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What is hypogonadism?

Hypogonadism can occur when a person’s sex glands (gonads) don’t produce enough, or any, hormones. It can cause a lowered sex drive (libido), altered sexual characteristics, infertility, and other health conditions.

Hypogonadism can affect both male and female adults and teenagers.

There are two types of hypogonadism: primary, caused by insufficient sex hormones, and secondary, usually caused by the brain or pituitary gland. Both types can also be caused by an inherited trait, or from an injury or infection.

When does hypogonadism begin?

It can start before birth when the fetus is developing, before puberty, or in adulthood, including after an injury or infection.

What causes hypogonadism?

It can develop when either the brain or sex glands change the production of sex hormones. It is not known why this change occurs.

In men, primary hypogonadism is caused when the testicles don’t produce enough testosterone. In women, it can occur when the ovaries don’t produce enough estrogen, progesterone and testosterone. Teenagers can have a late puberty.

Secondary hypogonadism can be caused by problems in parts of the brain called the hypothalamus and pituitary gland. These parts of the brain tell the testicles or ovaries to produce hormones. Primary and secondary hypogonadism can occur at the same time.

It’s normal for men’s and women’s sex hormone production to decrease in their late 40s or 50s. Although this can decrease sex drive, it’s not a specific cause of hypogonadism. However, any young adult with no interest in sex should be checked for hypogonadism.

**What causes primary hypogonadism?**

Klinefelter syndrome is an inherited condition that causes men to have an extra X chromosome. The extra chromosome causes abnormal development of testicles, which prevents the production of sufficient testosterone.
Undescended testicles can happen when, before birth, one or both testicles fail to move down into their permanent place in the scrotum. Testicles usually move into place without treatment during the first year of life. If this doesn’t happen by early childhood, the testicles may not function correctly and fail to produce enough testosterone.
A mumps infection can damage the testicles in teenagers or adult men, and also limit testosterone production.
Hemochromatosis (too much iron in the blood) can limit or stop the production of testosterone, or cause the pituitary gland to dysfunction and reduce testosterone.
Injury to one or both testicles, although there may be some testosterone production if only one testicle is damaged
Chemotherapy or radiation for cancer treatment can interfere with testosterone and sperm production. These effects can be temporary or cause permanent infertility.

**What causes secondary hypogonadism?**

The testicles are normal with secondary hypogonadism. However, they don’t function properly because of problems with the brain’s pituitary gland or hypothalamus. Causes include:

Kallmann’s syndrome is an abnormal development of the hypothalamus, which controls pituitary gland hormones.
Pituitary gland abnormalities can slow or stop the release of hormones to the testicles, and reduce testosterone.
Pituitary or brain tumors can cause hormone deficiencies.
Brain tumor treatment with surgery or radiation can affect the pituitary gland.
Inflammatory diseases that affect the hypothalamus or pituitary gland can change testosterone production.
HIV/AIDS affects the hypothalamus, pituitary gland, and testicles, and causes lower levels of testosterone.
Medications (opiate pain meds and some hormones) can affect testosterone production.
Significant obesity, at any age, is linked to hypogonadism.

What increases risk for hypogonadism?

There is a higher risk of developing primary hypogonadism if you have:

Diabetes, Addison’s disease or other adrenal gland disorders
Cancer treatments
Genetic disorders
Hemochromatosis
Liver or kidney disease
Surgery on reproductive organs
Hypothyroidism reduces thyroid hormone and affects testosterone production

The risk of developing secondary hypogonadism is higher if you’ve had:

To take opioid medications or anabolic steroids
Cancer treatments
Genetic disorders affecting brain development
Infections, including HIV
Brain surgery
Inflammatory diseases
Obesity
Pituitary tumors or disorders

What are symptoms of hypogonadism?

Symptoms depend on the gender and age when it developed.

Teenagers may have secondary hypogonadism if they don’t start puberty at a normal age. In males, hypogonadism can delay puberty, cause abnormal development of masculine physical characteristics, and delay growth of the penis, testicles, body and facial hair, and muscle mass. Teenage males may have delayed voice deepening, excessive breast tissue, erectile dysfunction, and excessive growth of arms and legs. In females, there may be a delay in starting menstrual periods and developing breasts. These delays can cause a low libido, low energy, and depression.

Adult symptoms include a low libido, sexual dysfunction, hair loss, hot flashes, fatigue, and difficulty concentrating. Adult men can have erectile dysfunction, infertility, enlarged breasts, and loss of muscle. Adult women may have abnormal menstrual periods, and a milky discharge from their nipples. Severe cases can cause problems concentrating, hot flashes, and emotional changes.

Infants can be affected if the body doesn’t produce enough testosterone during fetal development. The infant may have impaired growth of its external sex organs. A child born genetically male may have female genitals, underdeveloped male genitals, or genitals that are not clearly male or female.

How is hypogonadism diagnosed?

Your doctor will start with a physical exam and listen to your symptoms. Blood tests can check hormone and iron levels. An MRI or CT scan can check for pituitary or brain tumors. Men may have a semen analysis to measure sperm count. Women may have a pelvic exam, and ultrasound to check for ovarian cysts or polycystic ovary syndrome.

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Can hypogonadism be treated?

Treatment is determined by the type of hypogonadism. Primary hypogonadism responds well to ongoing hormone replacement therapy. To increase hormone levels, men take testosterone supplements; women take estrogen and progesterone supplements. Stopping therapy can cause symptoms to return.

Secondary hypogonadism caused by a tumor may require medication, radiation therapy, or surgery. Hormone levels may return to normal after treatment.

At Inland Endocrine, we have highly trained specialists who provide the individual care and attention that will speed your recovery from hypogonadism. Call today for an appointment with Inland Endocrine’s treatment team.

**Mayo Clinic. 2019. Male Hypogonadism. Retrieved 7-6-2021, {https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881**}

**Cleveland Clinic. 2020. Low Sex Drive (Hypogonadism). Retrieved 7-6-2021, {https://my.clevelandclinic.org/health/diseases/15216-low-sex-drive-hypogonadism**}

Medically reviewed by:‍

Stuart Seigel, MD

Dr. Seigel is a board certified Endocrinologist. He completed his residency in internal medicine and fellowship in endocrinology, diabetes and metabolism at the University Of Pittsburgh Medical Center in 2011 and 2013.

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Hypogonadism

What is hypogonadism?

When does hypogonadism begin?

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What causes hypogonadism?

What causes primary hypogonadism?

What causes secondary hypogonadism?

What increases risk for hypogonadism?

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References

Mayo Clinic. 2019. Male Hypogonadism. Retrieved 7-6-2021, {https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881}

Cleveland Clinic. 2020. Low Sex Drive (Hypogonadism). Retrieved 7-6-2021, {https://my.clevelandclinic.org/health/diseases/15216-low-sex-drive-hypogonadism}

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**What causes primary hypogonadism?**

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**Mayo Clinic. 2019. Male Hypogonadism. Retrieved 7-6-2021, {https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881**}

**Cleveland Clinic. 2020. Low Sex Drive (Hypogonadism). Retrieved 7-6-2021, {https://my.clevelandclinic.org/health/diseases/15216-low-sex-drive-hypogonadism**}

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