Hypogonadism refers to the impairment in the functionality of the gonads: the ovaries in females and the testes in males, resulting in impaired or reduced biosynthesis of the sex hormones. Hence, we have male hypogonadism and female hypogonadism.
Male hypogonadism occurs when there is impaired function of the testes and consequent impairment in the production of the male sex hormone, testosterone, and other androgens. Female hypogonadism is impairment in the activity of the ovaries with resulting reduced female sex hormones, e.g., estrogen, produced by the ovaries.
Depending on the degree of impairment, hypogonadism can result in partial or complete infertility because low levels of sex hormones can lead to defective sexual development in both the primary and secondary stages.
Hypogonadism is broadly categorized into two by endocrinologists:
- 1. Primary hypogonadism
- 2. Secondary hypogonadism
In primary hypogonadism, there are low levels of gonadotropins with high levels of follicle stimulating hormone (FSH) and Luteinizing hormones (LH). Here, the problem is from the gonads.
Examples of hypogonadism, which can result from problems in the gonads, are Klinefelter and Turner syndromes.
In secondary hypogonadism, the FSH and LH are usually normal or low pointing to the fact the problem is from the pituitary or hypothalamus, the part of the brain responsible for the secretion of these hormones. Examples of hypogonadism which arise from hypothalamic or pituitary defects are Kallmann syndrome and hypopituitarism.
There is yet another type of hypogonadism which results from androgen-insensitivity or lack of androgen response. Here, there are not enough receptors to bind the male sex hormone, testosterone. This makes the male look more like a female, despite the XY chromosome.
- 1. Delayed puberty
- 2. Infertility (partial or complete)
- 3. Impairment in intellectual ability (memory)
- 4. Impaired social behaviors
There are congenital and acquired causes of hypogonadism.
Congenital causes arise from chromosomal aberrations, e.g., Turner syndrome in females and Klinefelter syndrome in males.
Acquired causes include:
- 1. Opioid deficiency-induced hypogonadism. This results from use of opioid drugs, e.g., morphine, oxycodone, methadone and hydromorphone.
- 2. Anabolic steroid — induced hypogonadism.
- 3. Infectious diseases such as mumps, which occur in childhood, and varicocele, which lead to failure of the testicles and affect the production of sex hormones.
- 4. Children of mothers who had used diethylstilbestrol, an endocrine disruptor.
- 5. Traumatic brain injury especially during childhood.
- 6. Age – especially in men is a major factor that causes a decrease in androgens.
Diagnosis of hypogonadism is made according to sex.
In men, testosterone levels can be determined using a blood test, e.g., hormonal assay. When the level of testosterone is low, other hormones such as luteinizing hormone should be checked. This will help elucidate the reasons for the low testosterone levels for appropriate treatment options.
In women, determination of serum levels of LH and FSH are usually employed in evaluating hypogonadism. This is especially helpful in diagnosing hypogonadism due to age. In post-menopausal women, there are high levels of these hormones despite the end of menstruation. So the levels if high are normal in post-menopausal women. But in younger women or teens, high levels of LH and FSH above the normal range might be pointing to primary hypogonadism. While low levels of LH and FSH might be a pointer to secondary or tertiary hypogonadism.
- 1. In males, primary hypogonadism can be treated with testosterone replacement therapy, e.g., transdermal, using a patch or gel, injection or pellets. This takes up to 2-3 months for optimum levels to be achieved. Blood levels of testosterone should be checked regularly to ensure it increases adequately.
- 2. Using human chorionic gonadotropin (hCG) in men with secondary hypogonadism. hCG stimulates the LH receptor and consequently enhances testosterone synthesis.
- 3. For both male and female hypogonadism, administration of low dose of clomifene stimulates the body naturally to produce sex hormones.
- 4. Female hypogonadism can be treated with hormone replacement therapy using estradiol and progesterone, and also giving them testosterone to enhance libido.
Stem Cell Treatment
Treatment of hypogonadism using hormone replacement therapy has significant side effects both in males and females. In recent research, scientists have used stem cells to bring the levels of testosterone to normal. This was achieved by transformation of adult skin cells to create Leydig cells of the testicles that are responsible for the production of testosterone. In another experiment conducted by the same team of scientists, testosterone levels were successfully brought to normal levels in rodents.
It therefore suggests that with further experiments, stem cell therapy would be a safer and quicker method of treating hypogonadism in both males and females.