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Hypogonadism

Gonadal deficiency; Testicular failure; Ovarian failure

 

Hypogonadism occurs when the body's sex glands produce little or no hormones. In men, these glands (gonads) are the testes. In women, these glands are the ovaries.

Causes

 

The cause of hypogonadism can be primary or central (secondary). In primary hypogonadism, the ovaries or testes themselves do not function properly. Causes of primary hypogonadism include:

  • Certain autoimmune disorders
  • Genetic and developmental disorders
  • Infection
  • Liver and kidney disease
  • Radiation
  • Surgery
  • Trauma

The most common genetic disorders that cause primary hypogonadism are Turner syndrome (in women) and Klinefelter syndrome (in men).

If you already have other autoimmune disorders you may be at higher risk of autoimmune damage to the gonads. These can include disorders that affect the liver, adrenal glands, and thyroid glands, as well as type 1 diabetes.

In central hypogonadism, the centers in the brain that control the gonads (hypothalamus and pituitary) do not function properly. Causes of central hypogonadism include:

  • Anorexia nervosa
  • Bleeding in the area of the pituitary
  • Taking medicines, such as glucocorticoids and opiates
  • Stopping anabolic steriods
  • Genetic problems
  • Infections
  • Nutritional deficiencies
  • Iron excess (hemochromatosis)
  • Radiation
  • Rapid, significant weight loss (including weight loss after bariatric surgery)
  • Surgery
  • Trauma
  • Tumors

A genetic cause of central hypogonadism is Kallmann syndrome. Many people with this condition also have a decreased sense of smell.

 

Symptoms

 

Girls who have hypogonadism will not begin menstruating. Hypogonadism can affect their breast development and height. If hypogonadism occurs after puberty, symptoms in women include:

  • Hot flashes
  • Energy and mood changes
  • Menstruation stops

In boys, hypogonadism affects muscle, beard, genital and voice development. It also leads to growth problems. In men the symptoms are:

  • Breast enlargement
  • Muscle loss
  • Decreased interest in sex (low libido)

If a pituitary or other 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)

The most common tumors affecting the pituitary are craniopharyngioma in children and prolactinoma adenomas in adults.

 

Exams and Tests

 

You may need to have tests to check:

  • Estrogen level (women)
  • Follicle stimulating hormone (FSH level) and luteinizing hormone (LH) level
  • Testosterone level (men)
  • Other measures of pituitary function

Other tests may include:

  • Blood tests for anemia and iron
  • Genetic tests including a karyotype to check chromosomal structure
  • Prolactin level (milk hormone)
  • Sperm count
  • Thyroid tests

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

 

You may need to take hormone-based medicines. Estrogen and progesterone are used for girls and women. The medicines come in the form of a pill or skin patch. Testosterone is used for boys and men. The medicine can be given as a skin patch, skin gel, a solution applied to the armpit, a patch applied to the upper gum, or by injection.

For women who have not had their uterus removed, combination treatment with estrogen and progesterone may decrease the chance of developing endometrial cancer. Women with hypogonadism who have low sex drive may also be prescribed low-dose testosterone or another male hormone called dehydroepiandrosterone (DHEA).

In some women, injections or pills can be used to stimulate ovulation. Injections of pituitary hormone may be used to help men produce sperm. Other people may need surgery and radiation therapy if there is a pituitary or hypothalamic cause of the disorder.

 

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. It can cause hot flashes, vaginal dryness, and irritability as estrogen levels fall. The risk of osteoporosis and heart disease increase after menopause.

Some women with hypogonadism take estrogen therapy, most often those who have early menopause. But long-term used of hormone therapy can increase the risk of breast cancer, blood clots and heart disease. Women should talk with their health care provider about the risks and benefits of hormone replacement therapy with your doctor.

In men, hypogonadism results in loss of sex drive and may cause:

  • Impotence
  • Infertility
  • Osteoporosis
  • Weakness

Men normally have lower testosterone as they age. However, the decline in hormone levels is not as dramatic as it is in women.

 

When to Contact a Medical Professional

 

Talk to your provider 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 provider if they have headaches or vision problems.

 

Prevention

 

Maintaining fitness, normal body weight and healthy eating habits may help in some cases. Other causes may not be preventable.

 

 

References

Ali O, Donohoue PA. Hypofunction of the testes In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 583.

Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559. PMID: 20525905 www.ncbi.nlm.nih.gov/pubmed/20525905.

Kansra AR, Donohoue PA. Hypofunction of the ovaries. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 586.

Swerdloff RS, Wang C. The testis and male hypogonadism, infertility, and sexual dysfunction. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 234.

 

        A Closer Look

         

          Tests for Hypogonadism

           

             

            Review Date: 8/7/2016

            Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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