Taking the mystery out of male hypogonadism

An increasingly common condition seen in men is male hypogonadism.  The prevalence rate is estimated to be as high as 38.7% in men age 45 and older. Male hypogonadism is when the testes also called the testicles are not making normal levels of the male sex hormone, testosterone.   Some men will either be born with it or it could develop later in his life. 

When a boy enters puberty, the pituitary gland releases luteinizing hormone (LH), which stimulates the testicles to produce testosterone.  Testosterone is responsible for developing the male characteristics in adolescent boys.  Another hormone, called follicle stimulating hormone (FSH), works along with LH to stimulate the production of sperm in the testicles.

Signs of male hypogonadism

There can be a variety of symptoms and signs signaling male hypogonadism.  The following signs can suggest low testosterone or androgen deficiency in adult men:

·      Reduced libido or sexual interest

·      Decreased number of spontaneous night-time and morning erections

·      Incomplete sexual development

·      Reduced growth of facial hair

·      Fatigue and loss of energy

·      Very small or shrinking testes

·      Breast enlargement

·      Reduced muscle mass and strength

·      Mild depression

·      Reduced sperm production causing infertility

·      Osteoporosis

The symptoms listed above are often what bring a man into his doctor’s office seeking treatment for these signs. However, because many of these symptoms also commonly occur in a variety of other conditions (obesity, diabetes, metabolic syndrome), diagnosing hypogonadism can be challenging. 

Confirming male hypogonadism

The definitive method of diagnosing male hypogonadism is through blood tests gauging whether testosterone levels are in the normal range.  A man usually needs to have more than one early morning blood test for checking his testosterone levels.  Depending on the laboratory conducting the test, the normal range may vary but it generally is considered to be 300 to1,000 ng/dl.  If the tests show repeatedly low testosterone levels, then pituitary gland functioning measuring both LH and FSH levels will need to be done also. 

 

Causes of male hypogonadism

There can be several reasons why a man has male hypogonadism.  One is what is called primary hypogonadism.  This means there is a problem with the testes not working properly that could be caused by the following:

·      Klinefelter’s syndrome

·      Improper development of the testes

·      Undescended testes – the testes are located in the body instead of in the scrotum

·      Damage to the testes from an infection, disease or injury

·      Surgical removal of the testes

·      Radiation or chemotherapy to the testes

Secondary hypogonadism occurs when the endocrine glands are not stimulating the testes to produce hormones which can be cause by:

·      Treatments with radiation for cancer

·      Certain medication such as opiates and replacement hormones

·      Damage to the pituitary or hypothalamus glands

·      Hemochromatosis – excess iron in the blood

·      Genetic conditions such as Kallmann syndrome, and Prader-Willi syndrome

Treating male hypogonadism

Men with consistently low testosterone levels along with signs and symptoms of androgen deficiency most likely will be advised to treat the condition with testosterone replacement therapy.  The goal of testosterone replacement therapy is to increase testosterone levels by improving or maintaining a man’s masculinity, enhance mood and energy, muscle strength, reduce bone loss and improve sex drive. 

Men who should not be treated with testosterone replacement therapy include those with active or a history of prostate cancer, untreated obstructive sleep apnea, uncontrolled severe heart failure or has a severe enlargement of the prostate causing difficulty in urinating.

Testosterone can be replaced in the following ways:

·      Injections into the muscle – usually every 2 weeks

·      Patches applied to the skin once a day

·      Gel or solution preparations applied once daily

·      Buccal tablets applied to the gums twice a day

·      Pellets implanted under the skin

·      Pills

For men able to use testosterone replacement therapy, how it is given depends on patient preference, tolerance, cost, and what their medical insurance will pay for.  Each one can have different side effects from injections being uncomfortable, skin patches causing redness and rashes or gels transferring testosterone to others who come into contact with the man’s skin where the medication is applied.

All men using testosterone replacement therapy require regular monitoring by his physician for the duration of the treatment.