What To Know About Male Hypogonadism and its Treatment

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The male sex hormone testosterone plays many vital roles in the body. Any fluctuation in its normal serum concentration can lead to serious health problems such as male hypogonadism.

This article talks about male hypogonadism in detail. Keep reading to learn about symptoms, types, causes, diagnosis, and treatments of male hypogonadism.

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What is male hypogonadism?

Male hypogonadism, also called andropause or low serum testosterone, is a condition in which testes do not produce enough testosterone, sperms or both.

It can affect men of all ages. A person can be born with hypogonadism or develop it later in life due to disease, infection, drug, or injury. Hypogonadism affects both men and women.

 

Male hypogonadism symptoms

Symptoms of male hypogonadism depend on when you developed this condition:

When it occurs during foetal development

If the body of a developing foetus produces insufficient testosterone, its external sex organs will go experience impaired growth. A baby boy having male sex chromosomes (XY) may be born with an underdeveloped male sex organ, female sex organ, or ambiguous sex organ (that is neither clearly female nor clearly male).

When it occurs during puberty

Puberty is the time when your body develops, and you transition into adulthood. If a boy develops male hypogonadism during this phase, he may experience the following symptoms.

• Breast enlargement
• Excessive growth of limbs
• Poor growth of the penis
• Poor growth of facial hair
• Increase in the muscle mass

When it occurs during adulthood

In adulthood, male hypogonadism can disturb the normal reproductive system and masculine physical traits. Adult men may experience the following symptoms after developing hypogonadism.

• Trouble getting and maintaining an erection
• Low sex drive
• Poor sperm production or infertility
• Anxiety and depression
• Hot flashes
• Loss of facial and body hair
• Loss of bone mass
• Decrease in bone density
• Gynecomastia (development of breast tissues)

 

Male hypogonadism types

It is divided into two categories:

Primary hypogonadism

This condition occurs when there is a problem with your testicles. They get a message from the brain to produce testosterone, but they fail to do so. It is also referred to as primary testicular failure.

Secondary hypogonadism

Occurs when there is a problem with your hypothalamus or pituitary gland (parts of the brain that regulate testosterone production).

Your hypothalamus secretes gonadotropin-releasing hormone. This hormone tells the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH tells the testes to form and release testosterone.

Both forms of hypogonadism can be congenital (genetic) or acquired (developed during an individual’s life) disorders.

 

Male hypogonadism causes

The causes of primary and secondary hypogonadism differ from each other.

Causes of primary hypogonadism

Here are a few common causes of primary male hypogonadism.

• Chemotherapy or radiation therapy: These treatments can have a negative impact on testosterone or sperm formation. They can cause permanent infertility.
• Testicle injury: Since testicles are present outside the abdomen, they can get injured due to an accident. Injury to one testicle does not cause hypogonadism, and you may still be able to produce enough testosterone. Damage to both testicles leads to hypogonadism.
• Klinefelter syndrome: It is a genetic disorder in which boys are born with abnormal sex chromosomes. Instead of having normal male sex chromosomes (XY), they have an additional X chromosome (XXY).

X and Y are sex chromosomes that determine gender. Men are XY, while females are XX. The presence of an extra X chromosome influences intellectual and physical development.

• Undescended testicles: During foetus development, testes form inside the abdomen of the foetus. After birth, they drop into the scrotum, their normal place.

As the name of the disorder indicates, an undescended testicle is a condition in which testicles do not move into the scrotum. It can be treated surgically, but when left unchecked, it can lead to male infertility or no testosterone production.

• Hemochromatosis: If your blood has an abnormally high amount of iron in it, it can cause testicular failure leading to no testosterone production.

Causes of secondary hypogonadism

Enlisted below are some common causes of secondary hypogonadism.

• Pituitary disorder: Any pituitary disorder, such as a pituitary tumour, can reduce the production of pituitary hormones (LH and FSH) that control testosterone production. The deficiency of pituitary hormones leads to testosterone deficiency.

People who have had testosterone surgery or therapy in their lives may also experience this problem.

• Obesity: Having an abnormally high body weight at any age can reduce free testosterone levels in your bloodstream.
• Medication: Certain medications like opioids containing pain medications can decrease testosterone production.
• Ageing: A decline in testosterone production is a natural ageing phenomenon. After age 30, about a 1 per cent reduction in the total testosterone levels occurs per year in men.
• Kallmann’s syndrome: It is the abnormal development of the hypothalamus that sends signals to the pituitary gland for the production of LH and FSH. This genetic disorder causes a delay or the absence of puberty.
• Inflammatory illness: Some inflammatory diseases such as tuberculosis and sarcoidosis affect the pituitary gland’s performance. Therefore, they can also contribute to low testosterone levels.

 

How is it diagnosed?

Physical exam

Your doctor will ask you to describe your symptoms in detail. Based on your current health condition and described symptoms, they will perform a physical examination. During it, they may analyse your breast size, muscle mass, penis growth, and the amount of body hair.

Blood tests

These tests are performed to check hormone levels in the blood. Your LH, FSH, and testosterone levels are measured. If your testosterone levels are low and LH and FSH levels are normal, you may have primary hypogonadism. On the other hand, if your LH and FSH levels are low, it may mean you have secondary hypogonadism.

These tests are mostly performed in the morning because your hormone levels are high at this time.

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Hormones	Normal concentration in men
Testosterone	300 to 1,000 ng/dL
Luteinizing hormone (LH)	1.42 to 15.4 IU/L
Follicular stimulating hormone (FSH)	1.5 to 12.4 mIU/mL

 

Imaging

Imaging tests like CT scans and MRIs are used to identify an abnormality in the pituitary gland. They tell whether the person has a pituitary tumour or not.

Semen analysis

Is performed to find sperm count.

Treatment

Testosterone replacement therapy (TRT) is used to treat primary male hypogonadism. It comes in different forms, such as:

• Skin patches: They are applied to different body parts. Doctors recommend their patients to apply a skin patch every day.
• Injections: Testosterone injections are usually given every 12 to 14 days.
• Testosterone gels: It is usually applied to the arms and upper back. Make sure you do not transfer it to others through skin-to-skin contact. The gel can catch fire. Therefore, you should let it fully dry before you go near the fire.
• Pellets: They are the size of a rice grain. They are implanted under the skin. Testosterone pellets have a size equal to a rice grain. They contain crystallised testosterone that is gradually released for up to a few months before a new pellet is implanted.

If your hypogonadism is due to a pituitary tumour, your doctor will recommend treatments that can remove or shrink the tumour. These treatments include:

• Medication
• Radiation
• Surgery

 

Benefits of TRT

TRT aims to elevate your testosterone levels. It can reverse the effects of low testosterone levels. Millions of men have this treatment every year to restore their testosterone levels and improve their quality of life.

Here are a few TRT benefits that people experience.

• It increases bone density and strengthens them.
• It improves your sex drive.
• It helps you gain an erection.
• It improves your mood.
• It reduces body fat and helps you gain lean muscle mass.
• It may improve your memory and cognitive health.

TRT also has some side effects. Talk to your doctor about them to ensure you select the safest treatment plan.

 

Who should not have TRT?

TRT is not for all. People suffering from the following problems should not have this treatment as it can worsen their condition.

• Prostate cancer
• Breast cancer
• Severe sleep apnea
• Heart failure
• Men who want to grow their families and have children should also not have TRT.

 

Can male hypogonadism be prevented?

No, there is no possible way to prevent hypogonadism that is caused by injury to the testes or pituitary gland and the genetic abnormality. However, you can improve your lifestyle, perform regular exercise, maintain healthy body weight, eat a balanced diet and manage stress to naturally boost your testosterone levels.

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Conclusion

Male hypogonadism is a chronic disease, and it requires life-long treatment. If your hypogonadism is treatable, you should discuss it with your doctor to learn how you can reduce the symptoms of the illness and improve the quality of your life. Click the contact button above to speak to one of our specialised TRT doctors and discuss your options!

 

References/Bibliography/Further Reading/Scientific Studies

https://www.nih.gov/news-events/nih-research-matters/understanding-how-testosterone-affects-men

https://www.healthline.com/health/low-testosterone/warning-signs

Nedresky, D. and Singh, G., 2021. Physiology, luteinizing hormone. In StatPearls [Internet]. StatPearls Publishing.

Corona, G., Rastrelli, G. and Maggi, M., 2013. Diagnosis and treatment of late-onset hypogonadism: systematic review and meta-analysis of TRT outcomes. Best Practice & Research Clinical Endocrinology & Metabolism, 27(4), pp.557-579.

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