Hypogonadism and Its Causes, Symptoms, Treatment

Hypogonadism and Its Causes, Symptoms, Treatment
Published : Feb 04, 2024
Last Updated : Feb 07, 2024

What is Hypogonadism?

Hypogonadism is a condition in which our body does not produce enough sex hormones. It appears when the sex glands either produce little or no sex hormones. The treatment option depends on whether you are trying to conceive or not. 

The sex glands that recreate sex hormones are also known as gonads. People assigned female at birth have ovaries, while those assigned male at birth have testes. The produced sex hormones control secondary sex characteristics in the body. For example, breast development occurs in people with AFAB, resulting in AMAB people and pubic hair growth. Sex hormones play a vital role in sperm production in males and in the menstrual cycle in females. 

Hypogonadism is a condition also known as gonadal deficiency. It is sometimes called andropause or low serum testosterone in assigned male at birth individuals. 

What are the types of Hypogonadism?

Hypogonadism is of three types: Primary, secondary, and gonadotropic. We have described each of them below-

Primary Hypogonadism

The condition appears when you do not have enough sex hormones in your body to a problem in your gonads. In this case, your gonads still receive messages from the brain to produce hormones, but they can't. Primary Hypogonadism is also known as hypogonadotropic Hypogonadism.

Secondary Hypogonadism

It is a brain-originated problem in which your gonads aren't properly stimulated. In this condition, glands like the hypothalamus or pituitary found in or near the brain do not work perfectly. These areas are generally known to control your gonads. That's why your gonads do not stimulate properly and can lead to conditions like Secondary Hypogonadism. It is also known as central Hypogonadism or Hypogonadism. 

Eugonadotropic hypogonadism

The condition of Eugonadotripic Hypogonadism appears when your pituitary gland is working usually, but you still have Hypogonadism. Eugonadotropic Hypogonadism only affects people assigned to females at birth. It causes problems with the ovaries, like polycystic ovarian syndrome (PCOS). The condition is also known as normogonadotropic Hypogonadism. 

What causes Hypogonadism?

The causes for Primary Hypogonadism are-

Genetic disorders like Klinefelter syndrome and Turner syndrome

Autoimmune diseases such as Hypoparathyroidism and Addison's disease

  • Undescended testes
  • Mumps or infection of the testicles or ovaries
  • Liver or kidney diseases
  • Radiation exposure
  • Surgery of any sexual organs

The secondary hypogonadism-like condition may appear due to the following issues-

  • Genetic disorders like Kallmann syndrome(abnormal hypothalamic development)
  • A Tumor in or near the pituitary gland
  • Infections including HIV
  • Injury to the hypothalamus or pituitary gland
  • Inflammatory diseases such as tuberculosis and sarcoidosis
  • Rapid weight loss 
  • Obesity
  • Brain surgery
  • Nutritional deficiencies
  • Use of opioids or steroids
  • Hemochromatosis is a condition that occurs when your body absorbs too much Iron

The causes of Eugonadotropic Hypogonadism include-

  • Polycystic ovary syndrome(PCOS)
  • Delayed menarche
  • Hyperprolactinemia, or having an excess amount of the hormone known as Prolactin

Symptoms of Hypogonadism

The symptoms that may appear in people with AFAB include-

  • Slow or absent breast growth
  • Hot flashes
  • Lack of menstruation
  • Loss of body hair
  • Low or absent sex drive
  • Milky discharge from the breasts
  • Osteoporosis
  • Infertility

The symptoms that can occur in people with AMAB include- 

  • Muscle loss
  • Reduced growth of the testicles and penis
  • Abnormal breast growth
  • Erectile dysfunction
  • Fatigue
  • Loss of body hair
  • Osteoporosis
  • Hot flashes
  • Infertility
  • Difficulty concentrating
  • Low or absent sex drive

 How is Hypogonadism diagnosed?

A doctor may conduct a physical examination to check your sexual development according to your age. During inspection, they will check your muscle mass, hair, and sexual organs. 

Laboratory tests

If your doctor suspects you have Hypogonadism, they may request lab tests to check hormone levels. For it, you need a blood test so that they can check the levels of Luteinizing hormone(LH) and follicle-stimulating hormone(FSH). Your pituitary gland produces these reproductive hormones, which are also known as Gonadotropins. 

If you are AFAB, you may need to get your estrogen levels tested. Also, a doctor may check your egg count by performing an anti-mullerian hormone(AMH) test. And if you are AMAB, you will have your testosterone levels tested. Testing your testosterone in the morning is best for the most accurate results. A doctor may ask for semen analysis to check sperm count because Hypogonadism can potentially lower it. 

Moreover, your doctor may ask for additional blood tests. These tests may help them confirm a diagnosis and discover any underlying causes. These tests include-

Prolactin tests

Check for the hormone known as Prolactin that helps in breast development and production of milk in AFAB people. But, this hormone is also present in people with AMAB. 

Iron tests

The levels of Iron in your body can affect your sex hormones. Thus, a doctor may ask for an iron test to check for high blood iron levels. 

Thyroid function tests

Thyroid can have similar symptoms like Hypogonadism. Thus, a doctor may also check for your thyroid hormone levels to identify the correct cause of the problem. 

Genetic tests

A doctor may ask for genetic testing if they suspect chromosomal irregularity can be a reason. In such cases, Turner syndrome is likely to interfere and lead to the condition like Hypogonadism. 

Imaging tests

Imaging tests can be one of the helpful tests in diagnosis, which is done through ultrasound. An ultrasound creates an image of the ovaries and checks for the problem, especially ovarian cysts and PCOS. Also, for advice, a doctor may order MRIs or CT scans to check for tumours in or near the pituitary gland. 

What are the treatments for Hypogonadism for both males and females?

If Hypogonadism appears due to a tumour affecting the pituitary gland, then all genders treat this condition similarly. 

A doctor may advise medication, radiation, or surgery to shrink or remove the tumour in this treatment. 

The treatments that are generally directed for females or males hypogonadism are-

Treatment for Female Hypogonadism

The treatment mainly focuses on increasing the amount of female sex hormones in females. Treatment will vary depending on your Hypogonadism type and if you are trying to conceive.

If you are dealing with primary Hypogonadism and actual ovarian failure, then you explore alternative forms of family-building options, such as

  • Adoption
  • Egg donation
  • Using a gestational carrier

If you have secondary Hypogonadism and low FSH levels, you must take FSG injections. In some cases, FSH and hormones like Human choriogonadotropin (hCG) may help trigger ovulation

Some may require estrogen therapy and supplemental estrogen available as a patch or pill. If you had a hysterectomy, estrogen therapy will be your first line of treatment. It is because it can increase the levels of estrogen that can increase the risk of endometrial cancer. So, a doctor may treat you with estrogen and progesterone if you have not had a hysterectomy. Hormones, like Progesterone, can help lower your risk for endometrial cancer if you're taking estrogen.

The other treatments for Hypogonadism can target specific symptoms and help treat or prevent them. A doctor may treat underlying causes such as PCOS in conditions like Eugonadotropic Hypogonadism. 

Treatment for Male Hypogonadism

 In males, hormones like gonadotropin-releasing hormone (GnRH) or gonadotropins can help start puberty or boost sperm production. 

A doctor may advise you of this treatment if you are trying to conceive and face primary Hypogonadism. Also, in such conditions, you can explore sperm harvesting and sperm donation. 

If you are not concerned about your infertility, then you can take treatment like testosterone replacement therapy(TRT). Testosterone for treatment is available in different forms, such as

  • Patches
  • Gels
  • Pellets
  • Injections
  • Lozenges

What's the long-term outlook for Hypogonadism?

Hypogonadism is a chronic condition and may be a lifelong treatment Unless a treatable condition is causing it. During the treatment, your sex hormones can decrease if you stop hormone therapy. So you may need your treatment to keep going to maintain your sex hormone in some type of Hypogonadism. Most of the cases of Hypogonadism will respond to medical treatments. Also, seeking support through therapy and support groups may help you throughout the treatment.