Hypogonadism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 4, 2016
StartDiseasesHypogonadism

Hypogonadism is a common condition that is marked by a lack of testosterone or estrogen. It affects both women and men and can occur before or after puberty, causing a wide range of symptoms. The condition is not typically life-threatening but can disrupt puberty and/or cause problems with reproductive functions of adults that reduce a person's quality of life.

Contents

Definition & Facts

Hypogonadism is a condition where the sex organs, or gonads, do not create enough hormones in the body. When these organs are affected, the body produces little or no testosterone or estrogen. The lack of these hormones causes complications with various sex characteristics.

There are two types of hypogonadism. The first type is called primary hypogonadism which means there is a problem with the ovaries or testes themselves; the brain is sending the correct signal, but the organ is not responding properly. The second type, central hypogonadism, is when the problem originates in the brain; that is, the brain is not sending the signal to create the proper hormones.

Symptoms & Complaints

How the condition affects the patient depends on when it manifests. For patients who get hypogonadism before puberty, the condition will cause them to not grow as much as their peers.

Sexual maturity, or puberty, is slowed or does not come at all. After puberty, the symptoms are more varied between men and women. Women with the condition will often find that their menstrual cycle is slowed or stopped altogether (amenorrhea). Also, the breasts can grow slowly or be underdeveloped. In certain situations, there may be a milky discharge from the breasts.

Men are likely to take on a softer, less lean appearance due to the lack of testosterone. This can also cause issues with male infertility as well as erectile dysfunction. Lack of testosterone can also cause the penis and testicles to be smaller in size.

A man might also find that he has difficulty concentrating. In many cases of hypogonadism, osteoporosis can develop in the bones of men with the condition. The lack of testosterone or estrogen in the body will lower or completely diminish the sex drive in either gender. There is also a high likelihood that a man or a woman will experience hot flashes

Causes

The causes of hypogonadism vary based on which form of the condition the patient has. If the patient has the “primary” form, the condition is caused by a malfunction in the testes or ovaries. This could be caused by genetic factors or certain autoimmune diseases. Liver disease and kidney disease can be a factor, or the dysfunction could also be caused by external traumas to the body such as surgery, radiation, or infection. The problem could originate in the chromosomes of the patient, in cases where they have Turner syndrome or Klinefelter syndrome.

If it is the central form of the condition, the brain itself is failing to tell the ovaries or testicles to produce estrogen and testosterone. Genetic mutations that have been identified as being associated with central hypogonadism affect the following genes: KAL 1 gene, DAX1, GNRHR, and proprotein convertase 1.

Central hypogonadism could also be due to nutritional problems. It could be caused by being overweight or obese or underweight or having anorexia nervosa. Having an excessive amount of iron in the body (hemachromatosis) may also be a cause of hypogonadism. It could also be triggered by surgery, a tumor, or bleeding near the pituitary gland. Also, certain medicines, like opioids, can be a cause. 

Diagnosis & Tests

Hormone tests are the most common way to check for hypogonadism. The first hormone tests will be looking for follicle stimulating hormone, also called FSH, and luteinizing hormone or LH. These are the hormones that stimulate the testes and ovaries. For men, the doctor will test the testosterone levels and will sometimes test the sperm as well. In women, the doctor will be looking at estrogen levels.

Low levels of any of these hormones can show that the gonads of the patient are not functioning properly. These hormones are checked by taking a blood test. Blood tests may also be used to check for any underlying causes of the condition. In some cases, imaging tests will be ordered. For some women, this will mean an ultrasound to check the ovaries for ovarian cysts or signs of polycystic ovary syndrome (PCOS).

Other imaging tests, like MRIs and CT scan may be used to check the brain, especially if the “central” form of the condition is suspected. Genetic testing can be performed to detect genetic mutations associated with the condition.

Treatment & Therapy

The most common treatment for hypogonadism is hormone replacement therapy. This will replace or aid the body’s natural hormones to counteract the symptoms of the condition. Men will be given testosterone. This testosterone can be taken as a pill or applied to the skin as a gel or patch. One of the most common and inexpensive ways men receive this treatment is through regular injections. There are even treatments that can be applied like an underarm deodorant.

Women will be given a mixture of estrogen and progesterone. The estrogen can be taken as either a pill or a wearable patch. For most people, the hormone replacement therapy by itself is enough to see a significant change. In extremely rare cases in which the underlying cause of the hypogonadism poses a danger, surgery may be needed. Surgery would be needed if a tumor was present. If the ovaries or testicles may be cancerous, they are removed. In men, a prosthesis can be used after surgery.

Prevention & Prophylaxis

Many of the causes of hypogonadism cannot be prevented like infection, surgery, or genetics. However, obesity, rapid weight loss, anorexia nervosa and iron levels can also be a cause for the condition. These factors may be able to be controlled by seeking mental health care treatment via psychotherapy, eating a balanced diet, getting regular exercise, and maintaining a healthy weight.