Male hypogonadism

Description

Male hypogonadism is a condition in which the body does not produce enough of the hormone that plays a key role in masculine growth and development during puberty (testosterone) or a sufficient amount of sperm, or both.

You can be born with male hypogonadism, or it can develop later in life, often from injury or infection. The effects — and what you can do about them — depend on the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.

Symptoms

The hypogonadism may begin during fetal development, before puberty or in adulthood. Signs and symptoms depend on when the condition develops.

Fetal development

If the body does not produce enough testosterone during fetal development, the result can be the degradation of the external growth of the sexual organs. Depending on when the hypogonadism develops and the amount of testosterone is present, a child who is genetically male may be born with:

  • The female genital organs
  • Genital thare neither clearly male nor clearly female (ambiguous genitalia)
  • Underdeveloped male genitals

Puberty

Male hypogonadism can delay puberty or cause incomplete or lack of normal development. It can hamper:

  • The development of lean muscle mass
  • The deepening of the voice
  • Growth of facial and body hair
  • The growth of the penis and the testicles

And that can cause:

  • Excessive growth of the arms and legs in relation to the trunk of the body
  • The development of breast tissue (gynecomastia)

Adulthood

In adult males, hypogonadism can alter certain masculine physical characteristics and affect normal reproductive function. The first signs and symptoms may include:

  • Decreased sexual desire
  • Decreased energy
  • Depression

Over time, the men with hypogonadism can develop:

  • Erectile dysfunction
  • Infertility
  • Decreased hair growth on the face and body
  • Decreased muscle mass
  • The development of breast tissue (gynecomastia)
  • The loss of bone mass (osteoporosis)

Severe hypogonadism can also cause mental and emotional changes. As testosterone decreases, some men have symptoms similar to those of menopause in women. These may include:

  • Difficulty concentrating
  • Hot flashes

When to seek help

Check with your health care provider if you have symptoms of male hypogonadism. Find the cause of hypogonadism is an important first step to geteaten by the treatment.

Causes

Male hypogonadism means the testicles don't produce enough of the male sex hormone testosterone. There are two basic types of hypogonadism:

  • Primary. This type of hypogonadism, also known as primary testicular failure — is originates from a problem in the testicles.
  • High school. This type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland — the part of the brain that signal the testicles to produce testosterone. The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to produce follicle-stimulating hormone (follicle-stimulating hormone (FSH) and luteinizing hormone (LH (luteinizing hormone)). Luteinizing hormone then signals the testes to produce testosterone.

Any type of hypogonadec can be caused by a hereditary (congenital) trait, or something that happens later in life (acquired), such as an injury or an infection. Sometimes, primary and secondary hypogonadism occur together.

Primary hypogonadism

The common causes of primary hypogonadec include:

  • Klinefelter's syndrome.This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male usually has one X and one y chromosome. In Klinefelter's syndrome, two or more X chromosomes are present in addition to one And chromosome. The y chromosome contains the genetic material that determines the sex of a child and related to the development. The extra X chromosome that occurs in Klinefelter's syndrome causes abnormal development of the testes, which in turn results in underproduction of testosterone.
  • Undescended testes.Before birth, the testicles develop inside the abdomen and usually move down into their permanent place in the scrotum. Sometimes, one or both testicles do not descend at birth. This condition is often cor -rects itself within the first year of life without treatment. If not corrected in early childhood, can cause a malfunction of the testicles and the reduction of the production of testosterone.
  • Mumps orchitis. A mumps infection involving the testicles that occurduring adolescence or adulthood, can cause damage to the testicles, affecting the function of the testicles and testosterone production.
  • Hemochromatosis. Too much iron in the blood can cause testicular failure or dysfunction of the pituitary gland, affecting the production of testosterone.
  • Injury to the testicles. Because they are out of the abdomen and the testicles are prone to injury. The damage to both of the testicles can cause hypogonadism. The damage to a testicle could not impair the overall production of testosterone.
  • The treatment of cancer.Chemotherapy or radiotherapy for cancer treatment can interfere with testosterone and sperm production. The effects of both treatments is often are temporary, but permanent infertility can occur. Despite the fact that many of the men regain their fertility within a couple of months after the treatment, the preservation of sperm before starting cancer therapy is an option for men.

Klinefelter's syndrome. This condition is the result of a congenital anomalies of the sex chromosomes, X and Y. A male usually has one X and one y chromosome. In Klinefelter's syndrome, two or more X chromosomes are present, in addition to a chromosome of Y.

The y chromosome contains the genetic material that determiness the sex of a child and related to the development. The extra X chromosome that occurs in Klinefelter's syndrome causes abnormal development of the testicles, which in turn results in the reduction in the production of testosterone.

Undescended testes. Before birth, the testicthem develop inside the abdomen and usually move down into their permanent place in the scrotum. Sometimes, one or both testicles do not descend at birth.

This condition often corrects itself within the first year of life without treatment. If not corrected in early childhood, can cause a malfunction of the testicles and the reduction of the production of testosterone.

The treatment of cancer. Chemotherapy or radiotherapy for cancer treatment can interfere with testosterone and sperm production. The effects of both treatments are often temporary, but permanent infertility can occur.

Despite the fact that many of the men regain their fertility within a couple of months after the treatment, the preservation of sperm before starting cancer therapy is an option for men.

Secondary hypogonadism

In secondary hypogonadism, the testes are normal, but do not work properly due to a problem with the pituitary gland or the hypothalamus. A number of conditions that can cause secondary hypogonadism, including:

  • Kallmann's syndrome. This is an abnormal development of the area of the brain that controls the secretion of hormones from the pituitary gland (hypothalamus). This abnormality can also affect the ability of sense of smell (anosmia) and the cause of red-green color blindness.
  • Disorders of the pituitary gland.An abnormality of the pituitary gland can impair the release of hormones from the pituitary gland and the testes, which affect the normal production of testosterone. A tumor of the pituitary gland or other type of brain tumor located near the pituitary gland can cause testosterone or other hormonal deficiencies. Also, treto be treated for a tumor in the brain, such as surgery or radiation therapy, can affect the pituitary gland and cause hypogonadism.
  • Inflammatory disease. Certain inflammatory diseases, such as sarcoidosis, histiocytosis, and tuberculosis, and the involvement of the hypothalamus and pi -tuitary gland and can affect the production of testosterone.
  • HIV/AIDS. HIV/AIDS can cause low levels of testosterone affect the hypothalamus, the pituitary, and the testes.
  • Drugs. The use of certain medications, such as opioid pain relievers, and some hormones, it can affect the production of testosterone.
  • Obesity. Being significantly overweight at any age could be linked with hypogonadism.
  • Aging. As men age, there is a slow and progressive decrease in the production of testosterone. The rate varies greatly.

Disorders of the pituitary gland. An abnormality of the pituitary gland can affect the release of hormones from the pituitary gland and the testes, which affect the normal production of testosterone. A tumor of the pituitary gland or other type of brain tumor located near the pituitary gland can cause testosterone or other hormonal deficiencies.

In addition, the treatment for a tumor in the brain, such as surgery or radiation therapy, can affect the pituitary gland and cause hypogonadism.

Risk factors

Risk factors for hypogonadism include:

  • HIV/AIDS
  • Prior treatment with chemotherapy or radiati- on therapy
  • Aging
  • Obesity
  • Malnutrition

Hypogonadism can be inherited. If any of these risk factors are in your family health history, tell your doctor.

Complications

The complications of untreated hypogonadism differ depending on when it develops during the fetal development, puberty or in adulthood.

Complications can include:

  • Abnormal genitalia
  • Enlargement of the male breasts (gynecomastia)
  • Infertility
  • Erectile dysfunction
  • Osteoporosis
  • Poor self-image

Male hypogonadism

Diagnosis

Early detection in children can help to prevent problems of delayed puberty. Early diagnosis and treatment in men offer a better protection against osteoporosis and other related conditions.

The doctor will perform a physical exam and take into account if your sexual development, such as its pubic hair, muscle mass, and the size of the testicles, that is consistent with their age.

Your healthcare provider will test your blood level of testosterone if you have signs or symptoms of hypogonadism. Because testosterone levels vary and are usually highest in the morning, blflood test is usually done early in the day, before 10 in the morning, possibly for more than a day.

If the tests confirm that they have low levels of testosterone, in addition to testing can determine if a testicular disorder or abnormality of the pituitary gland is the cause. These studies might include:

  • Hormone testing
  • Semen analysis
  • The pituitary gland images
  • Genetic studies
  • Testicular Biopsy

Treatment

Adults

Testosterone replacement can increase testosterone levels and help to relieve the symptoms of male hypogonadism. These include decreased sexual desire, less energy, less facial and body hair, and loss of muscle mass and bone mass.

For older adults who have low testosterone levels and symptoms of hypogonadism due to aging, it is less clear how well testosterone replacement works.

Any person who take testosterone replacement must have a medical examination and blood tests several times during the first year of treatment and annually after that. This is to see how well the treatment works and to monitor side effects.

Types of testosterone replacement therapy

Testosterone taken by the mouth, also called oral, it is not often used for the treatment of hypogonadism. Oral testosterone can cause serious liver problems. And not to maintain the levels of testosterone, even.

The Food and Drug Administration has approved oral testosterone replacement, testosterone undecanoate (Jatenzo, Tlando, Kyzatrex). The lymphatic system absorbs it, so that it might cause liver problems that are observed with other oral forms of testosterone. It is not used to treat hypogonadism caused by aging.

Other forms that you can choose from, you can rely on that are very easy to get and to use, how much they cost, and if the insurance covers. They include:

  • The gels.There are several available with different ways of applying them. Depending on the brand, you rub the testosterone in your skin in the upper arm or on the shoulder (AndroGel, Testim, Vogelxo) or to apply to the front and the inside part of the thigh (Fortesta). The body absorbs the testosterone through the skin. Do not shower or bathe for several hours after use of a gel to give you time to soak in. Side effects incinclude irritation of the skin and, if someone touches you, have the medicine to get to someone else. Do not let your skin touch anyone until the gel is completely dry. Or cover the area after putting on the gel.
  • The shot.Testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Xyosted) are given into a muscle or under the skin. Symptoms can vary between the dose in terms of the frequency with which you make the shots. You or a family member can learn to take testosterone injections at home. If you're not ok with giving shots, a member of your care team can do for you. The shooting form of testosterone undecanoate (Aveed) delves into a muscle, usually every 10 weeks. A member of your healthcare team should give you. Can have serious side effects.
  • The patch. A patch that contains testosterone is put in an arm or torso, every night. Possible side effects are mild or serious skin problems.
  • The gum and the cheek, also called oral cavity.Small and puttylike, the gum and the cheek of testosterone replacement sent to testosterone through the area above the top of the teeth where the gum and the upper lip, called the oral cavity. This product is taken one to three times a day, it sticks to the gum line and sends testosterone in the bloodstream. Can irritate the gums.
  • Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This option reduces the risk of the drug which is obtained in another person through contact with the skin. This type of testosterone is to put in each nostril three times a day. This may make it less easy to use than other methods.
  • Pellets placed under the skin, called Implants. Testosterone-containing pellets (Testopel) are surgically placed under the skin every 3 to 6 months.

The gels. There are several available with different ways of applying them. Depending on the brand, you rub the testosterone in your skin, in the upper part of the arm or on the shoulder (AndroGel, Testim, Vogelxo) or to apply to the front and the inside part of the thigh (Fortesta).

The body absorbs the testosterone through the skin. Do not shower or bathe for several hours after use of a gel to give you time to soak in.

Side effectivets include irritation of the skin and, if someone touches you, have the medicine to get to someone else. Do not let your skin touch anyone until the gel is completely dry. Or cover the area after putting on the gel.

The shot. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Xyosted) are given into a muscle or under the skin. Symptoms can vary between the dose in terms of the frequency with which you make the shots.

You or a family member can learn to take testosterone injections at home. If you're not ok with giving shots, a member of your care team can do for you.

The shooting form of testosterone undecanoate (Aveed) delves into a muscle, usually every 10 weeks. A member of your healthcare team should give you. Can have serious side effects.

The gum and the cheek, also calleded oral cavity. Small and puttylike, the gum and the cheek of testosterone replacement sent to testosterone through the area above the top of the teeth where the gum and the upper lip, called the oral cavity.

This product is taken one to three times a day, it sticks to the gum line and sends testosterone in the bloodstream. Can irritate the gums.

Testosterone therapy involves risks, including:

  • Make too many red blood cells.
  • Acne.
  • Larger breasts.
  • Sleep problems.
  • The growth of the prostate.
  • Not so much sperm.

Risks of testosterone therapy are more often due to too high a dose. Many of these side effects disappear when the dose is lowered. That is why it is so important to have regular follow-up visits with a health care professional, who will monitor the level of testosteronein your blood.

The treatment of infertility due to hypogonadotropic hypogonadism

If the pituitary gland problem that is the cause, pituitary hormones can be given to help the body produce more sperm and restore fertility. A tumor of the pituitary gland may need to be treated with surgery, medicine, radiation or replacement of other hormones.

There is often no way to help men with hypogonadism primary produce sperm. But there are ways to help couples who have not been able to have children. The assisted reproductive technology offers ways to help.

The treatment for children

Ttreatment of delayed puberty in children depends on the cause. Three to six months of testosterone injections can help to start puberty. Testosterone can help increase muscle mass, beard and pubic hair growth, and the growth of the penis. This treatment is administered only if the bones have matured enough.

Coping and support

Have male hypogonadism can affect your self-image and, possibly, of their relationships. Talk with your health care provider about how you can reduce the anxiety and stress that often accompany these conditions ofions. Many men benefit from the psychological and / or family counseling.

Find out if there are support groups in your area or online. Support groups put you in touch with other people with similar problems.

Preparing for your appointment

Although it is likely to start by seeing your family doctor or other care provider, you may be referred to someone that specializes in the production of hormones from the glands (endocrine).

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including any major stresses, recent life changes, and the history of childhood illnesses or surgeries
  • All the medications, vitamins, or other supplements you are taking, including dose
  • Questions to ask your provider

For male hypogonadism, some questions to ask your provider include:

  • What is the most likely cause of my symptoms?
  • There are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available?
  • I have other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your provider

Be prepared to answer questions about your condition, such as:

  • The symptoms been continuous or occasional?
  • How severe is Iur symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • When did you begin puberty? He did seem to be earlier or later than their peers?
  • Do you have any of the problems of growth as a child or teenager?
  • Have you injured your testicles?
  • Do you have mumps as a child or teenager? Do you remember if she felt pain in your testicles while you had mumps?
  • Do you have undescended testicles as a baby?
  • Did you have surgery for a hernia, inguinal or genital surgery as a child?
Symptoms and treatment of Male hypogonadism