Male Hypogonadism

Overview

Male hypogonadism is a medical condition marked by insufficient production of testosterone, the hormone crucial for masculine growth and development during puberty, as well as inadequate sperm production. It can manifest at birth or later in life due to factors like injury or infection.

The effects and treatment options vary depending on the cause and timing of onset. Testosterone replacement therapy is a potential intervention for specific types of male hypogonadism.

Symptoms

Hypogonadism can manifest during fetal development, before puberty, or in adulthood, with symptoms differing based on the timing of onset.

The male reproductive system functions in generating, storing, and transporting sperm. Sperm is produced in the testicles and it combines with fluid from the seminal vesicles and prostate gland to form semen. This semen is then ejaculated from the penis during sexual intercourse.

Fetal development

Insufficient testosterone production during fetal development can lead to impaired growth of the external sex organs. Depending on the timing of hypogonadism onset and the level of testosterone present, a genetically male child may be born with:

• Ambiguous genitals that are neither distinctly male nor distinctly female
• Female genitals
• Underdeveloped male genitals

Puberty

Male hypogonadism has the potential to delay puberty or lead to incomplete or absent normal development, hindering:

• Deepening of the voice
• Development ofmuscle mass
• Growth of the penis and testicles
• Increase in facial and body hair growth

Furthermore, it can result in:

• Disproportionate enlargement of the arms and legs compared to the body’s trunk
• Development of breast tissue (gynecomastia)

Adulthood

In adult males, hypogonadism can change specific masculine physical traits and disrupt regular reproductive function. Initial signs and symptoms may involve:

• Decreased energy
• Reduced sex drive
• Feelings of depression

Over time, individuals with hypogonadism may experience:

• Infertility
• Erectile dysfunction
• Decrease in muscle mass
• Reduction in bone mass (osteoporosis)
• Reduction in facial and body hair growth
• Development of breast tissue (gynecomastia)

Severe hypogonadism can also lead to mental and emotional changes. As testosterone levels decline, some men may exhibit symptoms akin to those observed during menopause in women, such as difficulty concentrating and hot flashes.

If you manifest symptoms of male hypogonadism, it is advisable to consult your doctor. Identifying the root cause of hypogonadism is a crucial initial step in receiving appropriate treatment.

Causes

Male hypogonadism refers to a condition where the testicles inadequately produce the male sex hormone testosterone. There are two fundamental types of hypogonadism:

• Primary: Also known as primary testicular failure, this type stems from an issue in the testicles.
• Secondary: This type indicates a problem in the hypothalamus or the pituitary gland, components of the brain responsible for signaling the testicles to produce testosterone. The hypothalamus generates gonadotropin-releasing hormone, prompting the pituitary gland to produce Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Subsequently, luteinizing hormone signals the testes to produce testosterone.

Both the pituitary gland and the hypothalamus, governing hormone production, are situated in the brain. Hypogonadism, whether primary or secondary, can result from a congenital trait or an acquired factor later in life, such as an injury or infection. On occasions, primary and secondary hypogonadism may coexist.

Primary hypogonadism

Frequent causes of primary hypogonadism encompass:

• Undescended testicles: During fetal development, testicles typically descend from the abdomen to the scrotum. Occasionally, one or both testicles fail to descend at birth. While this condition often self-corrects in early childhood without intervention, if left unaddressed, it can result in testicular malfunction and diminished testosterone production.
• Klinefelter syndrome: Arising from a congenital abnormality of the sex chromosomes, X and Y, this condition involves the presence of two or more X chromosomes along with one Y chromosome in males. The additional X chromosome disrupts normal testicular development, leading to decreased testosterone production.
• Mumps orchitis: An infection of the testicles resulting from mumps during adolescence or adulthood can lead to damage, impacting testicular function and testosterone production.
• Hemochromatosis: Excessive iron in the blood may induce testicular failure or dysfunction of the pituitary gland, affecting testosterone production.
• Testicular Injury: Due to their external position, the testicles are susceptible to injury. Damage to both testicles can result in hypogonadism, while harm to one may not significantly impair overall testosterone production.
• Treatment for cancer: Chemotherapy or radiation therapy used in cancer treatment can interfere with both testosterone and sperm production. Although these effects are often temporary, permanent infertility is a potential outcome. Preserving sperm before initiating cancer therapy is an option for men, even though many regain fertility within a few months post-treatment.

Secondary hypogonadism

In cases of secondary hypogonadism, the testicles exhibit normal structure but function improperly due to issues with the pituitary or hypothalamus.

Various conditions can contribute to secondary hypogonadism, including:

• Aging: As men age, there is a gradual, progressive decline in testosterone production, with the rate varying widely.
• Obesity: Being significantly overweight at any age might be associated with hypogonadism.
• Medications: The use of specific drugs, including opiate pain medications and certain hormones, may influence testosterone production.
• Inflammatory diseases: Certain inflammatory conditions like sarcoidosis, histiocytosis, and tuberculosis involve the hypothalamus and pituitary gland, impacting testosterone production.
• Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS): HIV/AIDS can lower testosterone levels by affecting the hypothalamus, pituitary, and testes.
• Pituitary disorders: Abnormalities in the pituitary gland can hinder the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production. Conditions such as a pituitary tumor or other brain tumors near the pituitary gland may result in testosterone or other hormone deficiencies. Treatment for a brain tumor, including surgery or radiation therapy, can also influence the pituitary gland, leading to hypogonadism.
• Kallmann’s Syndrome: An abnormal development of the hypothalamus, which controls pituitary hormone secretion, characterizes this syndrome. It can also impact the sense of smell (anosmia) and lead to red-green color blindness.

Risk factors

Factors that increase the risk of hypogonadism comprise:

• Advancing age
• Obesity
• Malnutrition
• HIV/AIDS
• Past chemotherapy or radiation treatment

Hypogonadism can also have a hereditary component. If any of these risk factors are present in your family medical history, it’s important to inform your doctor.