Hypogonadism can affect both men and women. In most cases, the condition can be successfully treated with the help of hormonal replacement therapy.
What is hypogonadism?
In general, the term hypogonadism describes an underfunction of the gonads (gonads). In the human body, the gonads are responsible for producing germ cells (eggs or sperm) and sex hormones. Often, however, the term hypogonadism in medical parlance refers only to an underfunction of the male gonads (the testes). Hypogonadism is an endocrine (affecting the hormonal system) dysfunction. So-called primary hypogonadism occurs when the gonads themselves are impaired in their function. Secondary hypogonadism is when the pituitary gland (a hormone gland in the brain, also known as the pituitary gland) is affected by dysfunction. Finally, if tertiary hypogonadism (which is very rare) is present, the hypothalamus (a regulatory center of endocrine processes located in the brain) is affected by dysfunction.
Causes
Primary hypogonadism in men is usually caused by absent or impaired Leydig cells, which are among the most important cells of the testis. As a result, testosterone production is impaired in the affected man. In various subtypes of primary hypogonadism, low testosterone may also be due to factors such as trauma, castration, or testicular inflammation. Primary hypogonadism in women may be favored by inflammatory processes or tumors of the gonads, among other factors. Congenital underdevelopment of the sex organs can also lead to primary hypogonadism in women. Damage to the pituitary gland as a cause of secondary hypogonadism can be caused by tissue neoplasms (tumors) or inflammation, for example. Finally, impairments of the hypothalamus behind tertiary hypogonadism may already be congenital or caused by factors such as trauma or various diseases.
Symptoms, complaints, and signs
Hypogonadism can affect both men and women. Depending on gender and age, the condition manifests itself in different ways. If hypogonadism occurs in children, it is most noticeable by the complete absence of puberty. In affected adolescents, pubertal development comes to a standstill. In girls, menstruation does not occur (primary amenorrhea). In boys, enlargement of the male mammary gland (gynecomastia) and undescended testicles (cryptorchidism) are common symptoms. Adolescents of both sexes usually have little interest in sexuality as well as underdeveloped primary as well as secondary sexual characteristics. If hypogonadism does not occur until adulthood, the clinical signs of the condition may be less pronounced. Affected individuals of both sexes usually experience loss of libido. Other symptoms include loss of secondary hair and osteoporosis. In women, depending on the severity, there is a marked drop in estrogen levels and associated pathological degeneration of the genital organs (genital atrophy) and absence of menstruation (secondary amenorrhea). In affected men, there is shrinkage of the testicles. Another symptom is the absence of mature male sperm cells (azoospermia). In most cases, affected individuals also have erectile difficulties and even impotence.
Diagnosis and course
Diagnostic procedures used when hypogonadism is suspected differ depending on the particular form of the disease and the individual symptoms, among other factors. Altered hormone levels can be detected, for example, with the aid of blood tests. For example, the levels of prolactin (a hormone of the pituitary gland), testosterone and/or estradiol (a sex hormone) are determined on a gender-specific basis. As a rule, most forms of hypogonadism are easily treatable. Possible complications in the course of hypogonadism include, for example, impotence, infertility, or cardiovascular disease.
Complications
Both male and female patients are affected by hypogonadism. Hypogonadism causes a so-called androgen deficiency in most cases.The man can become infertile due to this deficiency and thus also incapable of procreation. In most cases, these limitations lead to extreme psychological stress and the development of depression. It is not uncommon for patients to also suffer from inferiority complexes and lowered self-esteem. In the worst case, suicidal thoughts may even occur. The partner is also affected by psychological complaints due to hypogonadism and suffers from a reduced quality of life. The sexual organs often regress and can lead to bullying and teasing, especially in children. Furthermore, children may fail to reach puberty completely, leading to severe disturbances in physical and psychological development. Heart problems can also occur, which can lead to death. Treatment of hypogonadism is usually carried out with the help of hormones and leads to success in most cases. No particular complications occur. If depressive moods have occurred, they are also examined by a psychologist. Life expectancy is usually not reduced by hypogonadism.
When should one go to the doctor?
When signs of infertility first appear, a doctor should be consulted. Hypogonadism is rarely manifested by clear symptoms. Therefore, the first signs of a disease or disorder should already be clarified, because only in this way can physical and psychological sequelae be avoided. Men and women who feel less sexually active or who have had an unfulfilled desire to have children for a long time should consult their family doctor or a gynecologist or urologist. The doctor can clearly diagnose hypogonadism and suggest appropriate countermeasures. If this is done at an early stage, permanent damage can be avoided. Basically, hypogonadism must be clarified if it has a negative effect on the physical and psychological condition. If home remedies and self-measures do not help, the disorder must be taken to a doctor. The patient must then undergo regular check-ups, as this is the only way to ensure that there is no renewed deficiency of androgens, which are responsible for sexual health.
Treatment and therapy
The therapy of hypogonadism depends first of all on the form of the disease: the treatment of primary hypogonadism is usually carried out by the drug administration of reduced present or absent sex hormones (in men this is usually androgens such as testosterone, in women estrogens or progestins). This form of treatment is also known in medicine as substitution therapy. In many cases of hypogonadism, lifelong hormone administration is necessary. Substitution therapy can be carried out in various ways; for example, with the help of tablets or injections, but also specific patches. The amount of hormone administered to the individual depends, among other things, on the patient’s age and body weight. Secondary hypogonadism is often treated with so-called gonadotropin preparations. Gonadotropins are sex hormones that help stimulate the gonads. Appropriate preparations can supplement the various pituitary hormones. Gonadotropin preparations are administered in cases of secondary hypogonadism, especially if there is a desire to have children, because the sex hormone stimulates the formation of sperm or egg cells. Especially in men of advanced age, hypogonadism can be accompanied by symptoms such as depressive mood and/or anemia (anemia). In these cases, therapeutic steps to treat hypogonadism are usually supplemented by therapeutic measures that address the individual accompanying symptoms.
Prevention
The extent to which hypogonadism can be prevented depends primarily on the individual causes of the disease; secondary hypogonadism can be counteracted, for example, by a balanced diet that prevents deficiency symptoms that occur. Forms of hypogonadism that can develop, for example, due to inflammation of the testicles, can be prevented primarily by early treatment of the inflammatory disease.
Follow-up
Treatment of hypogonadism includes targeted follow-up care. This is to ensure that patients are not prone to depression or other secondary diseases such as anemia.Depending on the individual course of the disease and the symptoms, it may be advisable to change the diet. A vitamin-rich, balanced diet counteracts the typical deficiency symptoms of secondary hypogonadism. In the case of anemia, foods containing iron help. In order for those affected to feel better in the long term and to avoid complications, hormonal therapy must be consistently adhered to. The prescribed medication must be taken exactly as planned. Everyday life following therapy is relatively normal. In principle, patients are hardly restricted, but the sexual disorder may cause psychological problems. For this reason, the doctor recommends psychotherapeutic care as part of the aftercare. Some people already find it helpful to talk it out among family or friends. By taking part in a self-help course, those affected no longer feel so marginalized. The improved self-esteem has a positive effect on mood and the course of the disease. Furthermore, the information helps to assess the situation correctly and to focus on the essentials.
What you can do yourself
In any case, when hypogonadism occurs, patients are dependent on medical treatment. Only hormonal treatment can permanently relieve the symptoms and prevent complications. For this reason, patients should make sure that they take their hormones regularly. In many cases, the therapy can also be carried out by injections or by applying a patch. This means that further treatment measures are not necessary. As a rule, the treatment also does not lead to any particular restrictions in the patient’s everyday life. In men, hypogonadism can also lead to depression, so that this also needs to be treated. In this case, discussions with the closest friends, family or with one’s own partner can have a very positive effect on the course of the disease and prevent further complications. Contact with other hypogonadism patients can also have a positive effect on the course of the disease if information is exchanged. In the case of anemia, a balanced diet can alleviate the symptoms, and especially foods that contain a lot of iron should be taken. However, anemia can also be limited by dietary supplements or with the help of transfusions.
