Hypogonadism is a condition that results in lowered function of the testis in males or ovaries in females. This condition can be present at birth, but may also develop after infection or injury.
There are two types of hypogonadism. Primary hypogonadism is caused by a problem with the testis or the ovaries. Secondary hypogonadism (hypogonadotropic hypogonadism) is caused by pituitary or hypothalamic gland disorders.
Complications of hypogonadism in newborns may include abnormal genitals. In pubescent boys, lack of treatment can result in impaired genital growth, absence of body hair, and enlarged breasts. Complications in untreated adult males include:
- erectile dysfunction
Complications in females include:
- menstrual problems
The main treatment is hormone replacement therapy, but your course of treatment will be determined by the exact cause. In most cases, treatment results in substantial improvement.
Hormone Replacement Therapy
If your condition is caused by testicular failure, testosterone replacement therapy (TRT) can:
- improve sexual drive and function
- increase muscle strength
- decrease bone loss
- raise energy levels and feelings of well-being
In boys, low doses of testosterone over time can be used to replace naturally occurring testosterone during puberty. This also decreases the probability of negative side effects. For boys, TRT can stimulate puberty and:
- increase muscle mass
- promote growth of facial and pubic hair
- increase penis growth
Women who have a decreased sex drive may benefit from low-dose testosterone. TRT can be administered is several ways, such as:
- Injection. TRT injections are given in a muscle, usually at two-week intervals. They can be administered at home or by a health professional.
- Gel. Testosterone gel is rubbed into the skin on your shoulder, upper arm, or lower abdomen and is absorbed through the skin. When using the gel, you must avoid washing for a few hours after application. The gel can also be transferred to someone else, so great care should be taken to refrain from skin-to-skin contact until the gel has dried.
- Skin Patch. A hormone patch can be placed on your body at night. The site of the patch is generally rotated among your upper arm, abdomen, thigh, and back. This helps to lower the chances of site reactions.
- Oral. Over time, oral testosterone can cause cholesterol levels to rise and increases risk of heart and liver problems. It is generally not considered for long-term use.
- Buccal (Gum) Patch. A small patch containing testosterone is applied on your upper gum, above your incisor teeth. It is generally applied every 12 hours, on alternating sides. The patch softens and releases the hormone gradually. The gum looks very much like a tablet, but should never be swallowed or chewed.
Discuss the pros and cons of each of these methods with your doctor.
Estrogen and Progesterone
Pre-menopausal women can benefit from estrogen that comes in pill or patch form. Estrogen and progesterone are sometimes combined to lower the chances of a woman developing endometrial cancer.
If your hypogonadism was caused by a problem with your pituitary gland, pituitary hormones can increase sperm production. In boys, pituitary hormones can help promote growth of the testicles.
Tumors of the pituitary may require surgical removal and radiation treatment, as well as the replacement of other hormones.
Risks of Hormone Replacement Therapy
While you’re on HRT, your doctor will monitor the following:
- blood counts
- hormone levels: adjustments can be made if necessary
- prostate screening: in men, prostate-specific antigen (PSA) levels need to be checked at three, six, and 12 months of hormone replacement therapy. A PSA test checks for prostate cancer. Hormone replacement therapy itself does not increase the risk of prostate cancer, according to the Cleveland Clinic (CC)
Men who are treated with testosterone may have an increased risk of urinary problems. Testosterone is not advised for men who have breast or prostate cancer. Testosterone therapy may increase the risk of water retention or edema in people who have heart, liver, or kidney problems. It also may aggravate sleep apnea or interfere with male fertility.
When used for a long time, oral testosterone can cause an increase in cholesterol levels, liver problems, and heart disease.
Most cases of hypogonadism are treatable. Although long-term treatment may be necessary, results are generally very favorable.
Hypogonadism can take an emotional toll, but there are things you can do to minimize stress. For example:
- Tend to your overall health.
- Ask your doctor for dietary recommendations.
- Make sure you’re getting the right amount of vitamins and minerals for your age.
- Get plenty of exercise.
- Educate yourself on the facts about infertility and erectile dysfunction.
- Seek professional counseling if you are experiencing emotional distress or relationship problems.