Male hypogonadism: causes, symptoms, diagnosis and treatment

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

A person may be born with male hypogonadism, or this condition may present later in life, often as a result of injury or infection. The effects and what you can do about them depend on the cause and when male hypogonadism occurs in your life. Some types of male hypogonadism can be treated with testosterone replacement therapy.

Symptoms

Hypogonadism can begin during fetal development, before puberty, or in adulthood. Signs and symptoms depend on when the condition appears.

fetal development

If the body does not produce enough testosterone during fetal development, the result can be stunted growth of the external sex organs. Depending on when hypogonadism develops and the amount of testosterone present, a genetically male boy may be born with the following: Female genitals Genitals that are neither clearly male nor female (ambiguous genitalia) Underlying male genitalia developed

Puberty

Male hypogonadism can delay puberty or lead to incomplete development or lack of normal development. It can hinder: The development of muscle mass The deepening of the voice The growth of body and facial hair The growth of the penis and testicles

And this 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 male physical characteristics and impair normal reproductive function. Early signs and symptoms may include the following: Decreased sex drive Decreased energy Depression

Over time, men with hypogonadism may develop the following: Erectile dysfunction Infertility Decreased hair growth on the face and body Decreased muscle mass Growth of breast tissue (gynecomastia) Loss of bone mass (osteoporosis )

Severe hypogonadism can also cause mental and emotional changes. As testosterone declines, some men experience symptoms similar to those of menopause in women. These may include the following: Difficulty concentrating Hot flashes

When to ask for help

Risk factors for hypogonadism include: HIV/AIDS prior chemotherapy or radiation therapy aging obesity malnutrition

Hypogonadism can be hereditary. If any of these risk factors are in your family medical history, talk to your doctor.

Diagnostic

Early detection in children can help prevent problems with delayed puberty. Early diagnosis and treatment in men offers better protection against osteoporosis and other related conditions.

Your health care provider will perform a physical exam and note whether sexual development, such as pubic hair, muscle mass, and testicular size, is consistent with age.

Your healthcare provider will test your blood testosterone levels if you have signs or symptoms of hypogonadism. Since testosterone levels fluctuate and are generally higher in the morning, blood tests are usually done early in the day, before 10:00 a.m., possibly over more than one day.

Male hypogonadism is usually treated with testosterone replacement to bring testosterone levels back to normal. Testosterone can help counter the signs and symptoms of male hypogonadism, such as decreased libido, decreased energy, decreased facial and body hair, and loss of muscle mass and bone density .

For older men who have low testosterone, in addition to signs and symptoms of hypogonadism due to aging, the benefits of testosterone replacement are less clear.

While you are taking testosterone, the Endocrine Society recommends that your healthcare provider monitor treatment effectiveness and side effects several times during the first year of treatment and once a year thereafter.

Types of Testosterone Replacement Therapy

Oral preparations of testosterone have not been used to treat hypogonadism as they can cause serious liver problems. Additionally, they do not keep testosterone levels stable.

An oral testosterone replacement preparation approved by the Food and Drug Administration, testosterone undecanoate (Jatenzo), is absorbed through the lymphatic system. This could prevent the liver problems seen with other oral forms of testosterone.

Other preparations you may choose, depending on convenience, cost, and your insurance coverage, include:

Freeze. There are several gels and solutions available, with different forms of application. Depending on the brand, testosterone is rubbed into the skin of the upper arm or shoulder (AndroGel, Testim, Vogelxo) or applied to the front and inner thigh (Fortesta).

Your body absorbs testosterone through the skin. Do not shower or bathe for several hours after applying the gel to ensure that it is well absorbed.

Side effects include skin irritation and the possibility of transferring the drug to another person. Avoid skin-to-skin contact until the gel is completely dry or cover the area after one application.

Injection. Testosterone Cypionate (Depo-Testosterone) and Testosterone Enanthate are delivered into a muscle or under the skin. Your symptoms may vary between doses, depending on how often you inject.

You or a family member can learn how to give testosterone injections at home. If you don’t feel comfortable giving yourself the injections, a member of your healthcare team can give them.

Testosterone undecanoate (Aveed) is given by deep intramuscular injection, usually every 10 weeks. It must be administered at the health care provider’s office and can have serious side effects. Patch. A patch containing testosterone (Androderm) is applied every evening to the thighs or torso. A possible side effect is a severe skin reaction.

Gingiva and cheek (oral cavity). Gum and Cheek Testosterone Replacement is a small putty-like substance that releases testosterone through the natural depression above the upper teeth where the gum meets the upper lip (oral cavity).

This product, taken three times a day, adheres to the gum line and allows testosterone to be absorbed into the bloodstream. May cause gum irritation. Nasal. This testosterone gel (Natesto) is inserted into the nostrils. This option reduces the risk of the drug being transferred to another person through skin contact. Nasally administered testosterone must be injected twice into each nostril, three times a day, which can be more cumbersome than other methods of administration. Implantable pellets. Lozenges containing testosterone (Testopel) are surgically implanted under the skin every three to six months. This requires an incision.

Testosterone therapy has several risks, including: Increased red blood cell production Acne Enlarged breasts Trouble sleeping Enlarged prostate gland Limited sperm production

Treatment of infertility due to hypogonadism

If the cause is a pituitary problem, pituitary hormones may be given to stimulate sperm production and restore fertility. A pituitary tumor may require surgical removal, medication, radiation therapy, or other hormone replacement.

There is often no effective treatment to restore fertility in men with primary hypogonadism, but assisted reproductive technologies can be helpful. This technology covers a variety of techniques designed to help couples who have been unable to conceive.

treatment for men

Treatment for delayed puberty in boys depends on the underlying cause. Testosterone supplements given by injection can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and penis growth.