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Hypogonadism
Definition
Hypogonadism is when the sex glands produce little or no hormones. In men, these glands (gonads) are the testes; in women, they are the ovaries.
Alternative Names
Gonadal deficiency
Causes
The cause of hypogonadism may be "primary" or "central." In primary hypogonadism, the ovaries or testes themselves do not function properly. Some causes of primary hypogonadism include:
- Certain autoimmune disorders
- Genetic and developmental disorders
- Infection
- Liver and kidney disease
- Radiation
- Surgery
The most common genetic disorders that cause primary hypogonadism are Turner syndrome (in women) and Klinefelter syndrome (in men).
In central hypogonadism, the centers in the brain that control the gonads (hypothalamus and pituitary) do not function properly. Some causes of central hypogonadism include:
- Bleeding
- Certain medications, including steroids and opiates
- Genetic problems
- Infections
- Nutritional deficiencies
- Iron excess(hemochromatosis)
- Radiation
- Rapid, significant weight loss
- Surgery
- Trauma
- Tumors
A genetic cause of central hypogonadism that also takes away the sense of smell is Kallmann syndrome (males). The most common tumors affecting the pituitary are craniopharyngioma (in children) and prolactinoma (in adults).
Symptoms
Girls who have hypogonadism during childhood will not begin menstruating. The condition can affect girls' breast development and height. If hypogonadism occurs after puberty, symptoms include:
- Hot flashes
- Loss of body hair
- Low libido
- Menstruation stops
In boys, hypogonadism in childhood affects muscle and beard development and leads to growth problems. In men the usual symptoms are:
- Breast enlargement
- Decreased beard and body hair
- Muscle loss
- Sexual problems
If a brain tumor is present (central hypogonadism), there may be:
- Headaches or vision loss
- Milky breast discharge (from a prolactinoma)
- Symptoms of other hormonal deficiencies (such as hypothyroidism)
People with anorexia nervosa (who diet to the point of starvation) and those who lose a lot of weight very quickly (such as after gastric bypass surgery) also may have central hypogonadism.
Exams and Tests
Tests may be done that check:
- Estrogen level (women)
- FSH level and LH level
- Testosterone level (men)
Other tests may include:
- Blood tests for anemia and iron
- Genetic tests
- Prolactin level (milk hormone)
- Sperm count
- Thyroid level
Sometimes imaging tests are needed, such as a sonogram of the ovaries. If pituitary disease is suspected, an MRI or CT scan of the brain may be done.
Treatment
Hormone-based medicines are available for men and women. Estrogen comes in the form of a patch or pill. Testosterone can be given using a patch, a product soaked in by the gums, a gel, or by injection.
For women who have not had their uterus removed, combination treatment with estrogen and progesterone is often recommended to decrease the chances of developing endometrial cancer. Women with hypogonadism who have a low sex drive can also take low-dose testosterone.
In some women, injections or pills can be used to stimulate ovulation. Injections of pituitary hormone may be used to help male patients produce sperm. Other people may need surgery and radiation therapy.
Outlook (Prognosis)
Many forms of hypogonadism are treatable and have a good outlook.
Possible Complications
In women, hypogonadism may cause infertility. Menopause is a form of hypogonadism that occurs naturally and can cause hot flashes, vaginal dryness, and irritability as a woman's estrogen levels fall. The risk of osteoporosis and heart disease increase after menopause.
Some women with hypogonadism take estrogen therapy especially those who have early menopause (premature ovarian failure). However, there is a small but significant increase in risk for breast cancer and possibly heart disease when hormone therapy is used to treat menopause symptoms.
In men, hypogonadism results in loss of sex drive and may cause:
- Impotence
- Infertility
- Osteoporosis
- Weakness
Men normally have lower testosterone as they age, but the decline is not as dramatic or steep as the decline in sex hormones that women experience.
When to Contact a Medical Professional
Talk to your doctor if you notice:
- Breast discharge
- Breast enlargement (men)
- Hot flashes (women)
- Impotence
- Loss of body hair
- Loss of menstrual period
- Problems getting pregnant
- Problems with your sex drive
- Weakness
Both men and women should call their health care provider if they have headaches or vision problems.
Prevention
Maintain normal body weight and healthy eating habits to prevent anorexia nervosa. Other causes may not be preventable.
References
Sigman M, Jarow JP. Male infertility. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.
Molitch ME. Anterior pituitary. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 242.
White PC. Disorders of sexual differentiation. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 252.
Faiman C. Male hypogonadism. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:pgs 397-401.
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
