Kallmann syndrome as a genetic origin, or trauma, tumor formation, cancer for the tumors, etc.
- Inflammation, resulting from infections, such as when the hypothalamus and pituitary gland are inflamed from tuberculosis, histiocytosis, and others
- Obesity at any age is linked to hypogonadism
- AIDS, as the HIV virus can affect the hypothalamus and pituitary gland
- Stress
- It can be inherited
Symptoms
There may be no obvious or minimum symptoms during childhood/ before puberty, but symptoms in adulthood can include:
- Testosterone levels lower than 300 ng/dL
- Poor penile sensation
- Low sex drive than usual/normal
- Difficulty in reaching orgasm
- Erectile dysfunction
- Poor energy levels and stamina
- Anemia
- Osteoporosis (low bone density)
- Hot flashes
- Infertility
In boys going through puberty, symptoms include:
- Decreased development of muscle mass
- Voice not deepening
- Impaired body hair growth or of penis or testicles
- Non-proportionate growth of limbs compared to torso
- Breast tissue development
Progression
Males advance through the stages more slowly than women. All stages are considered hypogonadism
- Stages 1-2: Mild to moderate hypogonadism, usually occurs between 30-55 years old
- Stage 3: Advanced hypogonadism, occurs by 55-60 years and older
Not many sources explicitly define hypogonadism through stages, but it differs at the age in which it is developed. It typically starts with lack of or no appearance of male sex characteristics, and progresses to lack of energy and accompanying fatigue, ultimately increasing chances of mortality.
Treatment
The most common treatments are hormone-based medicine or hormonal therapy. Both are shown to work. Hormone-based medicines for men usually include testosterone or work to increase testosterone levels, relieving symptoms. Hormonal therapy works with men to cope with their life's distress accompanying hypogonadism. Doctors also use male hormone replacement therapy, which can restore muscle strength and prevent bone loss, as well as increase energy levels and sense of well-being. Complications involving tumors most often than not require surgery.
