According to medical terminology (ICD 10), hypogonadism is a syndrome characterized by dysfunction of the sex glands and a violation of the synthesis of sex hormones. The “hypogonadism” diagnosis includes a metabolic disorder, with the progression of which pain in the heart occurs, general health deteriorates, the structure of bone tissue changes, and obesity develops. The disease can occur in men in ages, in young men, as well as in infants.
In addition, low testosterone levels can be observed in women. However, this is a separate topic for study and we will not consider it.
Low testosterone symptoms – how does the condition manifest itself?
Low testosterone symptoms are largely related to the age at which the disease has appeared. The signs of hypogonadism depend on the time of occurrence of the disease. Therefore, specialists distinguish prepubertal (it is always primary) and postpubertal (can be primary or secondary) types of ailment. If the disease appears before puberty, the patient suffers from the severe eunuchoid syndrome, severe gynecomastia, and the pallor of the skin.
Symptoms of hypogonadism also concern the weakened development of secondary sexual characteristics:
- There is a lack of hair on the face and body. A child’s high voice does not transform into a rough one. Sexual organs do not develop properly (the penis is small in size; the scrotum is depigmented and has no folds). Moreover, the prostate gland is also underdeveloped, and it is often impossible to determine it by palpation.
- Secondary hypogonadism is characterized not only by the above-described consequences. Frequent signs of the disease are obesity, hypothyroidism and thyroid adrenal cortex. The symptoms of the disease include the absence of sexual desire and potency.
- Signs of hypogonadism is less noticeable when the disease occurred after puberty. However, such symptoms as testicles of smaller size, reduction of the hairline on the face and body, loss of elasticity by the skin, are common. In addition, female-type obesity may be observed. Often signs of low testosterone include vegetative-vascular diseases and infertility.
Additional signs of low testosterone – depression, anxiety, and others
Men with testosterone insufficiency may suffer from depression, feeling devastated, anxiety, forgetfulness and absentmindedness, the inability to concentrate attention. In addition, sleep disturbance, which leads to nervous exhaustion and rapid fatigue, is possible.
Scientists note that the propensity to develop depression and increased anxiety in men with testosterone insufficiency remains underestimated by specialists, which prevents the timely treatment of these conditions. Scientists are confident in the advisability of conducting an additional study aimed at researching the relationship between low testosterone and the deterioration of mental health.
The main causes of low testosterone
Causes of low testosterone may be different. Congenital primary hypogonadism can occur due to the following causes:
- deterioration of testicles development;
- сryptorchidism (the absence of one or both testes from the scrotum);
- the Shereshevsky-Turner syndrome (this disease is caused by chromosomal abnormalities, characterized by a lack of puberty and deterioration of physical development);
- Ahumada-Del Castillo syndrome (chromosomal underdevelopment of testicles, as a result of which spermatozoa are not produced);
- syndrome of incomplete masculinization (when sensitivity to androgens is reduced).
Acquired primary hypogonadism can be a result of:
1) traumas of genital organs, testicular tumors,
2) age factor (according to Harvard Medical School, after 30 years, the testosterone level decreases by about 1% every year);
3) pesticides’ and alcohol’s toxic effects on the body;
4) taking large doses of hormones, for example, during the steroid cycle, so after the cycle, one needs to take anti-estrogens such as anastrozole. According to steroids before and after reviews, prolonged intake of these tablets can lead to a decrease in testosterone.
5) influence of radiation or chemotherapy, consequences of infections (vesiculitis, epidemic parotitis, deferentitis).
Secondary hypogonadism in males can occur as result of disorders of hypothalamic-pituitary regulation (caused by tumors, inflammation or the vascular system condition). The level of gonadotropins is needed for the synthesis of androgens, decreases.
Low testosterone in men – diagnosis
Low testosterone in men (hypogonadism) is a syndrome when the function of the sex glands is not sufficient and sex hormones are not produced in normal amounts. Diagnosis of hypogonadism is usually performed jointly by an endocrinologist, gynecologist, urologist (for men) and a reproductive endocrinologist (for women).
As mentioned earlier, hypogonadism can be primary and secondary. Primary type can be detected immediately after the birth of the child. In case of this pathology, the baby doesn’t have testicles. In order to diagnose secondary hypogonadism, the patient needs to pass the following tests:
- quantitative human chorionic gonadotropin (hCG) blood test;
- general tests of blood and urine;
- study of chromosomal recruitment and sexual chromatin;
- urine and blood testosterone and gonadotropin tests;
- detection of daily excretion of testosterone with urine;
- computed tomography of the head, examination of the fundus condition.
Low testosterone treatment – basic methods
Low testosterone treatment should be carried out strictly in consultation with the doctor. It is not recommended to do this on your own. Prescription of medical remedies depends on the clinical picture of the particular patient.
The goal of treating males is to normalize the level of androgens and restore sexual function.
Primary hypogonadism, the treatment of which is stimulating therapy, is different for men and boys. For boys, the treatment usually includes non-hormonal drugs. Men can be treated with small amounts of androgens and gonadotropins (the hormonal treatment). The same goes for acquired hypogonadism when the testicles retain the reserves of Endocrinocytus cells. If the testicles lack these reserves, the intake of androgens (testosterone) is required throughout the life of the patient (the so-called lifelong therapy).
Secondary hypogonadism (hypogonadotropic hypogonadism), whose treatment will be quite different, involves the use of hormone therapy for patients of all ages. Treatment options for this type of the condition include the combination of gonadotropins with sex hormones. Doctors also recommend doing gymnastics and performing general restorative treatment in case of secondary hypogonadism.
Сhorionic gonadotropin can be used to treat secondary hypogonadism. Treatment is performed with the help of intramuscular injections of such drugs as Profasi. Gonadotropins provide a stimulating effect on secondary sexual characteristics and increase the penis. Also, intramuscular injections of Omnadren and Nebido (steroid drugs) may be used. Sometimes steroids pills are used.
These drugs improve sexual function, reduce the amount of fat deposits while contributing to an increase in muscle mass.
Herbal pills (for example, the so-called over the counter steroids) are ineffective or not very effective in such cases.
Sometimes it is not possible to cure hypogonadism using conservative methods. In this case, patients need to perform a surgical procedure. A doctor can choose one of the following treatment options:
- transplantation of the testis;
- testes descent (in the case of cryptorchidism);
- phalloplasty (if underdevelopment of the penis is observed);
- implantation of a synthetic testicle (if there is no undescended testicle in the peritoneum).
Surgical intervention is accepted to be carried out with the use of microsurgical techniques. At the same time, the hormonal and immunological status of the patient is carefully monitored.
If the therapy of hypogonadism is regular, the potency is partially normalized, the secondary sexual characteristics begin to develop again, and such accompanying symptoms as osteoporosis begin to disappear.
Consequences of low testosterone in men
If treatment of hypogonadism is performed improperly or too late, one of the consequences of the disease may be infertility. In men, hypogonadism can lead to excessive body weight and the appearance of problems with the heart and blood vessels. Hypogonadism-caused deposition in cholesterol vessels may lead to atherosclerotic changes. Osteoporosis can also be a concomitant condition. In case of osteoporosis, bones become less dense, which increases the likelihood of their fractures.