Hypogonadism

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Hypogonadism

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Overview

Hypogonadism is a medical term for a defect of the reproductive system which results in lack of function of the gonads (ovaries or testes). The gonads have two functions: to produce hormones (testosterone, estradiol, antimullerian hormone, progesterone, inhibin B), activin and to produce gametes (eggs or sperm). Deficiency of sex hormones can result in defective primary or secondary sexual development, or withdrawal effects (e.g., premature menopause) in adults. Defective egg or sperm development results in infertility.

The term hypogonadism is usually applied to permanent rather than transient or reversible defects, and usually implies deficiency of reproductive hormones, with or without fertility defects. The term is less commonly used for infertility without hormone deficiency.

Differential Diagnosis

In alphabetical order.

Primary Testicular Failure

• Anorchidism
• Chemotherapy
• Cryptorchidism
• FSH beta subunit mutation (follicle stimulating hormone)
• FSH receptor mutation
• Klinefelter Syndrome
• LH (luteinizing hormone) beta subunit mutation
• LH receptor mutation
• LH resistance
• Radiation therapy
• Sertoli-cell-only syndrome
• Testicular biosynthetic defects

Primary Ovarian Failure

• Autoimmune oophoritis
• Chemotherapy
• Familial and sporadic XX gonadal dysgenesis and its variants
• Familial and sporadic XY gonadal dysgenesis and its variants
• FSH beta subunit mutation (follicle stimulating hormone)
• FSH receptor mutation
• Galactosemia
• Glycoprotein syndrome type 1
• LH (luteinizing hormone) beta subunit mutation
• LH/human chorionic gonadotropin resistance
• LH receptor mutation
• Noonan Syndrome
• Premature menopause
• Polycystic ovarian disease
• Radiation therapy
• Resistant ovary
• Turner Syndrome

Secondary Hypogonadism

• Astrocytoma
• Bardet-Biedl Syndrome
• Congenital adrenal hypoplasia
• Congenital hypogonadotropic hypogonadism
• Craniofacial anomalies
• Craniopharyngioma
• Exercise-induced amenorrhea
• Functional gonadotropin deficiency
• Gaucher Disease
• Germinoma
• Head trauma
• Hyperprolactinemia
• Hypothalamic glioma
• Isolated FSH deficiency
• Isolated LH deficiency
• Kallmann Syndrome
• Langerhans histiocytosis
• Laurence-Moon Syndrome
• Marijuana use
• Optic glioma
• Other germ cell tumors
• Pituitary tumor
• Postinfectious lesions of the central nervous system (CNS)
• Prader-Willi Syndrome
• Radiation therapy
• Vascular abnormalities of the CNS

Classification

There are many possible types of hypogonadism and several ways to categorize them.

by Congenital vs. acquired

• An example of congenital hypogonadism (present at birth) is Turner syndrome.
• An example of acquired hypogonadism (develops in childhood or adult life) is castration.

by Hormones vs. fertility

Hypogonadism can involve just hormone production or just fertility, but most commonly involves both.

• Examples of hypogonadism that affect hormone production more than fertility are hypopituitarism and Kallmann syndrome; in both cases fertility is reduced until hormones are replaced but can be achieved solely with hormone replacement.
• Examples of hypogonadism that affect fertility more than hormone production are Klinefelter syndrome and Kartagener syndrome.

by Affected system

Hypogonadism is also categorized by endocrinologists by the level of the reproductive system which is defective.

• Hypogonadism resulting from defects of the gonads is traditionally referred to as primary hypogonadism. Examples include Klinefelter syndrome and Turner syndrome.

• Hypogonadism resulting from hypothalamic or pituitary defects are termed secondary hypogonadism or central hypogonadism (referring to the central nervous system).
  • Examples of Hypothalamic defects include Kallmann syndrome
  • Examples of Pituitary defects include hypopituitarism

• An example of a hypogonadism resulting from hormone response is androgen insensitivity syndrome

Steroid use

Hypogonadism may be induced by chronic use of anabolic/androgenic steroids (AAS). The negative-feedback system of the hypothalamic-pituitary-gonadal axis (HPTA) shuts down pituitary production of gonadotropins after extended exposure to AAS. This has been documented both in patients receiving AAS for legitimate medical reasons such as AIDS or cancer as well as athletes using AAS illicitly.

Hypogonadism may persist for some time after steroid use is discontinued.

Symptoms

Low Testosterone (Low T) symptoms include loss of energy, fatigue, loss of libido, muscle mass decline, decreased positive mood factors and an increased negative mood factors.

Diagnosis

Low Testosterone can be identified through a simple blood test performed by a physician. Normal testosterone levels range from 298 - 1098 ng/dl. Physicians measure gonadotropins (LH and FSH) to distinguish primary from secondary hypogonadism. In primary hypogonadism the LH and/or FSH are usually elevated, while in secondary hypogonadism both are normal or low.

Hypogonadism is often discovered during evaluation of delayed puberty, but ordinary delay which eventually results in normal pubertal development and reproductive function is termed.

Treatment

Hypogonadism is most often treated by replacement of the appropriate hormones. For men this is testosterone. Commonly used testosterone formulations include transdermal testosterone, injectable testosterone, and buccal testosterone. Oral testosterone is no longer used in the U.S. because it is broken down in the liver and rendered inactive. Another feasible alternative is hCG. For women estradiol and progesterone are replaced. Some types of fertility defects can be treated; some cannot.

External links

• NIH
• Anabolic Steroid Induced Hypogonadism

Cost Effectiveness of Hypogonadism

| group5 = Clinical Trials Involving Hypogonadism | list5 = Ongoing Trials on Hypogonadism at Clinical Trials.gov • Trial results on Hypogonadism • Clinical Trials on Hypogonadism at Google

| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Hypogonadism | list6 = US National Guidelines Clearinghouse on Hypogonadism • NICE Guidance on Hypogonadism • NHS PRODIGY Guidance • FDA on Hypogonadism • CDC on Hypogonadism

| group7 = Textbook Information on Hypogonadism | list7 = Books and Textbook Information on Hypogonadism

| group8 = Pharmacology Resources on Hypogonadism | list8 = AND (Dose)}} Dosing of Hypogonadism • AND (drug interactions)}} Drug interactions with Hypogonadism • AND (side effects)}} Side effects of Hypogonadism • AND (Allergy)}} Allergic reactions to Hypogonadism • AND (overdose)}} Overdose information on Hypogonadism • AND (carcinogenicity)}} Carcinogenicity information on Hypogonadism • AND (pregnancy)}} Hypogonadism in pregnancy • AND (pharmacokinetics)}} Pharmacokinetics of Hypogonadism •

| group9 = Genetics, Pharmacogenomics, and Proteinomics of Hypogonadism | list9 = AND (pharmacogenomics)}} Genetics of Hypogonadism • AND (pharmacogenomics)}} Pharmacogenomics of Hypogonadism • AND (proteomics)}} Proteomics of Hypogonadism

| group10 = Newstories on Hypogonadism | list10 = Hypogonadism in the news • Be alerted to news on Hypogonadism • News trends on Hypogonadism</small>

| group11 = Commentary on Hypogonadism | list11 = Blogs on Hypogonadism

| group12 = Patient Resources on Hypogonadism | list12 = Patient resources on Hypogonadism • Discussion groups on Hypogonadism • Patient Handouts on Hypogonadism • Directions to Hospitals Treating Hypogonadism • Risk calculators and risk factors for Hypogonadism

| group13 = Healthcare Provider Resources on Hypogonadism | list13 = Symptoms of Hypogonadism • Causes & Risk Factors for Hypogonadism • Diagnostic studies for Hypogonadism • Treatment of Hypogonadism

| group14 = Continuing Medical Education (CME) Programs on Hypogonadism | list14 = CME Programs on Hypogonadism

| group15 = International Resources on Hypogonadism | list15 = Hypogonadism en Espanol • Hypogonadism en Francais

| group16 = Business Resources on Hypogonadism | list16 = Hypogonadism in the Marketplace • Patents on Hypogonadism

| group17 = Informatics Resources on Hypogonadism | list17 = List of terms related to Hypogonadism

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