Male Hypogonadism

By:    Published: July 24, 2012

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Male hypogonadism can be present from birth or may occur later in life as a result of an infection or injury. The side effects of hypogonadism vary depending on the underlying cause, as does the way in which you can manage and treat those effects.

Definition

The term male hypogonadism refers to a condition in which a male does not produce adequate amounts of testosterone in the body. Testosterone is the key hormone that is responsible for masculine growth and normal physical development during the pubescent years.

Symptoms

The symptoms experienced by individuals who suffer from hypogonadism will depend largely on the underlying cause and the age at which the condition develops. Hypogonadism can develop while in the womb, or may occur during puberty or later years.

Hypogonadism can occur during fetal development if the fetus does not produce enough testosterone while in the womb. When this occurs, it can result in impairment of the growth of the male external sex organs. Males who develop the condition during fetal development may exhibit symptoms at birth such as:

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

Male children who are born with hypogonadism may experience delayed puberty. They may also suffer from incomplete development. Male children who develop the condition in childhood may also experience these symptoms. Additional symptoms that may occur around the time of puberty include:

  • Delays in muscle mass development
  • Lack of deepening of the voice
  • Impaired body hair growth
  • Impaired penis and testicular growth
  • Growth of arms and legs without trunk growth
  • Development of breast tissue

When hypogonadism occurs in adulthood, men may suffer from:

  • Erectile dysfunction
  • Infertility
  • Decrease in body hair growth
  • Decrease in beard growth
  • Decrease in muscle mass
  • Development of breast tissue
  • Loss of bone mass
  • Fatigue
  • Decreased libido
  • Difficulty concentrating
  • Hot flashes

Causes

Male hypogonadism occurs when adequate amounts of testosterone are not produced by the testicles. There are two causes of hypogonadism, primary and secondary.

  • Primary hypogonadism occurs as a result of a problem within the testicles.
  • Secondary hypogonadism occurs as a result of a problem affecting the hypothalamus in the pituitary gland. The pituitary gland is the section of the brain that is responsible for sending the signal to the testicles to produce testosterone.

Both primary and secondary hypogonadism can develop as a result of an inherited trait or can be acquired later in life due to an infection or injury.

Some causes for the development of primary hypogonadism include:

  • Congenital abnormality that produces 1 Y chromosome and 2 or more X chromosomes instead of one X and one Y chromosome. This condition is known as Klinefelter syndrome
  • Undescended testicles
  • Mumps infection involving the testicles that occurs during adolescence or adulthood
  • Excess iron in the blood, known as hemochromatosis
  • Testicular injury
  • Chemotherapy, radiation or other cancer treatments

Some causes for the development of secondary hypogonadism include:

  • Abnormal development of the hypothalamus, known as Kallman syndrome
  • Pituitary disorders
  • Brain tumors
  • Certain inflammatory diseases such as tuberculosis
  • HIV/AIDS
  • The use of certain medications such as pain medications or hormone medications
  • Obesity
  • The normal aging process

Risk Factors

Risk factors for hypogonadism include any of the medical conditions listed above, as well as:

  • Injury to the testicles
  • Undescended testicles in infancy
  • Testicular injury
  • Previous chemotherapy or radiation treatment

Diagnostic Tests

To diagnose hypogonadism, a through physical exam will be performed, during which time your doctor will record your health history and check your sexual development. He will check to see if your sexual development is where it should be for your age.

If hypogonadism is suspected, your doctor will order blood tests to check your testosterone levels. If low testosterone levels are confirmed, additional tests will likely be ordered to check for the presence of a testicular disorder or a problem with the pituitary glands. Additional testing may include:

  • Further hormonal testing
  • Semen analysis
  • Pituitary imaging
  • Genetic studies
  • Testicular biopsy

When hypogonadism is detected early in children, treatment can be more effective at prevent the problems associated with a delayed onset of puberty.

Treatment Options

Treatment for hypogonadism will depend on both the underlying cause at the age at which it develops.

Treatment options for hypogonadism that occurs in adults includes:

  • Hormone replacement therapy
  • Surgical removal of pituitary tumors
  • Medications
  • Assisted reproduction techniques to improve the odds of reproducing

Treatment options for hypogonadism that develops in the womb or in childhood includes testosterone replacement therapy to stimulate puberty or the use of pituitary hormones.

The type of testosterone replacement therapy for both men and boys can include injection, a hormone patch, topical gels, intraoral medications applied to the gums and inner cheeks, and oral medications.

Considerations

When hypogonadism occurs during adulthood, it is important to take preventative measures to decrease the likelihood of developing osteoporosis. Healthy lifestyle changes such as good diet and regular exercise, as well as supplementation with calcium and vitamin D, can help to maintain bone strength.

Explore different ways to decrease the stress and anxiety that often accompanies hypogonadism. Seek out local support groups and consider relaxation techniques such as mediation, yoga and massage therapy.

Hypogonadism may be especially difficult for teenage boys who may feel as though they don’t fit in with their peers. It is important for parents to be aware of the emotional effects of hypogonadism so that they can help their adolescent son seek out the support he needs.

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