According to medical terminology (ICD 10), hypogonadism in males is a syndrome featuring the dysfunction of reproductive organs and worsening of the production of sex hormones. “Hypogonadism” is a metabolic disorder, the progression of which gives rise to pain in the heart. General health deteriorates, the structure of bone tissue changes, and obesity develops. The disease can occur in men of all ages, in young men and in infants.
Furthermore, low testosterone levels can be observed in women. However, this is a separate topic for study not to be considered here.
Low Testosterone Symptoms — How Does the Condition Manifest Itself?
Low testosterone symptoms are to a great degree related to the age at which the disease appears. The signs of hypogonadism depend largely on the time of the disease occurrence. Therefore, specialists distinguish prepubertal (it is always primary) and postpubertal (can be primary or secondary) types. If the disorder appears before puberty, a patient suffers from what is classified as severe eunuchoid syndrome, serious gynecomastia, and paleness (pale complexion).
Symptoms of the illness also include non-pronounced secondary sexual characteristics:
There is a low amount of hair on the face and body. A child’s high voice does not deepen into a low, masculine one. Sexual organs do not develop properly; the penis is small in size; the scrotum is depigmented and has no labioscrotal folds. Morevoer, the prostate gland is also underdeveloped, and it is often not possible to determine its existence by palpation.
Secondary hypogonadism is diagnosed not only by the above-described characteristics. Its recurring signs include obesity, hypothyroidism and thyroid adrenal cortex and the absence of sexual desire and potency.
Symptoms are less pronounced when the disease occurred after puberty. However, such manifestations as small balls, reduction of the hairline on the face and body and the loss of skin elasticity, are common. In addition, female-type obesity may be present. Other signs of low testosterone can include vegetative-vascular diseases and infertility.
Additional Signs of Low Testosterone — Depression, Anxiety, and Others
Men with testosterone insufficiency may suffer from depression, low mood, anxiety, forgetfulness and absentmindedness plus the inability to concentrate and focus 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 undiagnosed by specialists, which prevents the timely treatment of these conditions. Scientists are confident in the veracity of conducting further study, researching the relationship between low testosterone and mental health deterioration.
Main Causes of Low Testosterone
Causes of low testosterone may vary. Congenital primary hypogonadism can occur due to the following causes:
- deterioration of testicular development;
- cryptorchidism (the absence of one or both testes from the scrotum);
- Shereshevsky-Turner syndrome or simply Turner Syndrome (this disease is caused by chromosomal abnormalities, characterized by an absence of puberty and deterioration of physical development);
- Ahumada-Del Castillo syndrome (chromosomal underdevelopment of testicles leading to spermatozoa production suppression);
- incomplete masculinization (due to androgen insensitivity).
An acquired form of the disease can result from:
- genital injuries, testicular tumors,
- age factors (according to Harvard Medical School, T level declines by about 1% per year after the age of 40);
- pesticides and the toxic effect of alcohol on the body;
- taking large doses of hormones, for example, during the steroid cycle. Thus, after the cycle, one needs to take anti-estrogens such as Anastrozole. According to steroids before and after reviews by “juicers”, prolonged intake of these tablets can lead to a decrease in testosterone.
- the influence of radiation or chemotherapy, consequences of infectious diseases (vesiculitis, epidemic parotitis, deferentitis – inflammation of the vas deferens).
The secondary form can be caused by hypothalamic-pituitary-adrenal regulation abnormalities (due to tumors, inflammation, vascular conditions). The level of gonadotropins which is required for the synthesis of androgens, decreases.
How Do You Know if You Have Low Testosterone?
Low testosterone in men is a condition hallmarked by the sex glands working poorly, failing to produce sex hormones in healthy amounts. Diagnosis of hypogonadism is usually performed jointly by an endocrinology specialist, gynecologist, urologist (for men) and a reproductive endocrinologist (for women).
The disorder can have primary and secondary etiology. Primary type can be detected immediately after the birth of a child. In the case of this pathology, a baby doesn’t have testicles. To diagnose secondary hypogonadism, the patient needs to undergo the following tests:
- quantitative human chorionic gonadotropin (hCG) blood test;
- general tests of blood and urine;
- study of chromosomal recruitment and chromatin;
- urine and blood T and hCG tests;
- detection of daily excretion of testosterone with urine;
- computed tomography (CT scan) of the head, examination of the fundus condition.
Low Testosterone Treatment: Basic Methods
Low testosterone treatment should be prescribed by a healthcare expert. Self-treatment measures are not advised. Prescription of exact medical remedies depends on the patient’s condition and personal medical history.
Treatment is aimed at normalizing androgen rates and improving sexual function.
The primary form is treated by stimulating therapy which differs for men and boys. For boys, the treatment usually includes non-hormonal drugs. Adult males can take androgen and gonadotropin drugs in small quantities (that is, use hormonal therapy or HT). The same methodology is applied with acquired hypogonadism when the testicles do not retain 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).
The treatment for secondary (hypogonadotropic) hypogonadism is quite different, involving the use of HT in any age. Treatment options include the combination of gonadotropins with sex hormones.
HCG can also be used to treat secondary form. Treatment is performed with the help of intramuscular shots of such drugs as Profasi, Gestoron, Medofasi, Materna-HCG, HCG Mochida, Predalon, Choragon, and Brevactid. Gonadotropins stimulate secondary sexual characteristics and increase penis size. Intramuscular injections of Omnadren and Nebido (steroid drugs) may be used or, on occasion, steroids pills.
These drugs improve sexual function, reduce the number of fat deposits whilst contributing to an increase in muscle mass.
Herbal pills, (for example, the so-called over-the-counter steroids), are ineffective or demonstrate only mild efficacy in such cases.
Sometimes it is not possible to cure hypogonadism using standard methods. Here, patients need to have a surgical procedure performed. A doctor can choose one of the following treatment options:
- testicular transplantation;
- descent of testis (for treatment 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 generally carried out with the use of microsurgical techniques. The hormonal and immunological status of a person is carefully monitored.
Proper and regular treatment of the disease lead to normalization of male potency, helps to restore secondary sex features and contributes to the disappearance of concomitant conditions like osteoporosis.
Consequences of Low Testosterone in Men
If left untreated, the disease may cause infertility. In men, hypogonadism can lead to excessive body weight and cardiovascular disease. Hypogonadism-caused deposition of cholesterol in blood vessels can cause atherosclerotic changes. Osteoporosis can also be a concomitant condition: bones lose density thereby increasing the risk of bone fracture.