Hypogonadism

Congenital underdevelopment of the genital glands , toxic, infectious, radiation damage to them, impaired function of the hypothalamic-pituitary system .

Decreased secretion of sex hormones by the testes . In primary hypogonadism, the testicular tissue is directly affected; in secondary hypogonadism, hypofunction of the gonads arises as a result of damage to the hypothalamic-pituitary system with a decrease in the gonadotropic function of the pituitary gland.

The clinical manifestations of hypogonadism depend on the age at which the disease arose and the degree of androgen deficiency. There are pre-puberty and post-puberty forms of hypogonadism. When the testicles are damaged before puberty, a typical eunuchoid syndrome develops, there is a high disproportionate growth due to a delay in the ossification of the epiphyseal growth zones, lengthening of the limbs, underdevelopment of the chest and shoulder girdle. Skeletal muscles are poorly developed, subcutaneous fatty tissue is distributed according to the female type. True gynecomastia is not uncommon. The skin is pale. Weak development of secondary sexual characteristics:

• lack of hair growth on the face and body (on the pubis - according to the female type);
• underdevelopment of the larynx;
• high voice.

Depending on the degree of androgen deficiency, the following symptoms may occur:

• lack of libido ;
• lethargy;
• Depression
• sleep disturbance;
• the tides .

The genitals are underdeveloped:

• penis of small size;
• the scrotum is formed, but depigmented, without folding;
• the testicles are hypoplastic;
• the prostate gland is underdeveloped, often not palpable.

With secondary hypogonadism, in addition to the symptoms of androgen deficiency, obesity is often observed, symptoms of hypofunction of other glands of internal secretion — the thyroid, adrenal cortex — are frequent (the result is the loss of tropic pituitary hormones ). Symptoms of panhypopituitarism may be observed. Sex drive and potency are absent.

If the loss of testicular function occurred after puberty, when sexual development and the formation of the musculoskeletal system are already completed, the symptoms of the disease are less pronounced. Characterized by a decrease in the testicles, a decrease in the hair growth of the face and body, thinning of the skin and loss of its elasticity, the development of obesity according to the female type, impaired sexual function, infertility , and vegetative-vascular disorders.

In the diagnosis of hypogonadism, X-ray and laboratory data are used. With hypogonadism, which developed before puberty, there is a lag of "bone" age from the passport age by several years. Blood levels of testosterone are below normal. With primary hypogonadism, an increase in the level of gonadotropins in the blood, with secondary hypogonadism, its decrease, in some cases their content may be within normal limits. Excretion in urine 17-KS may be within normal limits or below it. When analyzing ejaculate - azo - or oligospermia ; in some cases, ejaculate cannot be obtained.

The prognosis for life is favorable. The disease is chronic, during treatment it is possible to reduce the symptoms of androgen deficiency. There are no difficulties in the treatment of hypogonadism. In each case, therapy should lead to a complete normalization of clinical manifestations and serum testosterone levels. Currently, the minimum value of testosterone in the blood of a healthy man is officially determined:

• total testosterone, the lower limit of the norm of which is the level of 12 nmol / l (346 ng / dl), regardless of age;
• free testosterone, the lower limit of the norm of which corresponds to 250 pmol / l (72 pg / ml), regardless of age.

For the treatment of hypogonadism, depending on the clinical picture, the following drugs can be used:

• testosterone undeconoate (Andriol) ;
• testosterone enanthate ;
• testosterone propionate (frequent injections);
• a combination of testosterone esters ( Sustanon-250 , Omnadren-250);
• selective (selective) estrogen receptor modulators;
• aromatase inhibitors;
• chorionic gonadotropin (HCG).

• Kalinchenko S. Yu. Practical andrology
• Ramasamy R, Scovell JM, Kovac JR, Lipshultz LI. Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy // J Urol. 2014 Sep; 192 (3): 875-9. PMID: 24657837.
• Shabsigh A, Kang Y, Shabsign R, Gonzalez M, Liberson G, Fisch H, Goluboff E. Clomiphene citrate effects on testosterone / estrogen ratio in male hypogonadism // J Sex Med. 2005 Sep; 2 (5): 716-21. PMID: 16422830.
• Information for patients with congenital hypogonadotropic hypogonadism (IGH) and Kalman syndrome (Kallman)

• MedlinePlus Medical Encyclopedia Associated Hypogonadism
• eMedicine
• MESO-Rx On Anabolic Steroids Leading to Hypogonadism