Causes and Diagnosis of Hypogonadism | Endocrinology


What is hypogonadism?

Hypogonadism occurs when your sex glands are low or do not produce sex hormones. The sex glands, also known as gonads, are primarily the testes in men and the ovaries in women. Sex hormones help regulate secondary sex characteristics, such as breast development in women, testicular development in men, and the growth of pubic hair. Sex hormones also play a role in the sexual cycle and sperm production.

Hypogonadism is also known as gonadal insufficiency. When this happens in men, it is called andropause or low serum testosterone. Hypogonadism is a condition in which the testicles do not function as they should.

In adults, the testes have two main functions: testosterone (the male hormone) and producing sperm. These activities are a part of the brain called the pituitary. The pituitary sends signals (called gonadotropins) to the testicles that, under normal circumstances, cause the testicles to produce sperm and testosterone.

The signals from the pituitary can vary depending on the feedback signals the brain receives from the testes. Therefore, hypogonadism can be divided into two main categories:

  • Problem with signals from the brain to the testicles
  • The problem is in the testicles themselves.
  • These categories are important because they affect how hypogonadism is treated and play a role in the outcome.

Types of hypogonadism

Types of hypogonadism: primary and central.

Primary hypogonadism

Primary hypogonadism means that you don’t have enough sex hormones in your body due to a problem with your gonads. Your gonads keep getting the message to make hormones in your brain, but they can’t make them.

Central (secondary) hypogonadism

In central hypogonadism, the problem is in your brain. The hypothalamus and pituitary gland that controls your gonads do not work properly.

Causes of hypogonadism

Causes of primary hypogonadism:

  • Autoimmune disorders such as Addison’s disease and hypoparathyroidism.
  • Genetic disorders such as Turner syndrome and Klinefelter syndrome
  • Acute infections, especially of the testicles.
  • Liver and kidney disease
  • Unexplained testicles
  • Hemochromatosis, which occurs when your body absorbs too much iron
  • Exposure to radiation
  • Surgery on your genitals

Central hypogonadism can be due to:

  • Genetic defects such as Coleman syndrome (abnormal hypothalamic development)
  • Infections, including HIV
  • Pituitary disorders
  • Inflammatory diseases such as sarcoidosis, tuberculosis, histiocytosis.
  • Blackberry
  • Rapid weight loss
  • Nutritional deficiencies
  • Use of steroids or opioids.
  • Brain surgery
  • Exposure to radiation
  • Injury to the pituitary gland or hypothalamus
  • A tumor in or near the pituitary gland.

Symptoms and signs of hypogonadism

Women with hypogonadism do not initiate structural ejaculation and this affects their height and breast development. Adolescence in women can cause menstrual problems, decreased libido, loss of body hair, and hot flashes. In men, it can lead to muscle weakness and body hair development, gynecomastia, loss of height, erectile dysfunction, and sexual dysfunction. If hypogonadism is caused by a disorder of the central nervous system (for example, a brain tumor), it is called central hypogonadism. Signs and symptoms of central hypogonadism include headache, vision problems, double vision, milky discharge from the breast, and other hormonal problems.

Hypogonadotropic hypogonadism

Symptoms of hypogonadotropic hypogonadism, a subtype of hypogonadism, include developmental delay, incomplete or adolescent development, and sometimes mild shortness of breath or inability to smell; In women, breast enlargement and structure, and in men, they have no sexual development, for example, facial hair, penis, and testicles, deep throat.

Risk factors

During fetal development, hypogonadism begins before or during puberty.

  • Fetal development: If the body does not produce enough testosterone during fetal development, the result can be poor growth of the external genitalia. Depending on when hypogonadism develops and how much testosterone is present, a genetically male child can be born with:
  • Female genitals
  • Genitalia that is not clearly male or clearly female (dark genitalia)
  • Undeveloped male genitalia
  • Adolescence

Male hypogonadism delays puberty or causes a lack of normal or incomplete development. Interferes with:

  • Development of muscle mass
  • The voice intensified
  • Growth of body and facial hair
  • Penis and testicle growth

And it may be due to:

  • Development of breast tissue (gynecomastia)
  • Adolescence: In adult males, hypogonadism can alter certain male physiological characteristics and affect normal reproductive function. The first signs and symptoms may include:
  • Decreased sex drive
  • Energy is reduced
  • Depression

Over time, men with hypogonadism develop:

  • Erection
  • Sterility
  • Decreases hair growth on the face and body.
  • The decrease in muscle mass.
  • Development of breast tissue (gynecomastia)
  • Loss of bone mass (osteoporosis)
  • Severe hypogonadism can also cause psychological and psychological changes. When testosterone is low, some men have symptoms similar to those of menopause in women. These include:
  • Difficult to focus
  • Hot flushes; Hot vapours

Diagnosis of hypogonadism

Early detection in children can help prevent problems as they come of age. Early diagnosis and treatment in men can provide better protection against osteoporosis and other related conditions. Your doctor will do a physical exam to see if your sexual development, pubic hair, muscle mass, and the size of your testicles are appropriate for your age.

Your doctor will test your blood testosterone level if you have signs or symptoms of hypogonadism. Since testosterone levels vary and are generally high in the morning, a blood test is usually done early in the day, before 10 a.m., probably for more than a day. If tests confirm that you have low testosterone, further tests can determine if it is caused by a testicular disorder or a pituitary abnormality. These studies can include:

  • Hormone test
  • Semen analysis
  • Pictures of the pituitary
  • Genetic studies
  • Testicular biopsy

Hypogonadism treatment

Adult men

Male hypogonadism is usually treated with the restoration of testosterone so that testosterone levels return to normal. Testosterone can help combat the signs and symptoms of male hypogonadism, such as decreased sex drive, decreased energy, loss of facial and body hair, and loss of muscle mass and bone density.

For the elderly who have low testosterone levels and signs and symptoms of hypogonadism due to aging, the benefits of testosterone replacement are less obvious.

When taking testosterone, the Endocrine Society recommends that your doctor monitor the effectiveness of treatment and side effects for the first year of treatment and for the following year.

Types of testosterone replacement therapy

Oral testosterone preparations have not been used to treat hypogonadism because they can cause serious liver problems. Also, they do not keep testosterone levels stable.

The FDA recently approved the manufacture of oral testosterone replacement endoconazole (jatenzo) absorbed by the lymphatic system. It can prevent liver problems seen with other oral forms of testosterone.

Convenience, cost, and other arrangements you choose based on your insurance coverage:

  • Gel. There are many gels and solutions available, there are different ways to apply them. Depending on the brand, you can rub testosterone on the upper arm or shoulder (Androgel, Testim, Vogelxo) or apply it to the front and inner thigh (Fortesta).
  • Your body absorbs testosterone through your skin. Do not bathe or bathe for several hours after applying the gel, make sure it is absorbed.
  • Side effects include skin irritation and the possibility of transferring the drug to another person. Avoid skin-to-skin contact until the gel is completely dry or cover that area after application.
  • Injection. Testosterone cypionate (depot-testosterone) and testosterone enanthate are administered intramuscularly or under the skin. Your symptoms will vary between doses depending on the frequency of the injections.
  • If you are not comfortable giving yourself an injection, a nurse or doctor may give you injections.
  • Testosterone endoconazole (AWD) is given by deep intramuscular injection, usually every 10 weeks. It must be administered in your doctor’s office and can cause serious side effects.
  • Patch. A patch containing testosterone (androderm) is applied to the thighs or torso every night. A possible side effect of a severe skin reaction.
  • Gums and cheeks (oral cavity). A small putty-like substance, resetting testosterone in the gums and cheeks provides testosterone through the natural depression on the upper teeth, where the gum meets the upper lip (oral cavity).
  • If this product is taken three times a day, it will stick to the gum line and allow testosterone to integrate into the bloodstream. May cause gu1m irritation.
  • Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This option reduces the risk of transmission to another person through skin contact. Nasal testosterone should be applied to each nostril twice, three times a day, which is more uncomfortable than other methods of administration.
  • Adjustable cartridges. Capsules containing testosterone (testosterone) are surgically implanted subcutaneously every three to six months. This requires cutting.

Testosterone treatment involves a variety of risks, including:

  • Increased production of red blood cells
  • Acne
  • Extended breasts
  • Sleep disturbance
  • Enlarged prostate
  • Limited sperm production

Treatment of infertility due to hypogonadism

If the cause is the pituitary problem, pituitary hormones may be given to stimulate sperm production and restore fertility. The pituitary tumor may require surgical removal, medication, radiation, or replacement of other hormones.

There is often no effective treatment to restore fertility in a man with primary hypogonadism, but assisted reproductive technology can help. This technique covers several methods designed to help couples who cannot conceive.

Treatment for children

Three to six months of injectable testosterone replacement stimulate puberty and the development of secondary sexual characteristics, such as muscle mass, chin and pubic hair growth, and growth.

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