What is Hypogonadism?

Hypogonadism occurs when your sex glands produce little or no sex hormones. The sex glands, also called gonads, are the testes in men and the ovaries in women. Sex hormones help control sex characteristics, such as breast and testicle development, and pubic hair growth. Sex hormones also play a role in menstrual cycles and sperm production.

Hypogonadism may also be called gonad deficiency. In males, it may be called low serum testosterone or andropause.

Most cases of this disorder can be successfully treated.

Types of Hypogonadism

There are two types of hypogonadism: primary and central hypogonadism.

Primary Hypogonadism

Primary hypogonadism means that you do not have enough sex hormones in your body due to a problem in the gonads. The gonads are still receiving the message to produce hormones from the brain, but are not able to produce them.

Central Hypogonadism

In central hypogonadism, the problem lies in the brain. Here the hypothalamus and pituitary gland—which control the gonads—are not working properly.

What are the Causes of Hypogonadism?

Causes of primary hypogonadism include:

  • autoimmune disorders, such as Addison’s disease and hypoparathyroidism
  • genetic disorders, such as Turner syndrome and Klinefelter syndrome
  • infection
  • liver and kidney diseases
  • hemochromatosis (when the body absorbs too much iron)
  • radiation exposure
  • surgery on the sex organs

Central hypogonadism may be caused by:

  • genetic disorders, such as Kallmann syndrome
  • infections, including HIV and AIDS
  • pituitary disorders
  • inflammatory diseases, including sarcoidosis, tuberculosis, and histiocytosis
  • obesity
  • rapid weight loss
  • nutritional deficiencies
  • use of steroids or opiates
  • bleeding
  • brain surgery
  • radiation exposure
  • injury to the pituitary gland or hypothalamus
  • a tumor in or near the pituitary gland

What are the Symptoms of Hypogonadism?

Symptoms that may affect females include:

  • no menstruation
  • slow or absent breast growth
  • hot flashes
  • loss of body hair
  • low sex drive
  • milky discharge from the breasts

Symptoms that may affect males include:

  • loss of body hair
  • muscle loss
  • breast growth
  • reduced growth of penis and testicles
  • erectile dysfunction
  • osteoporosis
  • low sex drive
  • infertility
  • fatigue
  • hot flashes
  • difficulty concentrating

Diagnosis and Tests

Your doctor will conduct a physical exam to confirm that your sexual development is at the proper level for your age. He or she may examine your muscle mass, body hair, and your sexual organs.

Hormone Tests

If your doctor suspects hypogonadism, the first round of testing will involve checking your sex hormone levels. You will need a blood test to check your level of follicle stimulating hormone (FSH) and luteinizing hormone (LH). The pituitary gland produces these reproductive hormones.

Females will have their estrogen level tested. Males will have their testosterone level tested. These tests are usually done in the morning, when hormone levels are highest. If you are male, your doctor may also order a semen analysis to check your sperm count. Sperm count can be reduced by hypogonadism.

Your doctor may order more blood tests to help confirm the diagnosis of hypogonadism and rule out any underlying causes.

Iron levels can affect your sex hormones. For this reason, your doctor may test for anemia (iron deficiency). Your doctor may also wish to measure your prolactin levels. Prolactin is a hormone that promotes breast development and breast milk production in women, though it is present in both genders. Your doctor may also check your thyroid hormone levels because thyroid problems can cause symptoms similar to hypogonadism.

Imaging Tests

Imaging tests can also be useful in diagnosis. An ultrasound of the ovaries uses sound waves to create an image of the ovaries and check for any problems, including ovarian cysts and polycystic ovarian syndrome (PCOS). MRI scans or CT scans may be ordered to check for tumors in the pituitary gland.

Treatment for Hypogonadism

For Women

Treatment for women involves increasing the amount of female sex hormones in the body.

The first line of treatment for women who have had a hysterectomy is usually estrogen therapy. The hormone estrogen can be administered as either a patch or a pill. Because increased estrogen levels can increase your risk of endometrial cancer, women who have not had a hysterectomy are usually given a combination of estrogen and progesterone. Progesterone can lower the risk of endometrial cancer if you are taking estrogen.

Other treatments can target specific symptoms. Women who are experiencing decreased sex drive may be prescribed low doses of testosterone. Women experiencing menstrual irregularities or trouble conceiving may be given injections of the hormone human choriogonadotropin (hCG) or pills containing FSH to trigger ovulation.

For Men

Testosterone replacement therapy (TRT) is a widely used treatment for hypogonadism in males. Testosterone (the male sex hormone) may be given as an injection, patch, gel or lozenge. Injections of a gonadotropin-releasing hormone may be given to trigger puberty or to increase the production of sperm.

Treatment for Men and Women

If your hypogonadism is caused by a tumor on your pituitary gland, treatment for males and females is similar. Treatment may include radiation, medication, or surgery to shrink or remove the tumor.