What is Hypogonadism? (Gonadal deficiency)
Hypogonadism is a reduced or absent secretion of hormones from the sex glands (gonads). In men, these are the testes and the testosterone they produce; in women, the ovaries and the estrogen they produce. The health effects from decreased levels of hormones in the body directly impact a person's sense of well-being.
Causes, incidence, and risk factors of Hypogonadism
The causes of hypogonadism may be "primary" or "central." In primary hypogonadism, the ovaries or testes themselves do not function properly creating a hormone deficiency. Some causes may include surgery; radiation; genetic and developmental disorders; liver and kidney disease; infection; and certain auto-immune disorders. The most common genetic disorders are Turner syndrome (in women) and Klinefelter syndrome (in men).
In central hypogonadism, the centers in the brain that control the gonads (hypothalamus and pituitary) do not function properly. Some causes of central hypogonadism include tumors (growths); surgery and radiation; infections; trauma; bleeding; genetic problems; nutritional deficiencies; and iron excess (hemochromatosis).
A genetic cause of central hypogonadism which also produces an inability to smell is Kallmann syndrome (males). The most common tumors affecting the pituitary area are craniopharyngioma (children) and prolactinoma (adults, this leads to the production of excess prolactin (which causes the breasts to produce milk, among other functions). Prolactinomas cause hypogonadism even if they are not large.
Primary Hypogonadism (congenital or acquired): Primary hypogonadism is characterized by testicular failure due to conditions such as cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, orchiectomy, Klinefelter's syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. Men will usually have low serum testosterone concentrations and gonadotropins (FSH, LH) above the normal range.
Hypogonadotropic Hypogonadism (congenital or acquired): Characterized by idiopathic gonadotropin or deficiency in (LH) luteinizing hormone-releasing hormone or LHRH, pituitary-hypothalamic injury from tumors, trauma, or radiation. Men will usually have low testosterone serum concentrations but have gonadotropins (FSH, LH) in the normal or low range.
Symptoms of Hypogonadism
In girls, hypogonadism during childhood will result in lack of menstruation and breast development and short height. If hypogonadism occurs after puberty, symptoms include loss of menstruation, low libido, hot flashes, night sweats and loss of body hair.
In boys, hypogonadism in childhood results in lack of muscle and beard development and growth problems. In men the usual complaints are sexual dysfunction, decreased beard and body hair, breast enlargement, weight gain and muscle loss.
If a brain tumor is present (central hypogonadism) there may be headaches or visual loss, or symptoms of other hormonal deficiencies (such as hypothyroidism). In the case of the most common pituitary tumor, prolactinoma, there may be a milky breast discharge. People with anorexia nervosa (excessive dieting to the point of starvation) also may have central hypogonadism.
Signs and Low Hormone Testing
Lab Tests may be perfomed that check testosterone levels, growth hormone levels, estrogen levels as well as FSH level and LH level, the pituitary hormones that stimulate the gonads. Other tests may include a thyroid level; sperm count; prolactin level (milk hormone); blood tests for anemia, chemistries, and iron; and genetic analysis.
Sometimes imaging is necessary, such as a sonogram of the ovaries. If pituitary disease is suspected, an MRI or CT scan of the brain may be done.
Treatment for Hypogonadism (Low Testosterone Condition)
Testosterone Hormonal preparations and medications are available for men and women.
Estrogen comes as a patch or pills.
Testosterone can be given as a patch, in a cream or gel or via injection. Testosterone pellets and natural testosterone booster pills are also available.
For women who have not had their uterus removed, combination treatment with estrogen and progesterone is often recommended to decrease the chances of developing endometrial cancer. In addition, low dose testosterone can be added for hypogonadal women with a low sex drive.
If there is a correctible cause of hypogonadism (e.g., a pituitary tumor), medication may be given (particularly for prolactinoma) or surgery and/or radiation therapy may be required. Injections or oral medication can be used to stimulate ovulation. Injections of pituitary hormones may be needed for men with hypogonadism to produce sperm. Therapy may also target nutritional, infectious, or other causes of the problem.
Expectations (prognosis) with Hormone Treatment
Many forms of hypogonadism are potentially treatable and have a good prognosis.
Complications due to Hypogonadism
In women, hypogonadism may cause infertility. Menopause is a form of naturally occurring hypogonadism, which can cause hot flashes, vaginal dryness, and irritability as a woman's estrogen levels fall. The risk of osteoporosis and heart disease increase after menopause.
Some women opt to take estrogen therapy, particularly women who have early menopause ("premature ovarian failure"). However, there is a small but significant increase in risk for breast cancer and heart disease with use of hormone replacement for treatment of menopause.
In men, hypogonadism results in loss of sex drive (loss of libido) and may cause weakness, impotence, infertility, and osteoporosis. Men also experience some decline in testosterone as they age, but it is not as dramatic or steep as the decline in sex hormones experienced by women.
Calling your health care provider, an endocrinologist or hormone specialist
Consult with your doctor if you notice loss of menstruation, breast discharge, inability to conceive, hot flashes (women), impotence, loss of body hair, weakness, or breast enlargement (men). Both men and women should call their health care providers if headaches or visual problems occur.
Bio-Identical Hormone Replacment Therapy for Hypogonadism
Bioidentical hormone medications and drugs with a variety of hormone replacement delivery systems now exists for treating hypogonadism.
Andropause Treatment for Men with Hypogonadism or Male Menopause Hormone Deficiency
Testosterone Therapy is the key to restoring male and female sexuality?
Consider testosterone therapy and bio-idenical testosterone treatments to help you feel younger and more vigorous as you age?
The potential of testosterone therapy under physician supervision can help restore your sex drive and desire, increase your muscle mass, sharpen your focus, memory and concentration, boost your libido and sexual performance, improve your energy level and your mood. As you get older and your testosterone levels dramatically decline, testosterone therapy may begin to seem like the ultimate anti-aging formula - the virtual fountain of yout. Testosterone treatments can be instrumental to healthy aging in both men and women.
What is testosterone?
Testosterone is a hormone produced primarily in the testes. For men, testosterone helps maintain:
- Healthy Sex Drive
- Bone Density
- Muscle Mass
- Blood Cells
- Fat Distribution
- Sperm Production
- Strength and Endurance
- Male Characteristics
If you have an unusually low level of testosterone (hypogonadism), your doctor may prescribe testosterone replacement for you. You may be able to choose from testosterone injections, creams, gels, patches or pellets. Testosterone replacement therapy is used to treat male hormone deficiency. Low testosterone symptoms can be alleviated through hormone treatment, ascertaining and monitoring testosterone levels, and using a variety of doses of injectable testosterone, testosterone patches, testosterone boosters, testosterone cream, gel or implantable hormone pellets.
What happens to your testosterone level with age?
Testosterone peaks during adolescence and early adulthood and after 30 gradually declines about 1 percent a year.
Hypogonadism - declining testosterone levels cause many of the signs and symptoms of aging.
Low testosterone levels may cause:
- Adverse changes in sexual potency, frequency and function. Reduced sexual desire, soft erections or inability to have erections (erectile dysfunction), loss of morning erections, lower frequency of sex, low sperm count or quality, infertility.
- Adverse changes in sleep patterns. Low testosterone and low human growth hormone causes sleep disturbance and insomnia. Trouble sleeping is one of the apparent symptoms that a hormonal imbalance is present.
- Adverse physical changes. Various physical changes including extreme fatigue and feeling tired all the time, increased body fat or uncontrollable weight gain, flabby muscles and reduced muscle mass and strength, decreased bone density and even osteoporosis, swollen or tender breasts (gynecomastia), hair loss, dry skin and wrinkling, hot flashes and night sweats - are all symptoms of a hormonal imbalance.
- Adverse emotional / mental changes. Low testosterone contributes to a decrease in motivation, ambition or self-confidence. Feeling sad, moody, over-emotional or depressed; having trouble focusing, concentrating or remembering things, withdrawing from society or suddenly feeling shy - are all symptoms of hormonal changes.
It's important to note that although some of these signs and symptoms are a normal part of aging, many hormone related health symptoms can be caused by a variety of underlying factors and health conditions. A comprehensive hormone blood test reflecting Free Testosterone and Total Testosterone is the only way to diagnose a low testosterone level.
| 
