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WHAT IS IT?
Hypogonadism refers quite simply to decreased activity of the gonads. This page focuses on hypogonadism in males. There are different types of hypogonadism such as:
- Primary hypogonadism (hypergonadotropic hypogonadism): refer to issues primarily with the gonad/testicular dysfunction that cause androgen deficiency.Klinefelter syndrome is a common cause.
- Secondary hypogonadism (hypogonadotropic hypogonadism): refer to issues outside of the gonads/testicles. Dysfunction of either the hypothalamus or the pituitary can cause secondary hypogonadism. Hyperprolactinoma is a common cause.
WHY IS IT A PROBLEM?
All types of hypogonadism result in decreased testosterone production (in males) which can cause various complications including: infertility, lack of male sex characteristics, loss of libido, and improper genital development/impaired puberty.
WHAT MAKES US SUSPECT IT?
Risk factors: glucocorticoid or opioid use (these can lower testosterone production)
Neonatal presentation: ambiguous/abnormal external genitalia can be one of the first signs of hypogonadism.
Absent/delayed/abnormal puberty
Primary amenorrhea if a phenotypic female (that has a 46,XY genotype)
Symptoms of late-onset hypogonadism can include the following:
- Reduced libido
- Erectile dysfunction
- Hot flashes
- Infertility
HOW DO WE CONFIRM A DIAGNOSIS?
*Low levels of testosterone helps diagnose hypogonadism in males!
Primary hypogonadism: has low testosterone and high levels of LH/FSH
Secondary hypogonadism: has both low testosterone and low levels of LH/FSH
Upon diagnosing hypogonadism we must search for the underlying cause!
- Genetic screening for underlying conditions (chromosomal abnormalities, mutations, etc)
- Imaging to search for casual tumors.
HOW DO WE TREAT IT?
Testosterone/methyltestosterone: these are agonists at androgen receptors which helps replace hormone signaling that is lost in hypogonadism.
HOW WELL DO THE PATIENTS DO?
This will depend on the underlying cause of the hypogonadism
WAS THERE A WAY TO PREVENT IT?
Some iatrogenic causes of hypogonadism can be avoided (such as avoiding certain medications).
WHAT ELSE ARE WE WORRIED ABOUT?
Kallmann syndrome: form of hypogonadotropic hypogonadism. This is characterized by incomplete completion of puberty.
Pituitary prolactinoma can be a cause of hypogonadism. Prolactin is a hormone that normally lowers GnRH.
Klinefelter syndrome is a common cause of primary hypogonadism. These patients have an XXY karyotype.
Prader-Willi syndrome is a different genetic abnromality that can cause hypogonadism.
OTHER HY FACTS?
Zinc deficiency can also be a cause of hypogonadism.
FURTHER READING
Page Updated: 02.11.2016