Male Hypogonadism

What is Male Hypogonadism?

Hypogonadism is a condition that causes the gonads, or the reproductive glands in the testicles that create sex cells, to stop functioning properly, and in turn, stop producing enough testosterone. Testosterone is a hormone that is vital for a man’s sexual function and development. While testosterone is mainly created in the testicles, a small amount is also created in the adrenal glands, which sit above the kidneys.

There are two types of hypogonadism: primary or central

Men with the primary type have testicles that do not properly function. Men with the central type have either a malfunctioning pituitary gland, which is an important gland in the brain that controls development and other hormones and glands, or a malfunctioning hypothalamus, which is responsible for homeostasis and sending signals to the pituitary gland to either release or inhibit hormones.

There are a plethora of causes for hypogonadism. For instance, if a man has primary hypogonadism, his condition may be a side effect of surgery or radiation therapy for cancer. Some genetic disorders, like Klinefelter syndrome, create extra chromosomes after conception, thus causing lifelong symptoms of hypogonadism. Some autoimmune disorders, like Addison’s disease, cause the reduction of hormone production. Some diseases, like kidney disease, liver disease, diabetes, etc., can also cause hypogonadism as a side effect.

Like primary hypogonadism, men with central hypogonadism can also be caused by genetic issues, surgeries, and the like. Taking certain medications, like selective-serotonin re-uptake inhibitors (SSRIs), glucocorticoids, reacreational drugs, etc. can cause lower levels of testosterone. Diet and weight loss after a major surgery can also play a role. For instance, having certain nutritional deficiencies or taking in too much iron can create a disturbance in testosterone levels. Lastly, trauma to the brain or bleeding in the brain can cause the pituitary to stop releasing adequate amounts of testosterone.

What are the Symptoms of Male Hypogonadism?

Since testosterone is responsible for helping to create red blood cells, building bone density, and regulating fat distribution, those with hypogonadism may actually develop osteoporosis, poor muscle tone, and enlarged breasts.

Other signs of the condition include a low sex drive, infertility, testicular issues, little body hair, irregular sleep cycles, low sperm counts, erectile dysfunction, and fatigue. While it is not completely clear that heart issues are caused by low testosterone, these cardiovascular difficulties have been correlated to hypogonadism.

Male Hypogonadism Causes

The causes of male hypogonadism are tied to the pituitary gland and hypothalamus. Male hypogonadism occurs when the testicles fail to produce the right amount of the hormone testosterone, stemming from two different origins:

  • Primary hypogonadism “otherwise known as primary testicular failure” starts as the name implies in testicles.
  • Secondary hypogonadism is a more complex problem that starts in the hypothalamus or in the pituitary gland “” areas in the brain that tell the testicles to start and stop producing testosterone. The hypothalamus makes the gonadotropin-releasing hormone, signaling the pituitary gland to start making follicle-stimulating hormone or FSH and luteinizing hormone or LH. Luteinizing hormone is responsible for signaling the testes to start producing testosterone.

Either of these two types of hypogonadism can be caused due to an inherited trait or an event that comes later in life, like an infection or an injury and on occasion, these types of hypogonadism can occur at the same time.

Typical causes of primary hypogonadism:

  • Klinefelter syndrome. This syndrome condition is the result of a congenital abnormality in the sex chromosomes, both X and Y. Normally, a male has a single X and single Y chromosome. However, in cases of Klinefelter syndrome, two X chromosomes or more occur along with one Y chromosome.
  • Undescended testicles. Prior to birth, testicles start developing within the abdomen and then typically descend into a permanent position within the scrotum. However, on occasion, one or both testicles fail to descend at birth.

How is Male Hypogonadism Treated?

Since testosterone therapy can increase the risk of acne, sleep apnea, and in worse cases, blood clots and strokes, men are only recommended to pursue it if they are well below the normal testosterone range””normal ranges are about 300 to 900 per deciliter.

Hormone replacements can come in many forms. For instance, a putty or patch can be applied to the gums in the mouth. Gels, oral medications, injections, patches, and the like are all options. A man should talk to his doctor to figure out which method has the least amount of side effects and would be best for his situation.

Male Hypogonadism Prevention

Doctors will commonly put patients who are at significant risk of developing male hypogonadism on HRT or hormone replacement therapy. Those undergoing HRT should follow their doctor’s directions to the letter including undertaking re-evaluations every six to 12 months.

Not having the typical amount of sex hormones in a person’s body can cause physical complaints and is even linked to an increased risk of heart disease as well as osteoporosis, thanks to the thinning of bones.

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Last Reviewed:
October 07, 2016
Last Updated:
June 21, 2018
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