Low libido, fatigue, and erectile dysfunction are the main symptoms of hypogonadism, a medical condition characterized by insufficient production of sex hormones in the testicles. Learn when to worry and the main treatments.
Have you heard about hypogonadism? This term, though not widely discussed, often brings some confusion when brought up in a medical consultation, mainly because many understand it as synonymous with male menopause (and menopause in women).
However, to start today’s blog, it’s important for you to understand that these conditions are not the same, although they can often be associated.
While hypogonadism in men is a medical condition characterized by insufficient production of sex hormones in the testicles, andropause specifically refers to the gradual decrease in testosterone production in men as they age, usually occurring between 40 and 50 years old, approximately.
Hypogonadism, on the other hand, can occur at any age and is more common than you might think, and can affect both men and women.
Today’s blog will not only explain what hypogonadism is but also its causes and main symptoms.
Furthermore, we will talk about the relationship between hypogonadism and the regulation of libido, maintenance of erectile function, and erectile dysfunction.
By identifying the condition early, it is possible to seek appropriate treatment, thus improving the quality of life of affected individuals. Follow along and learn everything about hypogonadism!
What is hypogonadism?
Hypogonadism is a medical condition characterized by malfunctioning of the gonads, which leads to insufficient production of sex hormones. It can occur in both men and women. In men, the gonads are called testicles, and in women, they are the ovaries.
These hormones are essential for reproductive function. However, besides affecting reproduction itself, hypogonadism also impacts the maintenance of secondary sexual characteristics, which refers, for example, to body changes that occur during puberty.
In men, hypogonadism hinders the growth of facial and body hair, voice changes, muscle mass increase, and body fat distribution, for example.
Primary Hypogonadism
To better understand hypogonadism, it is important to mention that there are two main types: primary and secondary.
The primary, also known as primary gonadal insufficiency, occurs when the problem is in the gonads themselves and can be caused by factors such as genetic issues, infections, injuries, or medical treatments that damage the testicles.
Secondary Hypogonadism
In the case of secondary hypogonadism, the dysfunction is in the hypothalamus or the pituitary gland, which are areas of the brain responsible for regulating the activity of the gonads, through the release of hormones that stimulate the production of sex hormones.
What does hypogonadism cause in men: main symptoms
The symptoms of hypogonadism in men can vary depending on the age of onset of the problem. These symptoms can also vary in intensity and are not necessarily present in all diagnosed patients.
Among the main possible symptoms are:
- Infertility with reduced sperm production, hindering reproductive capacity;
- Decreased libido (reduction in sexual desire);
- Erectile dysfunction (difficulty in having erections);
- Reduced bone density, with increased risk of osteoporosis and fractures;
- Loss of muscle mass and/or increase in body fat;
- Mood changes, such as depression, irritability, and anxiety;
- Fatigue;
- Reduced growth of facial, pubic, and body hair.
Early diagnosis and treatment are important to mitigate the effects and improve the quality of life of those affected by hypogonadism.
Causes and risk factors
Male hypogonadism can have various causes and risk factors, which can be separated in two ways: by problems in the gonads themselves (primary) or problems in the brain regions that regulate hormonal production (secondary).
The main risk factors for hypogonadism are aging; family history of the disease; chronic diseases; substance use such as alcohol; and finally, a sedentary lifestyle.
Among the most likely causes of primary hypogonadism are:
- Genetic conditions, such as Klinefelter’s syndrome, which involves the presence of an additional X chromosome in men;
- Autoimmune diseases, which can cause the immune system to attack the testicles;
- Chronic diseases, such as renal or hepatic insufficiency, which can affect testicular function;
- Traumas, injuries, or infections (such as orchitis, which can be caused by the mumps virus) in the testicles, affecting their ability to produce testosterone;
- Invasive cancer treatments, such as radiotherapy or chemotherapy.
In the case of secondary hypogonadism, we can mention:
- Problems in the hypothalamus or pituitary gland, such as tumors, injuries, infections, or diseases like Kallmann’s syndrome that affect these brain regions;
- Chronic diseases that can indirectly alter hormonal regulation;
- Malnutrition and eating disorders;
- Use of certain medications, such as opioids or corticosteroids.
Does hypogonadism affect male fertility?
Although hypogonadism does not always cause infertility, it is indeed possible for the condition to cause problems with male fertility, as the testicles, mainly responsible for reproductive health, are significantly affected.
The condition results in insufficient testosterone production. In addition, the man may also suffer from reduced sperm production or low sperm count.
Besides quantity, the quality of sperm can be affected in terms of mobility and structure, both important for the fertilization of the egg.
Diagnosis of the problem
To reach a diagnosis of hypogonadism, the urologist responsible for your case will analyze clinically, in addition to requesting laboratory tests to better investigate the severity of the condition and determine the cause.
Initially, the medical and family history of the patient is considered, analyzing symptoms, pre-existing hormonal diseases, lifestyle habits, and medications in use.
Also evaluated are aspects such as hair distribution, testicle size, and muscle development in men.
If hypogonadism is suspected, some tests may base the diagnosis, including:
- Testosterone levels;
- Hormones, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH);
Prolactin; - Thyroid hormones like TSH (thyroid-stimulating hormone) and free T4;
- Complete blood count and metabolic profile.
If there is suspicion of a tumor or other structural anomaly in the pituitary gland or hypothalamus, a Magnetic Resonance Imaging or Computed Tomography of the patient’s head may be necessary.
In some cases, the doctor may also request a testicular ultrasound to assess the anatomy of the testicles and detect possible structural abnormalities.
In cases of congenital hypogonadism or when there is suspicion of an underlying genetic condition, such as Klinefelter’s syndrome, genetic testing may be recommended.
For men who also present with infertility, a semen analysis may be performed to evaluate sperm count, motility, and morphology.
Treatments for hypogonadism
Treatments for hypogonadism may vary depending on the cause of the condition, i.e., whether it is primary or secondary. In addition, the severity of symptoms and the patient’s post-treatment goals are evaluated, especially when there are fertility issues.
When hypogonadism is primary, Testosterone Replacement Therapy (TRT) is considered, with hormone administration via intramuscular (injections), transdermal (patches or gels applied to the skin), or oral.
This type of treatment can increase testosterone levels in the body, relieving symptoms such as low libido, fatigue, and muscle loss.
In the case of treatments for infertility, therapies to stimulate sperm production may be considered. For this, hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are used, or assisted reproduction techniques, such as in vitro fertilization (IVF).
When hypogonadism is secondary, it may be necessary to add other hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), to stimulate the production of testosterone and sperm.
When secondary hypogonadism is caused by conditions such as pituitary tumors, hypothyroidism, or obesity, treating the underlying condition can help restore normal hormonal function.
Complications of hypogonadism
If untreated, hypogonadism can lead to some health complications, which vary depending on the severity and duration of the hormonal deficiency. Among the main ones are:
- Infertility;
- Osteoporosis or bone fractures;
- Loss of muscle mass or strength;
- Increase in body fat;
- Metabolic syndrome;
- Development of heart diseases;
- Depression and anxiety;
- Cognitive problems;
- Decreased libido;
- Erectile dysfunction;
- Increased breast development in men;
- Chronic fatigue;
- Overall decreased quality of life.
How to prevent hypogonadism?
Preventing hypogonadism may not be possible, mainly because many causes are genetic or due to specific medical conditions.
Although the causes cannot often be prevented, some measures can help reduce the risk or mitigate the effects of hypogonadism, including:
- Adopting a healthy lifestyle;
- Managing chronic medical conditions;
- Avoiding exposure to harmful substances, conducting regular medical monitoring.
Hypogonadism, being a complex condition, can negatively affect your life in various ways, causing inconvenient problems. With proper diagnosis and treatment, unpleasant situations can be reversed.
Schedule a pre-analysis today with urologist Dr. Paulo Egydio and take the first step toward recovering your quality of life!
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