Hypogonadism: causes, consequences and treatment

Hypogonadism is a condition in which the testes or ovaries are not functional or there is an inability of the hypothalamus to secrete adequate amounts of gonadotropin-releasing hormone (GnRH). Gonadotropins are essential in both men and women, as they are needed for spermatogenesis and ovulation.

In Europe and the United States, 2 to 13% of the population of middle-aged men have hypogonadism. This condition is much less common in women, so we will focus on the male variant along the following lines. If you want to know everything about the condition, keep reading.

How do the gonads develop?

The gonadal development process is known as gonadogenesis. It begins about the fourth week of fetal development, but until the seventh week the male and female characteristics of the gonads are not manifested.

These genital glands develop from the intermediate mesoderm, more specifically of the urogenital lamina. In the absence of specific masculinizing factors, there is a general trend towards the formation of female characters, as indicated by the University of Murcia.

Abnormal gonadogenesis during fetal development results in conditions such as bilateral testicular dysgenesis, dying, anorchia — evanescent testis — and, consequently, the hypogonadism already mentioned.

To know more: Most common causes of infertility in men

What are the types and causes of hypogonadism?

As we have said, we are going to focus on the male variant, since it reports much more interest at the clinical level due to its high incidence. Without going any further, magazine studies Nature they estimate that up to 4 million North American male patients suffer from it, while only 5% of them receive the relevant treatment.

The Revista de Urología Colombiana and other medical sources propose various types of male hypogonadism based on their etiology. We take advantage of this classification system to show you the possible causes of this condition.

1. Primary hypogonadism or HP type 1

It is the easiest clinical picture to understand, since It derives from a direct problem in the testicles. Primary hypogonadism involves the disappearance, distortion or alteration of these gonads, in which one of the most important hormones is normally produced: testosterone.

One of the most common causes of type 1 HP is congenital anorchia, that is, the absence of testicles at birth. Mixed gonadal dysgenesis, a disorder due to an abnormal number of sex chromosomes, can also cause it. Finally, a removal or severe damage to the testicles will also lead to primary hypogonadism.

2. Secondary hypogonadism or HP type 2

It involves a malfunction in the pituitary. The adenohypophysis is responsible for releasing the gonadotropin hormones described above and, therefore, when it does not perform its work, there is a deficit in the production and secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

In the male, the LH hormone is essential, as it stimulates the synthesis of testosterone in the testes. On the other hand, FSH promotes the production of hormones such as inhibin and participates in the spermatogenesis process. Due to the lack of circulating concentrations of these substances, HP type 2 is also known as hypogonadotrophic hypogonadism.

We are facing a slightly more complex entity to classify at the etiological level, since its appearance is not as simple as damage to the testicles. Among the possible causes of HP type 2 we find the following:

• Hemochromatosis: a disease that affects the metabolism of iron in the body, causing an excessive accumulation of this element in the organs and tissues of the patient.
• Adenoma: an epithelial tumor of a benign nature originating in glandular tissues.
• Ischemia: decrease in blood circulation that translates into a state of cellular distress in the places affected by lack of oxygen and nutrients.
• Drug use, certain drugs and exposure to some treatments, such as radiation therapy.

3. Tertiary hypogonadism or HP type 3

In this case, the failure occurs at the level of the hypothalamus. The hypothalamus is responsible for secreting gonadotropin-releasing hormone (GnRH), whose function is to stimulate the adenohypophysis to secrete luteinizing (LH) and follicle-stimulating hormones (FSH).

Thus, there is a kind of physiological domino effect. A lack of GnRH results in a decrease in the release of LH and FSH. Consequently, the levels of testosterone production in the male patient also drop.

4. Idiopathic hypogonadism or HP type 4

It is an androgen deficiency that appears with age and senescence. The lack of testosterone is not due to failures in the hypothalamic-pituitary-gonadal axis, so it does not fall into any of the classifications described above.

Symptoms

As the Mayo Clinic indicates, the signs of hypogonadism can appear from fetal development to adulthood. We show you the typical symptoms in the following list:

• Fetal development: If the body of the fetus does not produce enough testosterone during pregnancy, the baby can be born with abnormal characteristics despite its male biological sex. Among them, we find female genitalia, ambiguous or poorly developed gonads.

• Puberty: a lack of hormones during puberty can hinder muscle development, the formation of adult vocal tone, the growth of body and facial hair, and the development of the penis and testicles. Men with a lack of male sex hormones may have breast development (gynecomastia).
• Adulthood: Lack of testosterone causes erectile dysfunction, depression, decreased energy, and a lack of sexual desire. In the long term, this condition can promote the development of osteoporosis and even infertility.

How is it diagnosed?

First of all, a physical examination is necessary, in which the professional will evaluate the condition of the penis and testicles and observe the level of development of facial and body hair and muscle mass of the patient. A rectal exam is also usually necessary.

Once the hormonal imbalance already described is suspected, a blood sample will be taken from the patient to record testosterone, luteinizing hormone, and follicle-stimulating hormone levels. Thus, the presence of hypogonadism can be confirmed if the values ​​of these parameters are below normal.

Normal testosterone levels in men are 300 to 1000 nanograms per deciliter of blood (ng / dL).

Treatment of hypogonadism

The primary treatment for male hypogonadism, as indicated by the United States National Library of Medicine, is prescribe a dose of testosterone to the patient. This hormone comes in a skin patch form, such as a skin gel, a solution applied to the armpit, a mouth patch, or an injection.

This hormone replacement therapy can be different, depending on the deficiencies of each patient- But if the hypogonadism is secondary or tertiary, the underlying cause must be addressed. If there is a tumor, it will have to be removed, just as it is necessary to solve an ischemia when signs of it are noticed.

In addition, it is necessary to take into account a couple of specific points to cope with hypogonadism on a day-to-day basis:

• Obesity promotes testosterone deficiency: Based on this premise, if the patient is overweight, they must change their habits and routines. This happens by adjusting the diet, stopping drinking alcohol and smoking.

• Hypogonadism in adulthood is associated with type 2 diabetes and metabolic syndrome: therefore, diabetic patients must address this condition to notice an improvement in the associated symptoms. Going to sex therapy is also a good idea in these cases.

Forecast

Many forms of hypogonadism can be treated and have a good prognosis. However, sources already cited indicate that fertility often cannot be recovered in a male with the primary variant.

If the cause is secondary, this property can be recovered by addressing the underlying problem, but a congenital malformation – such as an anorchia – has a difficult solution. In these cases, do not be discouraged. There are assisted reproductive therapies that help couples who have not been able to conceive.

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Consult and do not stay with doubts

As you may have seen, hypogonadism usually finds its cause in 3 different axes: the testicles, the hypothalamus or the pituitary. Depending on the origin, the approach is more or less simple, but almost always usually goes through the administration of testosterone in the form of gels or patches.

If you have seen yourself reflected in any of these lines, do not hesitate to go to the doctor. We know that the situation entails a series of reservations and embarrassments, but the lack of libido and the signs associated with hypogonadism are hormonal imbalances that must be treated.