18 March 2019 Author : Carlos Fernandes What is hypogonadism? Male hypogonadism is a decrease in one or two main functions of the testicles: Testosterone production, which is the main male sex hormone; Sperm production. Primary hypogonadism is due to testicles lesions. Secondary hypogonadism results from hypothalamus or pituitary disorders. These organs that are, respectively, part of the endocrine and nervous systems, that control the production of testosterone and sperm by the testicles Causes of hypogonadism Both primary hypogonadism and secondary hypogonadism can have congenital (present at birth) or acquired causes. Among the congenital causes of primary hypogonadism are, for example: Klinefelter syndrome (the most common) and other chromosomal abnormalities; Changes in hormone receptors and in testosterone synthesis; Cryptorchidism or testicles retained in the abdominal cavity or in the inguinal canal, that can be unilateral or bilateral; Anorchy or absence of testicles. Among the acquired causes of primary hypogonadism are, for example: Infections (such as orchitis in measles), torsion and testicular trauma; Effects of radiation, some chemotherapy treatments, and of other toxins and compounds; Misuse of anabolic androgenic steroids; Orchiectomy; Some chronic illnesses. Likewise, secondary hypogonadism can result from congenital (for example, Kallmann syndrome) or acquired diseases , such as pituitary adenomas or tumors of the hypothalamus. Symptoms and diagnosis The signs and symptoms related to the decrease in testosterone depend on the disease age of onset , being different if the onset happens: In the fetal period; Before puberty; After puberty. When hypogonadism arises after puberty or in adulthood , the main symptoms of testosterone deficiency are: Decreased sexual desire; Erectile dysfunction; Reduction of strength and muscle mass; Reduction of body hair; Increase in fat mass / adiposity; Increase of the mammary gland (gynecomastia); Decrease in bone calcium; Fatigue, tiredness, and mood swings. On the other hand, the decrease in testosterone levels is also associated with other diseases such as obesity, diabetes, metabolic syndrome, and osteoporosis. Recent studies have linked low testosterone levels to an increased incidence of cardiovascular events. When hypogonadism affects sperm production, there may be complaints of infertility . The diagnosis of hypogonadism is based on: Patient history, clinical examination and evaluation of signs and symptoms that are possible related to low testosterone levels; Laboratory tests, including testosterone and other hormone that control testicular function, such as luteotrophic (LH) and follicle-stimulating (FSH) hormones levels and, eventually, a spermogram. Considering the several possible causes of hypogonadism, other medical tests may often be necessary to reach a definitive diagnosis, such as genetic and imaging tests. Treatment of hypogonadism The main objective of hypogonadism treatment is to reverse its cause . In many cases, testosterone therapy may be indicated. This treatment, with adequate doses and regular clinical follow-up, is a safe therapy and plays an important role in many cases of hypogonadism. Where testosterone replacement therapy is indicated, it can be administered in a variety of ways. There are, for example, injectable, gel and transdermal formulations (adhesives). During these treatments it is essential a close and regular follow-up of testosterone levels in the blood and of possible side effects that require dose adjustments. Several studies reveal that patients with hypogonadism treated with testosterone show an improvement in sexual desire, erectile function, mood and general well-being. Meet the endocrinology team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
