Hypogonadism

Answer 1

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, 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 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
• Genetic problems
• Infections
• Nutritional deficiencies
• Iron excess (hemochromatosis)
• Radiation
  • Rapid, significant weight loss
  • Surgery
  • Trauma
  • Tumors

A genetic cause of central hypogonadism that also produces an inability to smell is Kallmann syndrome (males). The most common tumors affecting the pituitary area are craniopharyngioma (in children) and prolactinoma (in adults).

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) and those who undergo rapid, extreme weight loss, as seen after gastric bypass surgery, also may have central hypogonadism.

Signs and tests

Tests may be done that check estrogen level (women) and testosterone level (men) as well as FSH leveland 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

Hormone-based medicines are available for men and women. Estrogen comes in the form of a patch or pill. Testosterone can be given by 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. In addition, low dose testosterone can be added for women with hypogonadism who have a low sex drive.

In some women, injections or pills can be used to stimulated ovulation. Injections of pituitary hormone may be used to help male patients produce sperm. In others, surgery and radiation therapy may be needed.

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 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 opt to take estrogen therapy, particularly 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 with use of hormone therapy for treatment of menopause symptoms.

In men, hypogonadism results in loss of sex drive and may cause weakness, impotence, infertility, and osteoporosis. Men normally 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, problems getting pregnant, hot flashes (women), impotence, loss of body hair, weakness, breast enlargement (men), or problems with your sex drive. 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.

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.

Swerdloff RS, Wang C. The testis and male sexual function. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 253.

White PC. Disorders of sexual differentiation. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 252.

Answer 2

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, 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 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.

Signs 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.

Expectations (prognosis)

Many forms of hypogonadism are treatable and have a good outlook.

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.

Calling your health care provider

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

Review Date: 10/14/2010

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.