Hypogonadism
Hypogonadism is a medical condition characterized by reduced function of the gonads, which are the testes in males and ovaries in females. This condition can result in insufficient production of hormones crucial for sexual development and reproduction. Hypogonadism can be classified into two main types: primary hypogonadism, where the gonads themselves fail to function properly, and central hypogonadism, which arises from issues in the brain's control centers that regulate these glands. The onset of hypogonadism can occur at different life stages, leading to distinct symptoms such as delayed puberty, infertility, and changes in secondary sexual characteristics.
In children, those with primary hypogonadism may not experience expected growth and development during puberty, while adults experiencing central hypogonadism may encounter symptoms like fatigue, erectile dysfunction, and diminished libido. There are various causes of hypogonadism, including genetic disorders, infections, and certain medical treatments. Diagnosis typically involves hormone level testing and imaging studies to assess the health of the pituitary gland. Treatment options often include hormone replacement therapy to restore hormonal balance and, in some cases, assist with fertility. Understanding hypogonadism is essential for addressing its health implications and managing its effects on individuals' quality of life.
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Hypogonadism
Hypogonadism is a condition that leads to reduced function of the gonads, or the sex glands. These glands, which are testes in men and ovaries in women, produce few to none of the hormones that play a role in sexual development during puberty.
People can be born with this condition, or develop it later in life as a result of infection or injury. Primary hypogonadism stems from problems of the testes or ovaries, and the ovaries or testes themselves fail to function correctly. Central hypogonadism results from problems in the brain centers that control the gonads. The pituitary gland and the hypothalamus do not function properly, leading to decreased levels of luteinizing hormone (LH) and follicle stimulating hormones (FSH).
Girls and boys with primary hypogonadism do not reach puberty as expected. Girls do not get their periods, and boys show limits in their growth. Adults with central hypogonadism see their signs of puberty reversing. Hormone-based medicines can be used to treat hypogonadism.
Background
Hypogonadism, a condition in which the body does not produce enough sex glands, can begin at different times of human development. Its onset can be during fetal development, before puberty, or during adulthood. Depending on when the condition develops, different signs and symptoms will appear.
When the body does not produce enough sex glands during fetal development, the result might be that the external sex organs might fail to grow to the anticipated size.
When hypogonadism occurs before puberty, a girl will not begin menstruating, and breast development and height might be limited. In a boy, puberty can be delayed, his voice might not deepen, and he may experience low muscle mass, impaired growth of the penis and testicles, development of breast tissue, and excessive growth of the arms and legs compared to the body’s torso.
When hypogonadism occurs after puberty, women can experience symptoms such as hot flashes, loss of body hair, stopping menstruation, and low libido. The ovaries become suppressed, resulting in infertility, decreased libido, breast atrophy, and osteoporosis.
In men, hypogonadism that appears post-puberty can cause symptoms such as infertility, erectile dysfunction, decrease in beard and body hair growth, development of breast tissue, and loss of bone mass. As their testosterone decreases, they may experience symptoms mimicking those of menopause in women. Fatigue, hot flashes, difficulty concentrating, and decreased sex drive might occur.
Causes. Some causes of primary hypogonadism, in which the ovaries or testes do not function as they should, have been identified. It can be caused by infection, genetic disorders, autoimmune disorders, liver disease, kidney disease, surgery, or radiation. Two genetic disorders that are known to cause primary hypogonadism are Turner Syndrome in women and Klinefelter Syndrome in men. Certain sources of central hypogonadism, in which the brain centers controlling the gonads are affected, have also been pinpointed. These include anorexia, brain tumors, infections, iron excess, radiation, nutritional deficiencies, rapid weight loss, trauma, surgery, bleeding in the area of the pituitary gland, and taking certain medicines, such as opiates. Kallmann Syndrome, a disorder that also causes a reduced sense of smell, is another known cause of central hypogonadism. In the case of a pituitary tumor or other brain tumor causing the condition, other blatant symptoms, such as headaches, vision loss, milky breast discharge, and hypothyroidism commonly appear.
Overview
In the medical condition of hypogonadism the testes or ovaries do not function properly. The testes (in males) and ovaries (in females) work in concert with two parts of the brain, the hypothalamic region and the pituitary gland. The gonads (sex hormones), hypothalamus, and the pituitary gland function together to help the body reach and maintain puberty. When working correctly, the hypothalamus releases a hormone called LHRH. The LHRH stimulates the pituitary gland to give off two other hormones, FSH and LH. The FSH and LH stimulate the testis and ovary to function. In turn, the gonads’ increased blood levels cause the pituitary gland to reduce the amount of FSH and LH it gives off. When this system is interrupted at any level, hypogonadism may arise.
Primary hypogonadism, which sets in before puberty, occurs when the gonad cannot produce enough sex hormone to suppress the amount of LH and FSH that is produced. Central hypogonadism, which appears after puberty, might result from a deficiency of LHRH in the hypothalamus, or from the pituitary gland’s problem in secreting LH and FSH. Usually, though, central hypogonadism develops after trauma, tumors, or radiation cause injury to the hypothalamus and/or pituitary gland.
Hypogonadism is not fatal. However, for both men and women, it can cause additional health problems such as anemia, osteoporosis, and infertility.
Diagnosis and Treatment. To diagnose hypogonadism, medical professionals are likely to test hormone levels. In females, they will test for estrogen, and in males, for testosterone. Additionally, they will test levels of the hormones LH and FSH, both of which are pituitary hormones affected by the gonads.
Other commonly administered tests are those that measure thyroid hormones and prolactin, which is a hormone released by the pituitary gland that stimulates breast development and milk production. Some doctors might also test for anemia and possible genetic disorder. Men who are suspected to have hypogonadism might have their sperm levels counted, and women might be sent for a sonogram of their ovaries.
If doctors suspect pituitary disease, they might send the patient for an MRI or CT scan, in order to better examine the pituitary gland.
Hormone replacement therapy can effectively treat hypogonadism in men and in women who have not yet reached menopause. Estrogen and progesterone, either in pill or skin patch formulations, can be effectively prescribed to girls and women. Women who have a low sex drive might be prescribed a low dose of testosterone.
For boys and men, the standard treatment is TRT—testosterone replacement therapy. The testosterone is applied via injection, skin gel, skin patch, or a putty-like substance that is placed on the gums.
Restoring fertility to people with central hypogonadism can be difficult. For some women, hormones in the form of injections or pills can stimulate ovulation, which means producing eggs that can be fertilized and create a pregnancy. For men, injections of pituitary hormone might be used to help produce sperm. Some men require surgery and radiation therapy to produce sperm, so they will be able to have children.
Bibliography
Basaria, Shehzad. "Male Hypogonadism." The Lancet 383.9924 (2014): 1250-63.
Chang, Simon, Anne Skakkebæk, and Claus Højbjerg Gravholt. "Klinefelter Syndrome And Medical Treatment: Hypogonadism and Beyond." HJ (2015): n. pag.
Giwercman, Aleksander, and Yvonne Lundberg Giwercman. "Hypogonadism in Young Men Treated for Cancer." HJ 14.4 (2015): 590-97.
Jones, T H. "Late Onset Hypogonadism." BMJ 338.feb13 1 (2009): b352-b352.
Kemp, Stephen, and George Griffing. "Hypogonadism Treatment & Management: Medical Care, Surgical Care, Consultations." Emedicine.medscape.com, 2016, n.p. Web. 27 June 2016.
Raivio, Taneli. "Hypogonadotropic Hypogonadism." Endocrine Abstracts (2013): n. pag.
Sinha, Sanjai. "Acquired Causes of Secondary Hypogonadism in the Adult Male." MedPage Today. MedPage Today, 2012, n. pag. Web. 27 June 2016.
Winters, Stephen J. Male Hypogonadism. Totowa, N.J.: Humana Press, 2004. Print.