Hypogonadism – an issue suffered in silence

Sex hormones

Sex hormones play an important role in sexual development and reproduction. The levels of sex hormones are fluctuating during different stages of life. However, if they are not present in the required amounts, they may have significant effects on your body in numerous ways.

Hypogonadism is a condition that occurs when the sex glands (gonads) in your body produce little or no sex hormones. It can happen both in males and females due to their ineffective testes or ovaries, respectively. Depending on how the condition is developed, there are two basic types of hypogonadism.

Hypogonadism that originates from problem in your gonads is known as primary hypogonadism. During this condition, your gonads are unable to produce sex hormones despitereceiving signals from your brain to produce them.

Another type known as secondary or central hypogonadism happens when there is a problem in your hypothalamus or pituitary gland that are involved in signaling your gonads to produce sex hormones.

How are sex hormones important for your body?

The sex hormones play an important role in masculine growth and sperm production in men. In women, they play a major role in menstrual cycle and breast development. They are also essential for other bodily functions in both the genders such as sexual desire, bone and muscle growth, regulating cholesterol levels, body-fat distribution and overall well-being.

What conditions can cause hypogonadism?

Both primary and secondary hypogonadism candevelop due to congenital (present from birth) or acquired (developed after birth) reasons.

Primary hypogonadism:Congenital causes may include conditions such as Klinefelter’s syndrome, cryptorchidism, varicocele and myotonic dystrophy.It can be acquired through infections (mumps orchitis), radiation, environmental toxins, alkylating agents, ketoconazole, glucocorticoids, testosterone and/or anabolic steroid abuse; testicular torsion, chronic systemic illness and idiopathic (unknown) causes.

Secondary hypogonadism: Congenital causes include conditions such as Kallman’s syndrome, Prader Willi syndrome or idiopathic.It can be acquired due to hyperprolactinemia, diabetes mellitus, obesity, steroid treatment, chronic opiate use, anorexia nervosa, critical illness, or idiopathic (cause unknown). Damage to the pituitary or hypothalamus, tumors and cysts, infections, trauma, radiation and pituitary bleeding may also lead to the condition.

How will I know if I have hypogonadism ?

In young girls and boys, hypogonadism may affect their pubertal development. Girls will not begin menstruating, and also affects their breast development and growth. Hypogonadism in boys may affect muscle, beard, genital, voice development growth and sexual maturity

The following symptoms might indicate a hormonal change in women include

  • Irregular menstruation

  • Hot flashes

  • Energy and mood changes

  • Milky discharge from breasts

  • Loss of body hair

The signs of hormonal change in men include

  • Muscle loss

  • Breast enlargement

  • Decreased sexual drive

  • Erectile dysfunction

  • Difficulty in concentrating

  • Hot flashes

  • Fatigue

  • Infertility

Other symptoms related to pituitary or other tumors may include headaches and vision loss.

What is the approach to treat hypogonadism?

The treatment depends on the type of the condition and its onset. It generally involves in taking hormone-based medicines.

In majority of cases, hormone replacement treatment (HRT) proves to be effective in managing hypogonadism. During this treatment, hormones that are not produced in the body are substituted through medications. These may include testosterone, estrogen and progesterone, or pituitary hormones.

In adult males, testosterone replacement therapy helps to improve sexual desire, increase muscle mass and energy levels and reduce bone loss. It can be used in young boys to stimulate puberty and in adolescent males to increase muscle mass, promote pubic and facial hair growth and encourage penis growth. Pituitary hormones are used if hypogonadism is caused due to problems related to pituitary gland. Estrogen and progesterone are used to improve sexual desire in women.

If the condition is caused due to pituitary or hypothalamic causes, it may need to be treated using surgical and radiation therapy.

Identifying the cause helps to know the appropriate treatment leading to better response. Majority of the cases are treatable and have significant improvement in the condition.

Is hormone-replacement therapy (HRT) a right option for Post Menopausal women

HRT therapy may not always be a good option. It may increase the risk of breast cancer, cardiovascular disease, endometrial hyperplasia or cancer in women. HRT may also increase the risk for prostate cancer and heart failure in men. It may also have several side effects such as erythrocytosis (increase in red blood cells), sleep apnea. Hence, screening is always important before starting the therapy and continuous monitoring for any abnormalities is required during the treatment.

What happens if hypogonadismis left untreated?

If left untreated, hypogonadism may lead to various complications. In women the possible complications in women may include infertility, vaginal dryness. It may also increase the risk for osteoporosis and heart disease. Men may develop impotence, weakness, loss of sex drive infertility and osteoporosis when the condition is left untreated.

How do lifestyle changes help to maintain sex hormone levels?

Depending on the underlying cause for hypogonadism, lifestyle modifications may sometimes help to maintain or even boost your hormonal levels. It is important to note that obesity and malnutrition are some of the risk factors that may lead to hypogonadism. Increasing physical activity and working towards losing your weight helps to improve your condition. A diet rich in nuts, proteins, leafy vegetables, fruits especially pomegranate, vitamin D-containing foods also helps to improve your hormonal levels. Managing your stress, avoiding smoking and alcohol, and getting enough sleep are also important factors that can positively affect your hormone levels.

What are sex hormone? Why are they important?

Sex hormones are the hormones produced by reproductive organs. Testosterone is the male sex hormone. Progesterone and estrogen are the female sex hormones. Sex hormones are responsible for development of sexual characteristics, sexual functions, development of female eggs and male sperms, and reproductive functions such as pregnancy, childbirth and lactation.

What are sexual hormone disorder? What are the symptoms of hormone disorders?

Sexual hormone disorders occur when there is overproduction or underproduction of sexual hormones. Some common sexual hormone disorders include:

  1. Hypogonadism in males in which there is low testosterone levels leading to erectile dysfunction, decreased muscle mass, decreased libido, and eventually infertility. Hypogonadism in females is characterized by Irregular menstruation, hot flashes, energy and mood changes, milky discharge from breasts, loss of body hair

  1. Polycystic ovarian disease in which there is high levels of male hormone testosterone in females. It is characterized by menstrual issues (amenorrhea, oligomenorrhea), increased body hair (hirsutism), acne etc.

Sex hormone imbalance by itself can cause many symptoms like weight gain, fatigue, constipation, dry skin, frequent urination, muscle weakness, mood swings etc.

How is sexual disorder diagnosed?

A variety of tests can be done to diagnose sexual disorders. A blood test can be done to check for hormone levels. Ultrasound examination may be helpful to view ovaries, testicles, uterus and pituitary.

Whom to see for treating sexual disorders?

If you experience any symptoms of sexual hormone disorders, you must visit an endocrinologist.

How are sex hormone problems treated?

Treatment depends upon the cause of the hormonal disorder.

Hypogonadism treatment: In men, testosterone therapy in the form of testosterone cream, gels, patches, pills or injections. If the problem is related to pituitary, pituitary hormone replacement (administered as pills) can be given to improve sperm production. In females, hypogonadism is treated by pills or patches of estrogen and progesterone.

Polycystic ovarian syndrome(PCOS): It can be treated by combination progesterone and estrogen pills. Progestin therapy for 10-15 days is also helpful to normalize periods. Ovulation can be stimulated by clomiphene(anti estrogen medication), letrozole, gonadotrophins.