Hypogonadism in men and women: the symptoms and treatment

Hypogonadism is a disease characterized by hypofunction of sexual glands with a decrease in the synthesis of sex hormones. Syndrome with underdevelopment of the reproductive system, absence or regression of secondary sexual characteristics, disorders of the metabolism of proteins and lipids.

The treatment of hypogonadism are in the competence of endocrinologists and andrologists and gynecologists (depending on the sex of the patient). Necessarily conducted, replacement therapy of hormones, and, if necessary, resort to surgical correction of the genitals.

According to medical statistics, hypogonadism is diagnosed in approximately half of the patients suffering from infertility.

Female hypogonadism

Types of hypogonadism in men

Hypogonadism in men is divided into primary and secondary. He and the other origin may be congenital or acquired.

Primary due to defect and dysfunction of tissues of testicles. Glands do not produce testosterone or synthesize it in insufficient quantity.

The secondary variety occurs when violations of the hypothalamic-pituitary system.

According to another classification, there are currently 3 types of hypogonadism:

• hypogonadotropic;
• normogonadotropic;
• hypergonadotropic.

Hypogonadotropic form caused by the low secretion of gonadotropins, which directly affects the synthesis of androgens. The reason for the development normogonadotrophic the type of disease – an excess of prolactin.

When hypergonadotrophic varieties of the syndrome of primary lesion of the genital glands is accompanied by elevated levels of gonadotropins.

Possible causes

Androgen insufficiency may develop in embryonic Joubertina and postpubertatne periods.

Pathology leading to congenital primary hypogonadism:

• Klinefelter syndrome (true);
• men’s false hermaphroditism;
• syndrome Shereshevsky-Turner;
• anarchism;
• Sertoli-cell syndrome.

Please note: anarchism is the lack of testicles and their appendages due to pathologies of intrauterine development. Dysfunction of the gonads is also possible on the background of cryptorchidism (neomusaria testicle into the scrotum) and ectopia (abnormal location of the testicle under the skin of the femoral region or perineum).

Causes of acquired secondary hypogonadism:

• about Klinefelter syndrome;
• traumatic injuries of the testicles;
• tumors of the gonads.

Reasons congenital secondary (hypogonadotropic) of the form:

• damage to the hypothalamus;
• pituitary dwarfism;
• formed at the time of birth the tumor (craniopharyngioma).

Causes of acquired secondary hypogonadism:

• adiposogenital dystrophy;
• abnormally increased levels of prolactin;
• Prader-wil;
• syndrome Laurence-moon-bardet-Biel.

Among the etiological factors contributing to the development of primary hypogonadism, belong to a genetic defect, intoxication of the mother during pregnancy, infection, and chemotherapy of oncological diseases. To dysfunction of the testicles causes effects of radiation, hormonal drugs in large doses, traumatic injury, and varicocele (varicose veins of the spermatic cord).

In the etiology of secondary species the importance of tumor pathology and fetal development, affecting hypothalamic-pituitary regulation. Hypogonadism is often caused by age-related decline in the synthesis of androgens.

Signs of hypogonadism in men

Symptoms of the disease is determined by the severity of androgen deficiency and age at which the pathology developed.

Important: if the lack of androgens occurred in utero, the child may be born with the primary characteristics of both sexes.

Symptoms of hypofunction of the testes in pre-adolescent:

• the absence of secondary signs;
• disproportionately long limbs;
• muscle weakness;
• underdeveloped rib cage;
• true gynecomastia;
• hypoplasia of the prostate;
• underdeveloped phallus (less than 5 cm);
• the lack of body hair growth in the pubic area;
• the deposition of tissue on the female type.

Secondary to hypofunction of the sex glands is characteristic of obesity, lack of libido, and erectile dysfunction.

When hypogonadism postpubertatne period, all the signs are not so expressed. The testicles decrease in size (the symptom is observed when all forms of pathology). Patients revealed a decrease in skin turgor; it is also common vegetative-vascular dysfunction. Secondary sexual characteristics tend to regress.

The production of sperm is significantly reduced or missing. The decline of testosterone synthesis male becomes infertile. The number of generalized clinical signs include General weakness and fatigue.

Identification of male hypogonadism and its treatment methods

The endocrinologist makes a diagnosis based on patient complaints, anamnesis, examination and laboratory tests for serum levels of testosterone, GnRH, estradiol, and prolactin. By biopsy testicular tumors are detected and installed their character; in General, this study is uninformative.

Please note: while hypogonadism is analyzed semen, however, is not always possible to obtain biological material from the patient.

Treatment primarily directed at eliminating the causes of pathology. Its main goal – prevention of delay of sexual development, the prevention of the degeneration of the sex glands and the struggle with infertility.

In congenital hypogonadism or doumentation to restore reproductive function.

The primary form shows the stimulation of non-hormonal drugs (before puberty) or androgens and gonadotropins (in adults). If you have installed the complete lack of reserves of testicular tissue, testosterone patients have to take regularly throughout your life.

Secondary hypogonadism is an indication for prescription of gonadotropins (often in combination with androgens).

In some cases, surgical treatment. It can involve the transplantation of testicles (if anarchisme), bringing down the testicles (in cryptorchidism) or the plasticity of the phallus (if underdeveloped).

Comprehensive, adequate treatment helps reduce the severity of core and associated symptoms.

Female hypogonadism

What is of female hypogonadism?

The fair sex this pathology due to the low functional activity of the ovaries. Primary hypogonadism is caused by intrauterine pathologies of these organs or their damage at an early age. In this form of the disease dramatically reduced the level of estrogen, resulting in a hypersecretion of gonadotropins.

Causes of the primary form:

• genetic mutations;
• congenital hypoplasia;
• infection;
• a radiation injury;
• autoimmune process;
• polycystic ovarian.

Significant signs of estrogen deficiency:

• atrophic changes in the reproductive system and mammary glands;
• primary amenorrhea;
• infertility.

The secondary form of the pathology caused by dysfunction of the hypothalamic-pituitary system. When they sharply reduced or blocked the synthesis of gonadotropins, are responsible for the regulation of functions of sexual glands.

Possible causes of secondary female hypogonadism:

Symptoms of hypofunction of sexual glands in women

Leading clinical signs of hypogonadism in female patients of childbearing age be amenorrhea (absence of menstruation) or dysmenorrhea (breaking the loop).

When estrogen deficiency are noted:

• the underdevelopment of genitals and mammary glands;
• scant body hair;
• violation of deposits of the subcutaneous tissue.

Please note: if conditions are congenital, pelvis patients are narrow and buttocks are flat.

Diagnosis and treatment of female hypogonadism

In the diagnosis takes into account the level of gonadotropins and estrogens, as well as anthropometric characteristics. Hypoplasia of the uterus and ovaries detected by ultrasound scan. X-ray examination allows to reveal the underdevelopment of the skeleton and pathological changes in bone structure (osteoporosis).

Treatment of primary ovarian hypofunction involves the appointment of ethinyl estradiol as hormone replacement therapy.

Patients it is advisable to take birth control pills with progestogen and estrogen.

Contraindications to hormonal methods – cancers of the reproductive system, as well as thrombosis, pathology of kidney and liver failure.