Hypogonadism
What is Hypogonadism? (Gonadal deficiency)
Hypogonadism is a reduced or absent secretion of hormones
from the sex glands (gonads). In men, these are the testes;
in women, the ovaries.
Causes,
incidence, and risk factors
The cause of hypogonadism may be "primary" or "central."
In primary hypogonadism, the ovaries or testes themselves
do not function properly. Some causes include surgery; radiation;
genetic and developmental disorders; liver and kidney disease;
infection; and certain auto-immune disorders. The most common
genetic disorders 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 tumors (growths);
surgery and radiation; infections; trauma; bleeding; genetic
problems; nutritional deficiencies; and iron excess (hemochromatosis).
A
genetic cause of central hypogonadism which also produces
an inability to smell is Kallmann syndrome (males). The most
common tumors affecting the pituitary area are craniopharyngioma
(children) and prolactinoma (adults, this leads to the production
of excess prolactin (which causes the breasts to produce milk,
among other functions). Prolactinomas cause hypogonadism even
if they are not large.
Symptoms
In girls, hypogonadism during childhood will result in lack
of menstruation and breast development and short height. If
hypogonadism occurs after puberty, symptoms include loss of
menstruation, low libido, hot flashes, and loss of body hair.
In
boys, hypogonadism in childhood results in lack of muscle
and beard development and growth problems. In men the usual
complaints are sexual dysfunction, decreased beard and body
hair, breast enlargement, and muscle loss.
If
a brain tumor is present (central hypogonadism) there may
be headaches or visual loss, or symptoms of other hormonal
deficiencies (such as hypothyroidism). In the case of the
most common pituitary tumor, prolactinoma, there may be a
milky breast discharge. People with anorexia nervosa (excessive
dieting to the point of starvation) also may have central
hypogonadism.
Signs
and test
Tests may be done that check estrogen level (women) and testosterone
level (men) as well as FSH level and LH level, the pituitary
hormones that stimulate the gonads. Other tests may include
a thyroid level; sperm count; prolactin level (milk hormone);
blood tests for anemia, chemistries, and iron; and genetic
analysis.
Sometimes
imaging is necessary, such as a sonogram of the ovaries. If
pituitary disease is suspected, an MRI or CT scan of the brain
may be done.
Treatment
Hormonal preparations are available for men and women.
Estrogen
comes as a patch or pills.
Testosterone
can be given as a patch or via 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. In addition,
low dose testosterone can be added for hypogonadal women with
a low sex drive.
If
there is a correctible cause of hypogonadism (e.g., a pituitary
tumor), medication may be given (particularly for prolactinoma)
or surgery and/or radiation therapy may be required. Injections
or oral medication can be used to stimulate ovulation. Injections
of pituitary hormones may be needed for men with hypogonadism
to produce sperm. Therapy may also target nutritional, infectious,
or other causes of the problem.
Expectations
(prognosis)
Many forms of hypogonadism are potentially treatable and have
a good prognosis.
Complications
In women, hypogonadism may cause infertility. Menopause is
a form of naturally occurring hypogonadism, which 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 opt to take estrogen therapy, particularly women who
have early menopause ("premature ovarian failure").
However, there is a small but significant increase in risk
for breast cancer and heart disease with use of hormone replacement
for treatment of menopause.
In
men, hypogonadism results in loss of sex drive and may cause
weakness, impotence, infertility, and osteoporosis. Men also
experience some decline in testosterone as they age, but it
is not as dramatic or steep as the decline in sex hormones
experienced by women.
Calling
your health care provider
Consult with your doctor if you notice loss of menstruation,
breast discharge, inability to conceive, hot flashes (women),
impotence, loss of body hair, weakness, or breast enlargement
(men). Both men and women should call their health care providers
if headaches or visual problems occur.
Prevention
Maintain normal body weight and healthy eating habits to prevent
anorexia nervosa. Other causes may not be preventable.
