Hypogonadism

Puberty

Male hypogonadism may delay puberty or cause incomplete or lack of normal development. It can cause:

• Decreased development of muscle mass
• Lack of voice deepening
• Impaired growth of body hair
• Impaired growth of testicles and penis
• Excessive growth of the arms and legs in relation to the trunk of the body
• Development of breast tissue (gynecomastia)

Adulthood

In adult males, hypogonadism may alter a few masculine physical characteristics and also impair normal reproductive function. Signs and symptoms include:

• Erectile Dysfunction
• Infertility
• The decrease in beard and body hair growth
• The decrease in muscle mass
• Development of breast tissue (gynecomastia)
• Loss of bone mass (osteoporosis)

Hypogonadism also causes mental and emotional changes. As testosterone decreases, some men may experience symptoms similar to those of menopause in women. These may include:

• Fatigue
• Decreased sex drive
• Difficulty concentrating
• Hot flashes

When to see a doctor

One should see a doctor when the signs and symptoms start appearing. Establishing the cause of hypogonadism is the important first step to acquiring appropriate treatment.

Causes of Hypogonadism

Male hypogonadism is a result of inadequate amounts of testosterone produced by the testicles. There are two types of hypogonadism. They are:

• Primary Hypogonadism: This type of hypogonadism is also known as a primary testicular failure. This occurs due to a problem which originates in the testicles.


• Secondary Hypogonadism: This type of hypogonadism indicates a problem with the hypothalamus or pituitary glands. These are the parts of the brain that signals the testicles to produce testosterone. The hypothalamus produces a gonadotropin-releasing hormone which stimulates or signals the pituitary glands to produce follicle stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormones signal the testicles to produce testosterone.

Either type of hypogonadism may be inherited (congenital) or can occur in later stages of life (acquired) due to an infection or an injury. In rare cases, both primary and secondary hypogonadism may occur together.

Primary Hypogonadism

Common causes of primary hypogonadism include

• Klinefelter Syndrome: This condition results from a congenital abnormality of the sex chromosomes, X and Y chromosomes. Usually, a male has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosome is present in addition to the Y chromosome. The Y chromosome has the genetic material that determines the sex of the child and related developments. The extra X chromosome which occurs in Klinefelter syndrome causes abnormal development of testicles, which in turn results in the underproduction of testosterone.


• Undescended Testicles: Before birth, the testicles develop inside the abdomen and normally move down into their permanent place the scrotum. Sometimes one or two testicles may not descend at birth. This condition often corrects itself in the first few years of life without any treatment. If it is not corrected in early childhood, it will lead to malfunction of the testicles and reduced production of testosterone.


• Mumps orchitis: If a mumps infection involving the testicles in addition to the salivary glands occurs during adolescence or adulthood, long-term testicular damage may occur. This will affect the normal testicular function and testosterone production.


• Hemochromatosis: If there is a higher quantity of iron in the blood, it will lead to testicular failure or pituitary gland dysfunction.
• Injury to the testicles: Since the testicles are situated outside of the abdomen, the testicles are prone to injury. Damage to normally developed testicles may cause hypogonadism. Damage to one of the testicles may not impair the total production of testosterone.


• Cancer treatment: Chemotherapy or radiation therapy used for the treatment of cancer may interfere in the normal production of testosterone and sperm. The effects of both the treatments are usually temporary, in rare cases, it may lead to infertility. Though many men regain fertility in a few months after the treatment. Sperm preservation is an option that many men consider before cancer treatment.

Secondary Hypogonadism

In secondary hypogonadism, the testicles are normal but function abnormally due to a problem in the hypothalamus or pituitary glands. There are a number of conditions which can cause secondary hypogonadism. They are

• Kallmann Syndrome: Hypothalamus is the area of the brain that controls the secretion of pituitary glands. Abnormal development of the hypothalamus can cause hypogonadism. This abnormality is associated with impaired development of the ability to smell (anosmia) and red-green color blindness.


• Pituitary Disorders: An abnormality in the pituitary glands can impair the release of hormones from the pituitary glands to the testicles, affecting normal testosterone production. Tumor in the pituitary glands or other brain tumors located near the pituitary glands may cause testosterone or other hormone deficiencies. The treatments for brain tumor-like surgery or radiation may also interfere in the function of the pituitary glands.


• Inflammatory Diseases: A few inflammatory diseases such as sarcoidosis, histiocytosis, and tuberculosis which involve the hypothalamus and pituitary glands and can interfere in the production of testosterone and cause hypogonadism.


• HIV/AIDS: HIV/AIDS affects the pituitary glands, hypothalamus, and testes, which in turn will affect the production of testosterone.


• Medications: The use of some medication such as opiate pain medications and some hormones might affect the production of testosterone.


• Obesity: Hypogonadism is related to being significantly overweight at any age.


• Normal Aging: Generally older men have low levels of testosterone than younger men. There is a slow and continuous decrease in the production of testosterone.


• Concurrent Illness: The reproductive system can temporarily shut down due to the physical stress of an illness or surgery. Emotional stress can also affect the reproductive system. This is a result of less signal from the hypothalamus and normally resolves with the successful treatment of the underlying condition.

Risk factors of Hypogonadism:

Risk factors for hypogonadism include:

• Kallmann syndrome
• Undescended testicles as an infant
• Mumps infection affecting your testicles
• Injury to your testicles
• Testicular or pituitary tumors
• HIV/AIDS
• Klinefelter syndrome
• Hemochromatosis
• Previous chemotherapy or radiation therapy
• Untreated sleep apnea



Hypogonadism can also be inherited. If there are risks factors in your family, tell your doctor.

Complications:

If hypogonadism is left untreated, there will be complications which depend on the age it first develops.

Fetal development

A baby may be born with:

• Ambiguous genitalia
• Abnormal genitalia
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Puberty

Pubertal development can be delayed or incomplete, resulting in:

• Diminished or lack of beard and body hair
• Impaired penis and testicle growth
• Unproportional growth usually increased the length of arms and legs compared with the trunk
• Enlarged male breasts (gynecomastia)

Adulthood

Complications may include:

• Infertility
• Erectile dysfunction
• Decreased sex drive
• Fatigue
• Muscle loss or weakness
• Enlarged male breasts (gynecomastia)
• Decreased beard and body hair growth
• Osteoporosis