What Is Hypogonadism?

Male hypogonadism refers to a series of manifestations of male testicular dysfunction caused by various reasons. The clinical manifestations of male hypogonadism vary with the age of onset. If gestational age is 2 and 3 months, androgen deficiency occurs, causing pseudo-hermaphroditism; puberty androgen deficiency, manifested by the lack of secondary sexual characteristics and scrotal body type; if androgen deficiency in adult males, it is manifested as hyposexual , Erectile dysfunction, poor physical strength, reduced sexual hair and beards, may cause infertility.

Basic Information

Visiting department

Department of Reproductive Medicine

Common locations

Gonad

Common causes

Congenital dysplasia, hypothalamic lesions, pituitary lesions, testicular lesions

Common symptoms

Decreased libido, erectile dysfunction, poor physical strength, decreased sexual hair and beards,

Causes of male hypogonadism

Male hypogonadism is mainly caused by insufficient androgen secretion. Testosterone plays a major physiological function. Testosterone secretion is regulated by the hypothalamus-pituitary-testicular axis. Problems in any part of it can cause male hypogonadism.

1. Hypothalamic, pituitary, and adrenal disorders

Common causes include tumors, inflammation, trauma, surgery, etc., which can affect the production and release of GnRH (gonadotropin-releasing [kinin] hormone), insufficient secretion of pituitary gonadotropin, which affects testicular development and reduces androgen production. In addition, like hypogonadotropin hypogonadism (Kallmann syndrome, also known as olfactory-testicular syndrome). The cause may be autosomal dominant, recessive or X-linked inheritance, due to the formation of olfactory bulbs during embryonic development. Insufficiency can cause hypothalamic GnRH secretion, leading to hypogonadism and decreased testosterone secretion), hyperprolactinemia, simple LH (luteinizing hormone) deficiency, simple FSH (follicle stimulating hormone) deficiency, muscle tone Depression-mental retardation-hyposexual development-obesity syndrome, sexual immature-pigmented retinitis-polydactyly (toe) malformation syndrome, Alstrams syndrome, obese reproductive incompetence syndrome, etc. can cause male hypogonadism. The adrenal cortex secretes cortisol and androgens. If they are produced too much, the two feedback inhibit the pituitary to release gonadotropins, reducing testosterone secretion and hypogonadism. Such as hypercortisolism, congenital adrenal hyperplasia and so on.

2. Testicular causes

Testicles are the main organs that produce androgens in the body. Abnormal development and structure of the testicles or decline in function caused by external factors can cause male gonads to decline. Common reasons are:

(1) Testicular development and structural abnormalities, such as congenital testicular dysplasia syndrome (one more X chromosome), male Turner syndrome, testicular anesthesia, cryptorchidism, etc.

(2) Acquired testicular abnormalities such as testicular infection (viral orchitis caused by mumps virus is the most common), trauma, radiation damage, and drug effects.

3. Defects in androgen synthesis or function

Such as androgen synthesis defects, androgen insensitivity (such as 5a-reductase deficiency).

Clinical manifestations of male hypogonadism

The clinical manifestations of male hypogonadism vary with the age of onset. If the gestational age is 2 and 3 months, androgen deficiency occurs, causing pseudohermaphroditism. Lack of androgen during puberty, manifested by lack of secondary sexual characteristics and scrotum body type, the penis is childlike, the testis is small, the scrotum is smooth without wrinkles, the pubic hair and armpit hair are thin, the face, chest, abdomen and back hair are lacking or very rare The speech is sharp, the muscles are underdeveloped, and the physical strength is lower than normal. If the androgen deficiency in adult males is manifested by decreased sexual desire, erectile dysfunction, poor physical strength, decreased sexual hair and beards, and may be accompanied by infertility.

Male hypogonadism test

1. Determination of blood and urine related hormones

Detection of blood testosterone, dihydrotestosterone (DHT), LH, FSH, and 24-hour urine 17-ketosteroids can help diagnosis. As needed, chorionic gonadotropin (HCG) stimulation test, LRH (luteinizing hormone releasing hormone) excitement test, etc. can be performed.

2. Chromosome analysis

The normal male karyotype is 46, XY, and the normal female karyotype is 46, XX. C-band analysis can identify the presence or absence of Y chromosomes in the middle stage of mitosis, and G-band analysis is helpful to find the type of chromosomal abnormalities. Sexual chromatin, also known as Papillary bodies, can be detected by oral mucosal smears. Female chromatin is positive and male is negative.

3. Other auxiliary diagnosis

Semen examination, X-ray bone age determination, CT, MRI, etc. can help evaluate the severity of the disease and find the cause.

Diagnosis of male hypogonadism

A diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.

Treatment for male hypogonadism

For male hypogonadism caused by hypothalamic-pituitary hypogonadotropin deficiency, the use of gonadotropin therapy can help restore spermatogenic function and promote the development of secondary sexual characteristics. The applicable preparations include chorionic gonadotropin (HCG), menopausal gonadotropin (HMG), LRH spray, etc., and Chinese medicine can also be tried.

Androgen replacement therapy can promote the development of external reproductive organs in patients with primary testicular dysfunction. Oral testosterone undecanoate, intramuscular testosterone propionate, long-acting heptanoic acid or testosterone decanoate, etc.

Cryptorchidism should be surgically treated within 2 years of age. For those with genitalia in the external genitalia, gender selection is very important. After sex determination, orthopedic surgery of the reproductive system and necessary hormone replacement therapy are required.