Do you experience erectile dysfunction, enlarged breast, muscle loss or infertility due to low sperm count as a man? Or abnormal menstruation and milky nipple discharge as a female? If yes, you might be experiencing something called hypogonadism. However, you are not alone; approximately 4 to 5 million men in the United States have hypogonadism, which can affect men of any age but is more prevalent in older men. Free testosterone levels are typically below those of men between the ages of 30 and 35 in more than 60% of males over the age of 65. In this blog post, we will be discussing, in detail, the meaning of hypogonadism, its classifications, causes, and treatment.
WHAT IS HYPOGONADISM?
Hypogonadism occurs when one’s sex glands produce little or no sex hormones. The testicles in men and the ovaries in women are the main sex glands, commonly known as gonads. Secondary sex traits, such as pubic hair growth and breast and testicular development in men and women are influenced by sex hormones. The menstrual cycle and sperm generation are two other processes influenced by sex hormones. Another name for hypogonadism is gonad deficiency. When it affects men, it may be referred to as andropause or low serum testosterone.
CLASSIFICATION OF HYPOGONADISM
Although the main types of hypogonadism are primary and secondary, it can be classified in more ways than one, including but not limited to classifications such as primary or secondary, congenital vs. acquired, and hormones vs. fertility. All these classifications will be briefly discussed.
PRIMARY OR SECONDARY
Primary hypogonadism occurs when you don’t have adequate sex hormones in your body because of a problem in your gonads. Your brain is still sending signals to your gonads to generate hormones, but they are unable to do so.
Secondary or Central hypogonadism
This kind of hypogonadism signifies an issue with the pituitary gland or hypothalamus, two regions of the brain that communicate with the testicles to generate testosterone. Gonadotropin-releasing hormone, which is produced by the brain, instructs the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The production of testosterone is then triggered by the luteinizing hormone.
CONGENITAL VS ACQUIRED
Either primary or secondary hypogonadism, whether inherited (congenital) or something that happens later in life (acquired), can be brought on by an illness or injury that occurs later in life.
A genetic condition known as congenital hypogonadism is characterized by a GnRH shortage and is frequently accompanied by a number of non-reproductive symptoms, including the loss of smell and structural malformations of the bone, eye, ear, kidney, and heart. The genetic make-up of congenital hypogonadism patients has been extensively studied thanks to recent advancements in DNA sequencing technology, which have also highlighted the resilient yet complicated structure of the human reproductive neuroendocrine system. Turner syndrome and Klinefelter syndrome are two instances of congenital causes of hypogonadism, that is, causes that are present at birth. It is a symptom of CHARGE syndrome as well.
Acquired hypogonadism is characterized by illnesses with a postnatal onset that impair or change the function of pituitary gonadotroph cells and/or gonadotropin-releasing hormone (GnRH) neurons. Thus, Acquired hypogonadism blocks the development of gonadotropin production during puberty or its maintenance beyond puberty. Although sellar tumors or cysts of the hypothalamus or infundibulum, infiltrative, vascular, iron overload, and other illnesses may also cause Acquired hypogonadism, pituitary tumors, particularly prolactinoma, are the most frequent cause. AHH is frequently caused by pituitary surgery, head trauma, or cranial/pituitary radiation therapy.
HORMONES VS FERTILITY
Hypogonadism can involve just hormone production or just fertility, but most commonly involves both.
Hypopituitarism and Kallmann syndrome are two examples of hypogonadism that primarily impair hormone production rather than fertility. In both of these conditions, fertility is decreased until hormone restoration but can be restored with hormone replacement alone.
Hypogonadism such as Klinefelter syndrome and Kartagener syndrome mostly impacts fertility rather than hormone production.
CAUSES OF HYPOGONADISM
Similarly, the causes of hypogonadism can be divided into causes of primary hypogonadism and causes of secondary hypogonadism, which will be discussed below.
Common causes of primary hypogonadism include:
- Genetic disorders such as Turner syndrome and Klinefelter syndrome: Particularly, Klinefelter is a congenital disorder of the X and Y chromosomes. There is typically one X and one Y chromosome in a male. In addition to one Y chromosome, Klinefelter syndrome is characterized by the presence of two or more X chromosomes. The genetic material that defines a child’s sex and subsequent development is found on the Y chromosome. The Klinefelter syndrome’s extra X chromosome results in faulty testicular development, which in turn reduces testosterone production.
- Undescended testicles. The testicles grow inside the abdomen prior to birth and often descend to take up residence in the scrotum. Occasionally, neither of the testicles descends at birth. Without any treatment, this illness frequently gets better on its own throughout the first few years of life. It can result in testicular dysfunction and decreased testosterone production if it is not treated early.
- Mumps orchitis. When the testicles are affected by mumps during adolescence or maturity, the testicles’ function and testosterone production may be compromised.
- Hemochromatosis. The synthesis of testosterone can be affected by pituitary gland malfunction or testicular failure brought on by an excess of iron in the blood.
- Injury to the testicles. The testicles are vulnerable to harm since they are located outside the abdomen. Hypogonadism may result from damage to both testicles. One testicle damage might not affect the production of testosterone overall.
- Radiation exposure. The production of testosterone and sperm can be affected by cancer treatments like chemotherapy and radiation therapy. Both treatments’ effects are frequently transient, although infertility that is permanent is a possibility. Although many men restore their fertility within a few months of treatment, men do have the option of conserving sperm before beginning cancer treatment.
The testicles are normal in secondary hypogonadism, but they don’t work correctly because of a pituitary or hypothalamic disorder. Secondary hypogonadism can result from a variety of circumstances, including:
- Kallmann’s syndrome. The region of the brain that regulates the release of pituitary hormones has developed abnormally in this case (hypothalamus). Red-green color blindness and anosmia, which affects the sense of smell, can also be caused by this condition.
- Pituitary disorders. The natural synthesis of testosterone can be affected by a pituitary disorder that interferes with the pituitary gland’s ability to deliver hormones into the testicles. Deficits in testosterone or other hormones can result from a pituitary tumor or another type of brain tumor that is close to the pituitary gland.
Additionally, the pituitary gland might be impacted by a brain tumor’s treatment, such as surgery or radiation therapy, leading to hypogonadism.
- Inflammatory disease. Certain inflammatory conditions that affect the hypothalamus and pituitary gland, including sarcoidosis, histiocytosis, and tuberculosis, can impact testosterone production.
- Medications. The synthesis of testosterone can be impacted by the use of several pharmaceuticals, including some hormones and opiate painkillers.
- Obesity. At any age, being significantly overweight may be associated with hypogonadism.
- HIV/AIDS. Low testosterone levels can result from HIV/AIDS because it affects the hypothalamus, pituitary, and testes.
- Aging. A gradual, steady decline in testosterone production occurs in males as they get older. The rate is quite variable.
SYMPTOMS OF HYPOGONADISM
Depending on the reason and the person’s gender, hypogonadism symptoms can differ. When adolescents delay the onset of puberty, secondary hypogonadism may be diagnosed. Teenage girls with hypogonadism, for instance, may not start their periods or form breasts. Boys may not develop facial hair or have testicles that are not fully grown.
Adults may experience hot flashes, hair loss, and reduced sex drive (sexual dysfunction). The inability to concentrate and feeling tired are additional frequent concerns.
Signs of hypogonadism in females include:
- Abnormal menstruation.
- Milky nipple discharge.
Signs of hypogonadism in males include:
- Enlarged breasts (gynecomastia).
- Infertility due to low sperm count.
- Erectile dysfunction.
- Muscle loss.
HOW IS HYPOGONADISM DIAGNOSED?
Your medical professional will evaluate your symptoms and do a physical examination. Also possible for women is a pelvic exam. You could undergo any of the following tests:
- Blood test: A blood test can measure levels of iron, prolactin (a hormone produced by the pituitary gland), thyroid hormones, and sex hormones. When hormone levels are at their highest, which is in the morning, you will have this test.
- Imaging tests: Brain or pituitary tumors can be found with an MRI or CT scan. An ultrasound can detect issues like polycystic ovary syndrome or ovarian cysts (PCOS).
- Semen analysis: This test measures sperm count.
HOW IS HYPOGONADISM MANAGED OR TREATED?
Depending on the reason, hypogonadism therapies can differ. Hormone replacement treatment can increase hormone levels in cases of primary hypogonadism. While women may receive estrogen and progesterone hormone therapy, men may receive testosterone therapy.
Testosterone replacement therapy (TRT) is the most common treatment for low testosterone levels in men. This means that it’s injected into the body through a needle and gives you more energy, improves muscle mass and strength, increases sex drive and feelings of well-being overall. Gel forms like gels can also be used by men who would like some convenience while avoiding needles altogether; however, there isn’t much evidence that these products work better than other forms such as injections or patches!
Testosterone pellets may be considered if you have low testosterone levels. These pellets are implanted under the skin or in the fat under the skin of your hip area by a doctor. This can be done as an outpatient procedure.
For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy
Ultimately, if you think you may have hypogonadism, it’s important to see a doctor for diagnosis and treatment. At HRT Doctors Group, we offer a wide range of medical services by qualified medical practitioners to help you in the treatment of your hypogonadism. Doctor consultations are available by phone or video call – no sitting in the waiting room! Feel free to reach us out – schedule a free consultation!
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Dr. Jay Flottman
Dr. Jay Flottmann is a physician in Panama City, FL. He received his medical degree from University of Texas Medical Branch and has been in practice 21 years. He is experienced in military medicine, an FAA medical examiner, human performance expert, and fighter pilot. Professionally, I am a medical doctor (M.D. from the University of Texas Medical Branch at Galveston), a fighter pilot (United States Air Force trained – F-15C/F-22/AT-38C), and entrepreneur.
- Education & Training
- National Defense UniversityNational Defense University – M.S., 2015
- Keesler Medical CenterKeesler Medical Center – Residency, Pediatrics, 1997 – 1998
- University of Texas Medical Branch School of Medicine – Class of 1997
- Texas A&M University – B.S., Biomedical Science, Magna Cum Laude, 1993