Hypogonadism

Also referred to as hypogonadism, this condition may occur later in life or someone may be born with it. When the body is lacking sufficient testosterone hormone, men can experience a variety of symptoms and discomforts.

All men should know about this condition so that they know when to consult a doctor.

This condition is caused by the testicles not producing sufficient amounts of testosterone. There is a primary and secondary type. The primary type stems from an issue with the testicles, while the secondary type stems from a problem with the pituitary gland or hypothalamus. Common causes of the primary type include:

• Klinefelter syndrome
• Mumps orchitis
• Testicular injury
• Undescended testicles
• Cancer treatment
• Hemochromatosis

Common causes of the secondary type include:

• Kallmann syndrome
• Inflammatory disease
• Medications
• Normal aging
• Pituitary disorders
• HIV/AIDS
• Obesity
• Concurrent illness

In adult men, some of the physical characteristics associated with masculinity can become altered and normal reproductive function may be impaired. Symptoms may include:

• Infertility
• Reduced muscle mass
• Bone mass loss
• Erectile dysfunction
• Body hair and beard growth reduction
• Breast tissue development
• Reduced sex drive
• Hot flashes
• Fatigue
• Trouble concentrating

Men may also experience emotional and mental changes as their levels of testosterone decline. Symptoms, such as feeling depressed, are possible.

When someone is born with this condition, the level of testosterone deficiency plays a major role in their symptoms.

A physical examination is usually done first to look at the patient’s characteristics and to determine if the physical signs of hypogonadism is present. In addition, the following tests may be performed:

• Hormone testing
• Pituitary testing
• Testicular biopsy
• Semen analysis
• Genetic studies

Testing testosterone levels is also common. This testing may continue as the patient undergoes treatment to monitor their progress.

Treatments are based on whether the patient is an adult or a child, whether fertility is a concern, and the underlying cause. If a medical condition is causing it, treatment for this may be the first step to see if it helps improve hypogonadism. For adult men, the following may also be considered:

• Assisted reproduction if the patient is trying to achieve conception. When primary hypogonadism is present, no treatment can fully restore fertility, but there are techniques that may help improve the chances of conception.
• Hormone replacement is another option to increase the patient’s testosterone levels.

In children or adolescent boys, testosterone therapy may be considered. There are several methods to administer the testosterone in both adults and boys. Common methods include a patch, injections, topical gel, nasal gel, and implantable pellets. Which option is best depends on several factors and patients will work with their doctors to choose the best one.