Male hypogonadism is a condition where the body doesn’t produce sufficient testosterone — the hormone that plays a key role in manly development and advancement during puberty — or has an impaired ability to produce sperm or both.
You may be born with male hypogonadism, or it can develop later in life, often from injury or infection. The results — and what you can do about them — depend upon the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.
Hypogonadism in Males
Symptoms
Hypogonadism can begin during fetal advancement, prior to puberty or during the adult years. Signs and symptoms depend upon when the condition establishes.
Fetal development
If the body does not produce sufficient testosterone during fetal advancement, the outcome may suffer growth of the external sex organs. Depending on when hypogonadism develops and how much testosterone is present, a child who is genetically male may be born with:
- Female genital areas
- Ambiguous genitals — genitals that are neither clearly male nor plainly female
- Underdeveloped male genitals
Adolescence
Male hypogonadism may postpone the age of puberty or cause insufficient or absence of normal development. It can cause:
- Decreased advancement of muscle mass
- Absence of deepening of the voice
- Impaired development of body hair
- Impaired growth of the penis and testicles
- Excessive development of the arms and legs in relation to the trunk of the body
- Advancement of breast tissue (gynecomastia)
Adulthood
In adult males, hypogonadism may change particular manly physical attributes and hinder normal reproductive function. Symptoms and signs may consist of:
- Impotence
- Infertility
- Reduction in beard and body hair growth
- Reduction in muscle mass
- Development of breast tissue (gynecomastia)
- Loss of bone mass (osteoporosis)
Hypogonadism can likewise cause psychological and psychological changes. As testosterone decreases, some men may experience symptoms just like those of menopause in women. These might include:
- Fatigue
- Decreased sex drive
- Difficulty focusing
- Hot flashes
When to see a doctor
See a doctor if you have any symptoms of male hypogonadism. Establishing the reason for hypogonadism is a crucial initial step to getting suitable treatment.
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Causes
Male hypogonadism means the testicles don’t produce sufficient of the male sex hormonal agent testosterone. There are two fundamental types of hypogonadism:
- Primary. This type of hypogonadism — also called main testicular failure — originates from a problem in the testicles.
- Secondary. This type of hypogonadism indicates an issue in the hypothalamus or the pituitary gland — parts of the brain that signify the testicles to produce testosterone. The hypothalamus produces gonadotropin-releasing hormonal agent, which indicates the pituitary gland to make follicle-stimulating hormonal agent (FSH) and luteinizing hormonal agent (LH). Luteinizing hormonal agent then signals the testes to produce testosterone.
Either type of hypogonadism may be triggered by an inherited (hereditary) characteristic or something that takes place later on in life (acquired), such as an injury or an infection. Sometimes, primary and secondary hypogonadism can happen together.
Primary hypogonadism
Typical causes of main hypogonadism consist of:
- Klinefelter syndrome. This condition arises from a hereditary irregularity of the sex chromosomes, X and Y. A male usually has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes exist in addition to one Y chromosome. The Y chromosome consists of the hereditary product that identifies the sex of a child and related development. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.
- Undescended testicles. Before birth, the testicles establish inside the abdominal area and normally move down into their long-term location in the scrotum. Often one or both of the testicles might not be descended at birth. This condition often corrects itself within the first couple of years of life without treatment. If not fixed in early youth, it might lead to malfunction of the testicles and reduced production of testosterone.
- Mumps orchitis. If a mumps infection including the testicles in addition to the salivary glands (mumps orchitis) occurs during teenage years or the adult years, long-term testicular damage may occur. This might impact normal testicular function and testosterone production.
- Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, impacting testosterone production.
- Injury to the testicles. Due to the fact that they’re positioned outside the abdomen, the testicles are vulnerable to injury. Damage to usually developed testicles can cause hypogonadism. Damage to one testicle may not impair total testosterone production.
- Cancer treatment. Chemotherapy or radiation therapy for the treatment of cancer can hinder testosterone and sperm production. The impacts of both treatments often are temporary, however long-term infertility might take place. Although many men regain their fertility within a few months after treatment ends, preserving sperm prior to starting cancer therapy is an option that numerous men think about.
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Secondary hypogonadism
In secondary hypogonadism, the testicles are normal but function poorly due to a problem with the pituitary or hypothalamus. A number of conditions can cause secondary hypogonadism, consisting of:
- Kallmann syndrome. Abnormal development of the hypothalamus — the area of the brain that manages the secretion of pituitary hormones — can cause hypogonadism. This problem is also related to impaired development of the ability to smell (anosmia) and red-green color blindness.
- Pituitary conditions. An irregularity in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production. A pituitary growth or other type of brain tumor situated near the pituitary gland may cause testosterone or other hormone deficiencies. Also, the treatment for a brain growth, such as surgery or radiation therapy, may hinder pituitary function and cause hypogonadism.
- Inflammatory disease. Specific inflammatory diseases, such as sarcoidosis, histiocytosis and tuberculosis, involve the hypothalamus and pituitary gland and can affect testosterone production, causing hypogonadism.
- HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
- Medications. The use of particular drugs, such as opiate pain medications and some hormones, can affect testosterone production.
- Weight problems. Being considerably obese at any age might be connected to hypogonadism.
- Normal aging. Older men usually have lower testosterone levels than younger men do. As men age, there’s a sluggish and continuous reduction in testosterone production.
- Concurrent health problem. The reproductive system can briefly close down due to the physical stress of a health problem or surgery, as well as during substantial emotional stress. This is an outcome of reduced signals from the hypothalamus and usually fixes with successful treatment of the underlying condition.
The rate at which testosterone declines varies significantly amongst men. As numerous as 30 percent of men older than 75 have a testosterone level that’s listed below the normal variety of testosterone in boys. Whether treatment is necessary remains a matter of debate.
Risk factors
Risk factors for hypogonadism include:
- Kallmann syndrome
- Undescended testicles as an infant
- Mumps infection impacting your testicles
- Injury to your testicles
- Testicular or pituitary growths
- HIV/AIDS
- Klinefelter syndrome
- Hemochromatosis
- Previous chemotherapy or radiation therapy
- Neglected sleep apnea
Hypogonadism can be acquired. If any of these risk factors are in your household health history, tell your doctor.
Complications
The complications of without treatment hypogonadism differ depending on what age it first establishes — during fetal development, puberty or adulthood.
Fetal advancement
A baby may be born with:
- Uncertain genitalia
- Irregular genitalia
Adolescence
Pubertal development can be delayed or incomplete, leading to:
- Diminished or absence of beard and body hair
- Impaired penis and testicle development
- Unproportional growth, usually increased length of limbs compared with the trunk
- Enlarged male breasts (gynecomastia)
Adulthood
Complications may consist of:
- Infertility
- Erectile dysfunction
- Decreased sex drive
- Tiredness
- Muscle loss or weakness
- Bigger male breasts (gynecomastia)
- Reduced beard and body hair development
- Osteoporosis
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Treatment
Treatment for grownups
Treatment for male hypogonadism depends upon the cause and whether you’re worried about fertility.
- Hormonal agent replacement. For hypogonadism brought on by testicular failure, physicians use male hormonal agent replacement therapy (testosterone replacement therapy, or TRT). TRT can restore muscle strength and avoid bone loss. In addition, men receiving TRT may experience a boost in energy, sex drive, erectile function and sense of well-being.
If a pituitary problem is the cause, pituitary hormones may promote sperm production and bring back fertility. Testosterone replacement therapy can be used if fertility isn’t really an issue. A pituitary tumor may require surgical removal, medication, radiation or the replacement of other hormones.
- Assisted recreation. Although there’s often no efficient treatment to restore fertility in a man with main hypogonadism, assisted reproductive technology might be handy. This innovation covers a variety of techniques developed to help couples who have actually been unsuccessful in accomplishing conception.
Treatment for kids
In boys, testosterone replacement therapy (TRT) can promote puberty and the development of secondary sex attributes, such as increased muscle mass, beard and pubic hair development, and growth of the penis. Pituitary hormonal agents might be used to promote testicle growth. An initial low dosage of testosterone with steady increases may help to avoid unfavorable effects and more carefully imitate the slow boost in testosterone that takes place during the age of puberty.
Types of testosterone replacement therapy
Several testosterone delivery techniques exist. Choosing a particular therapy depends on your preference of a specific delivery system, the side effects and the cost. Methods include:
- Injection. Testosterone injections (testosterone cypionate, testosterone enanthate) are safe and efficient. Injections are given in a muscle. Your symptoms may fluctuate in between dosages depending on the frequency of injections.
You or a family member can learn how to give TRT injections at home. If you’re unpleasant offering yourself injections, a nurse or doctor can give the injections.
Testosterone undecanoate (Aveed), an injection just recently approved by the Food and Drug Administration, is injected less often however need to be administered by a healthcare company and can have major side effects.
- Spot. A spot consisting of testosterone (Androderm) is used each night to your back, abdominal area, upper arm or thigh. The site of the application is turned to maintain seven-day intervals between applications to the exact same site, to reduce skin responses.
- Gel. There are numerous gel preparations offered with different ways of using them. Depending upon the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo), use with an applicator under each armpit (Axiron) or pump on your front and inner thigh (Fortesta).
As the gel dries, your body takes in testosterone through your skin. Gel application of testosterone replacement therapy appears to cause fewer skin responses than patches do. Do not shower or shower for numerous hours after a gel application, to be sure it gets taken in.
A prospective side effect of the gel is the possibility of moving the medication to another person. Avoid skin-to-skin contact until the gel is completely dry or cover the area after an application.
- Gum and cheek (buccal cavity). A little putty-like substance, gum and cheek testosterone replacement (Striant) delivers testosterone through the natural depression above your top teeth where your gum fulfills your upper lip (buccal cavity). This item quickly stays with your gumline and permits testosterone to be soaked up into your blood stream.
- Nasal. Testosterone can be pumped into the nostrils as a gel. This alternative minimizes the risk that medication will be moved to another person through skin contact. Nasal-delivered testosterone must be used twice in each nostril, three times daily, which might be more troublesome than other delivery methods.
- Implantable pellets. Testosterone-containing pellets (Testopel) are surgically implanted under the skin every 3 to six months.
Oral testosterone isn’t really recommended for long-lasting hormonal agent replacement since it may cause liver issues.
Testosterone therapy brings numerous dangers, including adding to sleep apnea, stimulating noncancerous growth of the prostate, enlarging breasts, limiting sperm production, stimulating development of existing prostate cancer and embolism forming in the veins. Recent research likewise suggests testosterone therapy might increase your risk of a cardiac arrest.
