Male Hypogonadism: Causes, Symptoms and Treatments

What is Male Hypogonadism?

Male hypogonadism is a clinical syndrome that occurs when a man doesn’t produce enough male sex hormones (testosterone), sperm or both in the gonads (testes).

Testosterone is the male sex hormone that is responsible for the development during the puberty years and male masculinity.

Male sex hormone helps control secondary sex characteristics, testicular and penis development, sperm production, and pubic hair growth.

Hypogonadism can also be known as testosterone deficiency, gonad deficiency or andropause (male menopause).

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Signs & Symptoms of Hypogonadism

When hypogonadism is present in the serum, testosterone levels are below 300 ng/dL and one or more symptoms are present. Some symptoms include:
  • An absence or regression of the secondary sex characteristics such as small penis and testicles, lack of facial hair, underdeveloped muscle mass, and failure of the voice to deepen.
  • Impaired sexual development
  • Reduction of muscle mass or muscle wasting
  • Anemia
  • Reduced bone mineral and bone mass density
  • Abdominal adiposity
  • Oligospermia (low sperm count)

Post-pubescent hypogonadism symptoms include:
  • Anemia
  • Depression
  • Decreased muscle mass and strength
  • Decreased of body hair (pubic, axillary, facial)
  • Erectile dysfunction
  • Enlarged breast (man boobs)
  • Lack of energy
  • Less stamina
  • Lack of concentration
  • Low libido or absent of sex drive
  • Low sperm count
  • Irritability
  • Higher cholesterol levels
  • Hot flushes
  • Osteoporosis
  • Poor concentration and decreased energy
  • Sleep disturbances or insomnia

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Causes of Hypogonadism

The cause of hypogonadism can be primary or secondary.

In primary hypogonadism, it is caused by testicular dysfunction.

Causes of primary hypogonadism include:
  • Certain autoimmune disorders, such as Addison’s disease and Type 1 diabetes
  • Congenital disorders,  such as Klinefelter’s syndrome and Turner syndrome
  • Severe infections
  • Liver and kidney disease
  • Undescended testes
  • Mumps
  • Radiation exposure
  • Chemotherapy
  • Surgery on your sex organs
  • Trauma to the testes
  • Tumours
  • Hemochromatosis (too much iron the blood)

In secondary hypogonadism is caused by a dysfunction of the hypothalamic-pituitary gland. The gland is responsible for releasing the hormones to stimulate the testes for the production of testosterone.
Causes of secondary hypogonadism include:
  • A tumour in or near your pituitary gland
  • Genetic disorders, such as Kallmann syndrome (abnormal hypothalamic development)
  • Injury or trauma to the pituitary gland or hypothalamus
  • Malnutrition or nutritional deficiencies
  • Morbid obesity
  • Liver disease
  • Long-term use of medications a such as steroids and opiates
  • Pituitary disorders
  • Radiation exposure
  • Side effects of certain medications
  • Systemic illness
  • Stress
  • Sexually related diseases (HIV & AIDS)
  • Toxins accumulation (alcohol and heavy metals)
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The Pathophysiology of Testosterone and Hypogonadism

The grey matter of the brain is called the cerebral cortex and the most highly developed portion of the brain. It encompasses as much as two-thirds of the brains mass and it’s responsible for information processing. In this area of the brain is where testosterone production begins. In the cerebral cortex, it signals the hypothalamus to allow the production of testosterone.

The pituitary gland is stimulated and this gland releases luteinizing hormone and follicle-stimulating hormone into the bloodstream. The luteinizing hormone then triggers activity in the Leydig cells which are located in the testes. Cholesterol in the Leydig cells is converted to testosterone.

When there’s enough testosterone, the pituitary gland will slow the release of the luteinizing hormone and testosterone production is slowed down. This is a complex process and many problems can occur along the way which may lead to hypogonadism

Studios have shown recently that testosterone does decline as men age, but this rate of decline can vary. Men usually experience a slow decline over time.

It’s estimated by The Baltimore Longitudinal Study of Aging, then around 20% of men in their 60s and around 50% of men in their 80s have hypogonadism.

A study done by the New Mexico Aging Process shows that there’s a decrease in serum cholesterol of 110 ng/dl, for every ten years of age.

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Throughout the life of a male, testosterone plays a vital role. It’s responsible for cognitive function, sexual function, and the development of the body.

Testosterone plays a large role during puberty when growth develops at a rapid rate. Once men reach puberty they have more libido, an increase in penis size, more muscle mass, more weight, deeper voice and more frequent erections. Testosterone also affects men well into adult age.

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Tests

Treatment and early diagnosis are possible to reduce the risks that are associated with hypogonadism. In young boys, this can help reduce delayed puberty issues. When it’s diagnosed with men problems such as osteoporosis is reduced.

One of the first tests is the ADAM or Androgen Deficiency in Aging Male test. This test is a 10-item questionnaire to help identify men that have low testosterone. The level of testosterone tends to vary during the day and is usually highest in the morning. This is usually when blood levels are drawn.

If low testosterone is found, then another testing will be conducted. This is to determine whether it’s pituitary, hypothalamic, or testicular in nature.

Tests may include semen analysis, hormone testing, testicular biopsy, pituitary imaging, and other studies. Once treatment is given the patient will have more testosterone levels drawn to see if medication or other treatments are increasing the testosterone level

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Treatment Options

The main treatment is testosterone replacement therapy. The main goal of this therapy is to:

  • Restore sexual function and general well-being
  • Maintain virility
  • Prevent osteoporosis and optimize the bone density
  • Normal hormone levels if the man is older
  • Reduce cardiovascular risks

There are many testosterone delivery systems available on the market. Therapy is usually reserved for those that have clinical symptoms and now just low testosterone levels. Options include:

Transdermal Patch

You can get the transdermal patch under the name Androderm. These patches deliver testosterone levels over 24 hours. Some side effects are usually related to the application site of the patch. Reactions may include skin irritations, blistering, dermatitis, vesicle formation, erythema, or induration. It’s estimated that 10% quit using the patch due to skin irritation. Some other side effects may include depression, headache, and some gastrointestinal bleeding. The patch is also difficult to get out of the package and it tends to fall off with relative ease.

Topical Gels

There are toe topical gels called Testim and Androgel. The application is done in the morning. These gels provide better elevate serum testosterone when you compare them to patches.

Side effects may include hot flushes, headache, increased blood pressure, insomnia, nervous and emotional problems. Skin irritation is 10 times less frequent then patches. Some problems include the cost and the fact that you can transfer the gel from person to person.

Buccal Tablets

Buccal tablets go under the name Striant and they release testosterone in a pulsatile manner. When you go this route, the testosterone is raised quickly and then this is followed up by another dosage.

The main side effects are a bitter taste and some gum irritation. The irritation of the gums trends to go away within one week of use. Some other side effects include stomatitis, toothache, and dry mouth.

Implantable Pellet

Testopel is an implantable pellet that you can use to raise testosterone levels. The pellet is implanted surgically and will slowly relapse testosterone into the body over the period of several months.

Side effects can include minor bleeding, pellet extrusion and some fibrosis at the pellet site.

Intramuscular Injections

You can also get Depo-Testosterone, which is an intramuscular formulation as well as testosterone enanthate or Delatestryl. You get peak testosterone within 72 hours with this method.

This method tends to produce the most variable pharmacokinetics when you compare it to the other methods. You get peak levels in 72 hours, but then things can change, and you will have varied sexual function, energy and mood levels.

Some side effects include reactions at the site. This is a cost-effective way to deliver testosterone even though the results can fluctuate. The main disadvantage is the frequent doctor’s visits, and the dosage administration as well as steady testosterone patterns.

Oral Tablets

Andriol is the name for oral tables which you can take to raise testosterone levels. These tablets are quite inexpensive but require several dosages per day. Oral tablets may raise liver enzymes, promote acne, cause GI intolerance, as well as gynecomastia.

Patients should know the risks of testosterone therapy such as:

  • Increase risk for prostate cancer
  • Prostatic hypertrophy may get worse
  • Sperm counts may be lower
  • There may be swelling of the body, feet, or ankles or heart failure
  • Problems with sleeping like sleep apnea
  • Clotting of the blood
  • Gynecomastia
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Summary

Hypogonadism can affect men of all ages. It can be acquired or congenital. There are treatment options for men with low testosterone. There are various treatment options available to meet the needs of the patient.

More awareness of hypogonadism needs to spread throughout the medical community. This condition is a common condition that needs to be addressed by medical professionals.

Related: 3 Essential Steps to Fire Up Your Testicles & Testosterone »

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