Hypogonadism
The hormone testosterone is responsible for numerous sex characteristics in men including the growth and development of the sex and reproductive organs. In addition to assisting with fat distribution, 
bone mass and deepening of the voice, testosterone also helps keep up energy levels, sex drive and fertility. As men age, their production of testosterone naturally begins to decline. However, some men may develop a testosterone deficiency during their life.
This disorder is known as hypogonadism.
What Is It?
Hypogonadism is one of the main causes of male infertility. It is estimated that 13 million men in the United States alone are affected by hypogonadism, yet less than 10% of these men actually seek treatment for the disorder. Hypogonadism occurs when there is disease or damage to the pituitary gland, testicles or hypothalamus. Any problems in these areas can lead to a deficient production of the gonadotropin hormone.
Testosterone deficiency can occur at any stage of a man’s life. Some males are born with the deficiency, making it a congenital abnormality, while others develop the disorder before the onset of puberty. Others still develop it later in life, during adulthood.
Due to the lack of testosterone, men affected by hypogonadism often have troubles producing sperm. The low levels of testosterone also result in an adult male having a low sex drive and erectile dysfunctions. All of these factors combine to make it difficult for a man to father a child.
What Causes Hypogonadism?
There are two types of male hypogonadism: primary and secondary. Primary hypogonadism refers to a testosterone deficiency that stems from abnormal testicular function. Secondary hypogonadism is the result of problems with the pituitary gland or the hypothalamus, which controls the secretion of pituitary hormones. When messages from either of these sources become impaired, normal performance of the testicles is compromised.
There are numerous causes for primary hypogonadism such as undescended testicles, excess iron in the blood (known as hemochromatosis), an injury that causes damage to the testicles, mumps, and chemotherapy or radiation treatment. Klinefelter’s syndrome, which results in a male being born with an extra x chromosome, can lead to impaired testicular growth as well as problems in sperm production and is another cause of primary hypogonadism.
Secondary hypogonadism can be the result of pituitary disorders and inflammatory diseases that affect the pituitary gland. Also, Kallman’s syndrome, which affects the proper development of the hypothalamus, ultimately leads to a testosterone deficiency. Additionally, certain medications, like those used to help heartburn or control moods, can affect the level of testosterone produced by the body.
Signs And Symptoms
The effects of hypogonadism vary depending on when a man develops the disorder. In cases where hypogonadism is congenital, the gonads fail to produce enough testosterone for proper development of the external genitals and internal reproductive organs. This results in a child whose sex is ambiguous at birth.
When testosterone deficiency becomes present at the start of puberty, normal growth and development is impaired. Muscle mass does not increase as much and the male voice remains high. There is often a lack of facial body hair growth while the penis and testicles fail to mature. The arms and legs may grow to be out of proportion with trunk of the body. There may even be some development of breasts.
The onset of hypogonadism in adulthood can significantly change the physical appearance of men as well as hinder the normal reproductive functions and cause emotional changes that mirror the experience of menopausal women. Signs of hypogonadism in adult males include:
- Impaired facial and body hair growth
- Smaller, softer testicles
- Less muscle mass
- Onset of osteoporosis
- Enlarged male breasts
- Rise in body fat
- Infertility and/or difficulties achieving and maintaining an erection
- Lack of sexual desire
- Loss of energy
- Irritability and mood swings
- Hot flashes
- Depression
Getting Help
If you display any of the symptoms of hypogonadism, make an appointment with your family physician. A blood test that measures testosterone levels can reveal whether or not there is a deficiency. Proper evaluation by an endocrinologist (a doctor that specializes in hormones) will be necessary, though, for a definitive diagnosis. Ask for a referral to an endocrinologist if your family physician does not automatically provide one.
There are different types of treatments available to help those with a testosterone deficiency. If you have primary hypogonadism, the most likely method of treatment will be testosterone replacement therapy (TRT). This will aid in increasing the production of testosterone. However, it may not help you recover your fertility. It may be necessary for you and your partner to employ assisted reproductive technology methods in order to conceive. Those men affected by secondary hypogonadism have a better chance of recovering their fertility through the use of TRT.
There are numerous ways in which TRT can be administered. The most popular method is a patch that can be worn on the scrotum or elsewhere on the body that will allow the body to receive a continuous supply of hormones. Aside from the patch, there are intramuscular injections that are given every two weeks, which men can do at home. A testosterone gel for hypogonadism is also available as is a mucoadhesive that dissolves into a more gel-like substance when you place it on your gum line. This allows the testosterone to be absorbed directly into the blood stream. There are also oral testosterone supplements available but these are rarely used nowadays due to the associated side effects.
Psychological counseling for both yourself and your partner is also a good idea to help you mutually deal with the emotional aspects of the problem. Additionally, you may want to seek a support group in your area where you can talk with other people who are also affected by the disorder.
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