Hypogonadism, also known as gonad deficiency, refers to a condition where the gonads (ovaries in females, testes in males) produce inadequate levels of sex hormones, particularly testosterone in males and estrogen in females. This deficiency can arise due to various factors, leading to a range of health problems that extend beyond reproduction.
Inadequate production of testosterone by the testes (or testicles) causes male hypogonadism, commonly known as low testosterone or low T. In addition to its role in regulating sex desire and sperm production, testosterone also plays a role in bone growth, heart health, and red blood cell count, all of which are essential for a healthy adult male.
In women with hypogonadism, the ovaries don’t produce any reproductive hormones. Estrogen promotes and supports the physical changes that begin in females throughout puberty and is essential for heart health, bone development, brain function, skin aging, and more. Progesterone helps the body get ready for pregnancy and regulates the monthly menstrual cycle.
Signs and symptoms of hypogonadism
It’s possible that many people who have hypogonadism are unaware that they have the disorder. Despite the existence of symptoms, hypogonadism in adult males is frequently missed, according to a study published in the International Journal of Clinical Practice.
Male Hypogonadism
Low testosterone has the following symptoms, according to the Cleveland Clinic:
- lower sexual desire
- Impairment of erection
- balding in the pubic or underarm areas
- loss of testicular volume
- symptoms of low testosterone levels, including hot flushes
- insufficient amount of sperm
- sad disposition
- trouble focusing and remembering
- to put on weight
- male breast enlargement
- loss of muscle mass and strength
- lessening of stamina
Female Hypogonadism
The following are some of the signs of low estrogen, according to the Cleveland Clinic:
- soft breasts
- skin that is dry
- fragile or weak bones
- concentration issues
- negative emotions and agitation
- symptoms of atrophic or dry vagina
- night sweats and flashes of heat
- menstrual irregularity or absence (amenorrhea)
- gaining weight, most noticeably around the middle
- premenstrual or menstrual headaches
- reduced sexual desire and painful encounters (dyspareunia).
- sleeplessness and exhaustion
Hypogonadism is a condition that can inhibit or delay puberty and sexual maturation in teenagers.
What can cause or contribute to hypogonadism?
A secondary hypogonadism
Both the pituitary gland and the hypothalamus gland, which produce hormones, can go awry, leading to this kind of hypogonadism.
Hypothalamic hormones signal the pituitary to release more hormones, which then tell the testes to create testosterone or the ovaries to produce estrogen and progesterone, respectively, in those without hypogonadism.
When the pituitary gland’s signal is inadequate, “secondary hypogonadism” occurs, according to Dr. Chubak. It’s possible that your gonads may produce hormones at a healthy level, but they aren’t getting the signal to do so.
Age, problems of the pituitary gland (such as a pituitary tumor or therapy for a pituitary tumor), inflammation, HIV/AIDS, and some drugs (including certain opiates) can all lead to secondary hypogonadism. Secondary hypogonadism may also result from Kallmann syndrome, a hereditary disorder.
Initial Hypogonadism
Abnormalities in the testes or ovaries cause primary hypogonadism rather than the brain or pituitary gland.
Pregnancy may not represent the beginning of a child’s primary hypogonadism. Possible effects on the developing baby from maternal food, behavior, and drug or chemical exposure One such link is between male hypogonadism and maternal zinc insufficiency. In other studies, exposure to endocrine-disrupting substances such as pesticides, radiation, air pollution, heavy metals, and other chemicals has been linked to oxidative stress and subsequent fetal malformations.
Hormone deficiency during pregnancy has been shown to slow the development of sexual characteristics. Extremely rare, a kid who is genetically destined to be either a man or a woman may be born with genitalia of the opposite sex, ambiguous genitalia that is neither male nor female or genitalia that are simply not fully developed.
Occasionally, primary hypogonadism has a hereditary basis. One of the conditions that can cause primary male hypogonadism is Klinefelter syndrome, which is due to an extra X chromosome.
Low estrogen levels are a hallmark of Turner syndrome, which, in some females, can result from an absent X chromosome. Low estrogen and premature menopause are only two of the many reproductive problems that can arise from the genetic disorder Fragile X syndrome.
Hypogonadism, either primary or secondary, can be a side effect of radiation and chemotherapy used to treat cancer.
Mumps complications and testicular or ovarian trauma are two of the most common causes of primary hypogonadism.
Causes of hypogonadism
Aging
After men reach the age of 40, their testosterone levels may normally decline by roughly 1% annually. Six out of ten men over the age of 65 have testosterone levels below the average for men in their thirties and forties, according to research from the Boston University School of Medicine.
Obesity
Male hypogonadism can develop in the presence of this disease. An enzyme found in fat cells called aromatase turns testosterone into estrogen, leading to an unbalanced hormone system. (Both males and females, albeit to varying degrees, generate estrogen and testosterone.)
Type 2 diabetes
carries a warning sign of hypogonadism. “Diabetes can do a number on a lot of different organs,” Chubak adds. “It can cause fibrosis, a type of scarring.” The fibrosis of the sexual organs caused by diabetes may contribute, at least in part, to hypogonadism.
Eating disorders
Female hypogonadism is associated with these factors. If a woman is underweight, has an eating disorder, or engages in extreme exercise, her ovaries may stop releasing estrogen before menopause.
How do medical professionals identify hypogonadism?
A physician can diagnose hypogonadism by gathering information from a patient’s medical history, performing a physical exam, and analyzing the results of any blood tests that were requested.
According to Nguyen, “the first step for someone worried they might have hypogonadism is to go to a primary care doctor and discuss their concerns. Next, “the patient may be referred to an endocrinologist if the primary care physician determines that it is necessary to do a further workup.”
Available medications and treatments for hypogonadism
There is currently no known cure for hypogonadism, but a doctor’s prescription for hormone replacement therapy can ease some of its symptoms.
Male Hypogonadism
Bone health, muscle growth, and anemia (a few red cells in the blood) may all benefit from increased testosterone levels brought on by testosterone replacement therapy. The Endocrine Society has deemed the treatment secure and potentially effective.
Millions of men in the United States currently use prescription testosterone injections, gels, patches, pellets, and buccal tablets to treat hypogonadism.
The American Society for Reproductive Medicine has linked hormonal changes brought on by testosterone replacement therapy to a decrease in both sperm production and fertility. Usually, testosterone therapy-related infertility is treatable.
Testing testosterone in the morning and perhaps requiring numerous measures plus subsequent tests with an endocrinologist is necessary for accurate and appropriately interpreted test findings.
If you have a history of prostate cancer in your family, severe urinary symptoms from a swollen prostate, or have been diagnosed with heart disease, a heart attack, or several risk factors for heart problems, you should talk to your doctor.
Testosterone levels, as well as the prostate and blood chemistry, should be monitored regularly if your doctor prescribes testosterone replacement therapy.
Female Hypogonadism
Estrogen, progesterone, or a combination of the two hormones may be recommended to women for hormone replacement therapy. Patches, tablets, gels, creams, sprays, and injections are all forms available for these drugs.
Hormone replacement medication has been linked to an increased risk of blood clots, heart attacks, strokes, breast cancer, and gallbladder disease, according to the Food and Drug Administration (FDA) in the United States. Estrogen increases the risk of endometrial cancer (uterine lining cancer), but progestin lowers it.
Hypogonadism’s potential risk factors
Male Hypogonadism
According to the University of Rochester Medical Center, male hypogonadism can cause or exacerbate a variety of health problems.
- circulatory problems
- hypertension, insulin resistance, abdominal obesity, and abnormal lipid profiles constitute metabolic syndrome.
- diabetes
- plaque formation inside the arteries (atherosclerosis) gradually narrows the blood vessel diameter over time.
- cancer of the prostate or other particularly deadly types
- osteoporosis
Hypogonadism in women
The University of Rochester Medical Center issued a warning that elevated risk factors for female hypogonadism include:
- osteoporosis
- infectious heart illness
Hypogonadism preventive measures
The United States Department of Veterans Affairs recommends a number of lifestyle changes in addition to medication to increase testosterone levels. These include achieving and maintaining a healthy body weight, preventing diabetes, exercising regularly, getting plenty of rest, eating well, managing stress, and avoiding tobacco, opiate pain relievers, and excessive alcohol.
Although health professionals caution that excessive exercise can deplete the body of estrogen, these behaviors can also help women maintain healthy estrogen levels.
Hormone replacement medication and healthy lifestyle adjustments may help people with hypogonadism improve their quality of life, sense of well-being, sexual function, and muscle and bone strength, despite the condition often being permanent and requiring continued treatment.
Piedmont, a non-profit community health organization, reports that combining cardiovascular exercise with strength training increases hormone levels.
Hypogonadism is a complex medical condition with wide-ranging effects on physical and mental well-being. Early detection, accurate diagnosis, and comprehensive management strategies are essential to improving the quality of life for individuals dealing with this condition.