Hypogonadism

Hypogonadism is when the sex glands produce little or no hormones. In men, these glands (gonads) are the testes; in women, they are the ovaries.

Causes, incidence, and risk factors

The cause of hypogonadism may be “primary” or “central.” In primary hypogonadism, the ovaries or testes themselves do not function properly. Some causes of primary hypogonadism include:

  • Certain autoimmune disorders
  • Genetic and developmental disorders
  • Infection
  • Liver and kidney disease
  • Radiation
  • Surgery

The most common genetic disorders that cause primary hypogonadism are Turner syndrome (in women) and Klinefelter syndrome (in men). In central hypogonadism, the centers in the brain that control the gonads (hypothalamus and pituitary) do not function properly. Some causes of central hypogonadism include:

  • Bleeding
  • Certain medications, including steroids and opiates
  • Genetic problems
  • Infections
  • Nutritional deficiencies
  • Iron excess (hemochromatosis)
  • Rapid, significant weight loss
  • Trauma
  • Tumors

A genetic cause of central hypogonadism that also takes away the sense of smell is Kallmann syndrome (males). The most common tumors affecting the pituitary are craniopharyngioma (in children) and prolactinoma (in adults).

Symptoms

Girls who have hypogonadism during childhood will not begin menstruating. The condition can affect girls’ breast development and height. If hypogonadism occurs after puberty, symptoms include:

  • Hot flashes
  • Loss of body hair
  • Low libido
  • Menstruation stops

In boys, hypogonadism in childhood affects muscle and beard development and leads to growth problems. In men the usual symptoms are:

  • Breast enlargement
  • Decreased beard and body hair
  • Muscle loss
  • Sexual problems

Treatment

Hormone-based medicines are available for men and women. Estrogen comes in the form of a patch or pill. Testosterone can be given using a patch, a product soaked in by the gums, a gel, or by injection. For women who have not had their uterus removed, combination treatment with estrogen and progesterone is often recommended to decrease the chances of developing endometrial cancer. Women with hypogonadism who have a low sex drive can also take low-dose testosterone.

In some women, injections or pills can be used to stimulate ovulation. Injections of pituitary hormone may be used to help male patients produce sperm. Other people may need surgery and radiation therapy.