Hypogonadism
Definition
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.
Alternative Names
Gonadal deficiency
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)
- Radiation
- Rapid, significant weight loss
- Surgery
- 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).
References
Sigman M, Jarow JP. Male infertility. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.
Molitch ME. Anterior pituitary. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 242.
White PC. Disorders of sexual differentiation. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 252.
Faiman C. Male hypogonadism. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:pgs 397-401.
Review Date: 10/14/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Gonadal deficiency
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:
If a brain tumor is present (central hypogonadism), there may be:
Headaches or vision loss
Milky breast discharge (from a prolactinoma)
People with anorexia nervosa (who diet to the point of starvation) and those who lose a lot of weight very quickly (such as after gastric bypass surgery) also may have central hypogonadism.
Signs and tests
Tests may be done that check:
Other tests may include:
Blood tests for
anemia and iron
Genetic tests
Thyroid level
Sometimes imaging tests are needed, such as a sonogram of the ovaries. If pituitary disease is suspected, an MRI or CT scan of the brain may be done.
References
Sigman M, Jarow JP. Male infertility. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.
Molitch ME. Anterior pituitary. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 242.
White PC. Disorders of sexual differentiation. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 252.
Faiman C. Male hypogonadism. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:pgs 397-401.
Review Date: 10/14/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Gonadal deficiency
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.
Expectations (prognosis)
Many forms of hypogonadism are treatable and have a good outlook.
Complications
In women, hypogonadism may cause infertility. Menopause is a form of hypogonadism that occurs naturally and can cause hot flashes, vaginal dryness, and irritability as a woman's estrogen levels fall. The risk of osteoporosis and heart disease increase after menopause.
Some women with hypogonadism take estrogen therapy especially those who have early menopause (premature ovarian failure). However, there is a small but significant increase in risk for breast cancer and possibly heart disease when hormone therapy is used to treat menopause symptoms.
In men, hypogonadism results in loss of sex drive and may cause:
Impotence
Infertility
Osteoporosis
Weakness
Men normally have lower testosterone as they age, but the decline is not as dramatic or steep as the decline in sex hormones that women experience.
Calling your health care provider
Talk to your doctor if you notice:
Both men and women should call their health care provider if they have headaches or vision problems.
References
Sigman M, Jarow JP. Male infertility. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.
Molitch ME. Anterior pituitary. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 242.
White PC. Disorders of sexual differentiation. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 252.
Faiman C. Male hypogonadism. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:pgs 397-401.
Review Date: 10/14/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Gonadal deficiency
Prevention
Maintain normal body weight and healthy eating habits to prevent anorexia nervosa. Other causes may not be preventable.
References
Sigman M, Jarow JP. Male infertility. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.
Molitch ME. Anterior pituitary. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 242.
White PC. Disorders of sexual differentiation. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 252.
Faiman C. Male hypogonadism. Cleveland Clinic: Current Clinical Medicine. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2010:pgs 397-401.
Review Date: 10/14/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 10/14/2010
Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.