Hypogonadism - Symptoms, causes and treatment

Hypogonadism is a condition when The sex glands don't produce enough hormones. This condition can cause various disorders, such as impotence in men and menstrual disorders in women.

The sexual glands in men are the testes, while the sexual glands in women are the ovaries. These glands are responsible for producing hormones that regulate sexual characteristics, such as testicular development in men and breast growth in women.

This hormone also regulates the production of male sperm as well as egg production and the female menstrual cycle. Not only that, sex hormones also play a role in many functions of other body organs, including the heart and brain.

Hypogonadism can occur due to damage to the sexual glands or due to certain diseases. This condition can not only cause disturbances in sexual function, but can also affect the overall physical condition.

Causes and Types of Hypogonadism

Based on the cause, hypogonadism is divided into primary and secondary. Primary hypogonadism is a condition when the sex glands are damaged so they are unable to produce enough sex hormones.

Some of the things that can cause primary hypogonadism are:

  • Autoimmune diseases, eg Addison's disease
  • Genetic disorders, eg Klinefelter syndrome, Turner syndrome, or Kallman syndrome
  • Kidney disorders
  • Heart trouble
  • Severe infection
  • Injury to the testicles
  • Hemochromatosis or high blood iron levels
  • Cryptorchidism or undescended testes
  • Side effects of radiotherapy or chemotherapy in cancer treatment
  • Surgery on the sexual organs

Meanwhile, secondary hypogonadism occurs due to damage to the glands in the brain, namely the pituitary (pituitary) and hypothalamus glands, which are in charge of sending signals to the sexual glands to produce hormones. Conditions that can cause secondary hypogonadism include:

  • Injury or tumor of the pituitary gland or hypothalamus
  • Genetic disorders, such as Kallmann's Syndrome
  • Infections, including HIV/AIDS infection
  • Radiation exposure to the head
  • Obesity
  • brain surgery
  • Nutritional deficiencies, for example due to anorexia nervosa
  • Drastic weight loss
  • Long-term use of corticosteroids or opioids
  • Diseases that cause inflammation, such as tuberculosis, sarcoidosis, or histiocytosis

Symptoms of Hypogonadism

Symptoms of hypogonadism can vary, depending on the sex and age of the sufferer. Here is the explanation:

Men before puberty

If hypogonadism has occurred since childhood, for example due to a genetic disorder, symptoms that can appear are:

  • Slow or abnormal growth of the penis and testes (ambiguous genitalia)
  • Enlarged breasts (gynecomastia)
  • Hands and feet look longer than the body
  • Skinny and small posture
  • The voice gets louder late at puberty or doesn't get louder at all

Men after puberty

If hypogonadism occurs after puberty, symptoms may include:

  • Body tired easily
  • Concentration difficulty
  • Loss of muscle mass
  • Loss of sexual desire
  • Impotence
  • Reduced hair on the face and body

Girls before puberty

Hypogonadism in prepubertal women can cause the following symptoms:

  • Breasts grow slowly or don't grow at all
  • Less hair growing on the pubic
  • Primary amenorrhea or delayed first menstruation (>14 years)

Women after puberty

If hypogonadism occurs in a woman who has gone through puberty, symptoms may include:

  • Menstruation becomes infrequent (oligomenorrhea) or does not occur at all for more than 3 months
  • Decreased desire and mood to carry out activities
  • Body feels hot
  • Heart pounding
  • Dry pussy
  • Decreased sexual desire
  • Thick white discharge from the breast

When to go to the doctor

You are advised to consult a doctor if you have symptoms of hypogonadism as mentioned above. The sooner hypoginadism is detected and treated, the better the chances of a cure.

Hypogonadism can be passed from parent to child. Therefore, if there is a family member who has a history of hypogonadism or other conditions that can cause hypogonadism, you should discuss this matter with a pediatrician so that the condition of the child's sex hormones can be monitored early on.

Diagnosis of Hypogonadism

Diagnosis of hypogonadism begins with asking questions about symptoms, medical history, and medications being used. The doctor will also perform a physical examination by examining the condition of the genital organs, hair growth patterns, and muscle mass.

For an accurate diagnosis, the doctor will also perform hormone tests, such as:

  • Inspection follicle stimulating hormone (FSH) and luteinizing hormone (LH) produced by the pituitary gland
  • Testing testosterone levels in male patients
  • Examination of estrogen hormone levels in female patients

Hormone checks are generally done in the morning before 10 o'clock, when testosterone and estrogen levels are rising.

In addition to hormone tests, the doctor may also perform the following tests to diagnose hypogonadism:

  • Sperm examination in male patients
  • Check iron and platelet levels
  • Check prolactin hormone levels
  • Thyroid hormone check
  • Genetic test

Doctors can also run an ultrasound to find out if there are problems with the ovaries (ovarian), such as ovarian cysts and polycystic ovary syndrome (PCOS). A CT scan or MRI may also be done to check for a tumor in the pituitary gland.

Hypogonadism Treatment

Treatment of hypogonadism will be tailored to the gender of the patient and the underlying cause.

Hypogonadism can be cured if the cause is a treatable condition, such as obesity. However, if the cause is an incurable condition, such as a genetic disorder, then hypogonadism can become a chronic disease that requires lifelong treatment.

Based on the gender of the patient, the following are treatments that can be done to treat hypogonadism:

Treatment of hypogonadism in men

In male patients, treatment of hypogonadism is generally carried out to cover the deficiency of the hormone testosterone, through testosterone replacement therapy (testosterone replacement therapy; TRT). TRT is done by giving artificial testosterone which can be given in the form of:

  • Gel

    The gel can be applied to the upper arms, shoulders, thighs, or armpits. Make sure the gel is absorbed if the patient is about to take a bath.

  • Inject

    Testosterone injections can be administered at home or by a doctor, depending on the preparation. Usually, injections are given every 2-3 weeks.

  • Tablet

    TRT tablets will make testosterone absorbed by the lymph system.

  • Koyo

    The patch can be applied nightly to the thigh, stomach, or back.

  • Gum paste

    The gum patch is shaped like a tablet, but you shouldn't bite or swallow it. The patch is used on the upper gums, between the gums and lips, and needs to be changed every 12 hours.

  • Nasal gel

    Different from the previous gel, this gel is inserted into the nostrils. The gel is applied 2 times in each nostril, performed 3 times a day.

  • Testosterone implants

    Testosterone implants are inserted into the skin surgically every 3–6 months.

It is important to remember that patients undergoing TRT should have regular check-ups with their doctor. The reason is, this therapy can trigger various risks, such as: sleep apnea, breast enlargement, prostate enlargement, reduced sperm production, blood clot formation, and heart attacks.

Treatment of hypogonadism in women

Hypogonadism in female patients is generally treated with estrogen replacement therapy in the form of pills or patches. Doctors can also provide low-dose testosterone therapy along with the hormone dehydroepiandrosterone (DHEA) to treat decreased sex drive in women.

In women who have menstrual cycle disorders or have difficulty getting pregnant, the doctor will give hormone injections choriogonadotropin (hCG) or pills containing the hormone FSH to trigger ovulation.

Complications of Hypogonadism

Hypogonadism that is not treated properly can lead to a number of complications, such as:

  • Early menopause
  • Barren
  • Osteoporosis
  • Anxiety disorder or depression
  • Heart disease
  • Disturbed relationship with partner

Prevention of Hypogonadism

Hypogonadism caused by genetic disorders cannot be prevented. However, some causes of hypogonadism, such as malnutrition, infection, and obesity, can be prevented by diligently exercising, adopting a healthy lifestyle and diet, and maintaining an ideal body weight.