Treatment

The sex glands, also known as gonads, primarily consist of the testes in men and the ovaries in women. These glands produce sex hormones such as testosterone and estrogen. Sex hormones help control secondary sex characteristics, including breast development in women, testicular development in men, and pubic hair growth in both sexes. They also play a role in the menstrual cycle and sperm production.

Hypogonadism develops when the sex glands produce little or no sex hormones, resulting in reduced function of the testes in males and ovaries in females. The condition can be present at birth, but it may also develop after infection or injury.

There are two types of hypogonadism. Primary hypogonadism originates from a problem with the testes or the ovaries, causing the sex glands to produce fewer sex hormones.

Secondary hypogonadism, also known as hypogonadotropic hypogonadism, is caused by a problem with the pituitary gland or hypothalamus. The hypothalamus and pituitary gland are located in the brain and help regulate various body functions, including the production of sex hormones. Disorders affecting these parts of the brain can result in lowered function of the sex glands and insufficient amounts of sex hormones.

The complications of hypogonadism in newborns may include abnormal genitals. In pubescent boys, a lack of treatment can lead to impaired genital growth, the absence of body hair, and enlarged breasts.

The complications of hypogonadism in untreated adult males include:

  • infertility
  • erectile dysfunction
  • osteoporosis
  • decreased muscle mass and body hair
  • a low sex drive

The complications of hypogonadism in untreated females include:

  • menstrual irregularities
  • early menopause
  • infertility
  • osteoporosis
  • a low sex drive

Hypogonadism is usually treated with hormone replacement therapy (HRT). However, your course of treatment may differ depending on the exact cause of your condition. The symptoms of hypogonadism often improve significantly with the proper treatment.

Hormone Replacement Therapy

In most cases, hypogonadism can be treated effectively with HRT. This treatment consists of taking medications containing the hormone that your body is lacking, such as testosterone, estrogen and progesterone, or pituitary hormones to replace the ones that the body no longer produces.

Testosterone

Adult males can be treated with testosterone replacement therapy if their condition is caused by testicular failure. This treatment can:

  • improve sexual drive and function
  • increase muscle strength
  • decrease bone loss
  • raise energy levels and feelings of well-being

In young boys and adolescent males, low doses of testosterone over time can be used to replace naturally occurring testosterone during puberty. This also lowers the risk of negative side effects from taking hormones. Aside from stimulating puberty, testosterone replacement therapy for young males can:

  • increase muscle mass
  • promote growth of facial and pubic hair
  • encourage penis growth

Women who have a decreased sex drive may also benefit from low-dose testosterone.

Testosterone replacement therapy can be administered is several ways, including the following:

Injection

You or a healthcare provider can inject testosterone into a muscle, usually at two-week intervals.

Gel

You can rub a clear gel containing testosterone onto the skin of your shoulder, upper arm, or lower abdomen. After applying the gel, you must avoid bathing for several hours so your skin has time to absorb the testosterone properly. The gel can also be transferred to someone else through direct contact, so make sure you refrain from skin-to-skin contact until the gel has dried.

Skin Patch

You can place a skin patch containing testosterone on your body at night. The patch should be switched to a different area of the body every few weeks. This helps to reduce the risk of having an adverse site reaction. You may want to consider rotating where you place the patch. You can place the patch on your:

  • upper arm
  • abdomen
  • thigh
  • back

Pill

You can take testosterone in a pill form. Over time, however, oral testosterone can cause cholesterol levels to rise and can increase your risk of heart and liver problems. For these reasons, it usually isn’t considered for long-term use.

Patch

You can apply a small patch containing testosterone to your upper gum, above your front teeth. This is called a buccal patch. The patch softens and releases the hormone gradually. It’s generally applied every 12 hours on alternating sides. The gum looks like a tablet, but you should never chew or swallow it.

You and your doctor can discuss which method would be best for you.

Estrogen and Progesterone

For females, treatment for hypogonadism mostly consists of increasing the amount of female sex hormones in the body. Increasing levels of estrogen and progesterone can help strengthen bones, improve cholesterol levels, and support sex drive.

If you’re a premenopausal female, you can benefit from estrogen that comes in pill or patch form. Estrogen and progesterone are sometimes combined to lower the chances of developing endometrial cancer.

Pituitary Hormones

Pituitary hormones can help treat hypogonadism that was caused by a problem with the pituitary gland. In adults, pituitary hormone replacement administered in pill form can increase sperm production. In boys and adolescent males, it can help promote growth of the testicles.

If a tumor is found on the pituitary gland, it can be treated with surgery, medication, or radiation therapy.

Risks of Hormone Replacement Therapy

Testosterone replacement tends to increase the risk of urinary problems. It may also increase the risk of edema, or water retention, in people who have heart, liver, or kidney problems. Testosterone therapy may even aggravate sleep apnea or interfere with male fertility.

When used for an extended period, oral testosterone can increase your risk of liver problems, heart disease, and high cholesterol.

Your doctor will monitor your blood counts and hormone levels during treatment, and they can make adjustments if necessary. This will help reduce the risks associated with HRT.

If you’re a male, then your doctor will also perform prostate screening tests to check prostate-specific antigen levels for signs of serious medical conditions. These tests will need to be done every three, six, and 12 months while you receive HRT.

Coping Strategies

Hypogonadism can take an emotional toll, but there are things you can do to minimize stress, including:

  • tending to your overall health by eating well
  • asking your doctor for dietary recommendations
  • making sure you’re getting sufficient amounts of vitamins and minerals
  • exercising regularly
  • seeking professional counseling if you’re experiencing emotional distress or relationship problems

You asked, we answered

  • What are the side effects of hormone replacement therapy?
  • Hormone replacement therapy (HRT) can have several side effects. In women, estrogen HRT can increase the risk of cardiovascular disease, breast cancer, endometrial hyperplasia and cancer, as well as gallbladder disease. Testosterone HRT can increase prostate disease risk in men, may worsen sleep apnea, and can cause some blood abnormalities such as erythrocytosis, which is an increase in the mass of red blood cells. There is variable data on whether testosterone can increase your cardiovascular disease risk. Talk to your doctor about your questions and concerns regarding HRT.

    - University of Illinois-Chicago, College of Medicine