hypoandrogenism

Hypogonadism or low testosterone is a condition in which the body does not produce enough testosterone. This hormone helps in building and maintaining muscle mass, bone mass, and also plays an important role in the development of sexual personality. When this hormone is lacking, the body will have no strength, reduced sexual feelings and emotions, and less sperm production in males, leading to infertility. This condition is caused by abnormalities in the pituitary gland or the sex glands, which prevents them from producing enough sex hormones. This condition can occur from birth or during puberty, and can occur in both males and females.

Symptoms of Hypogonadism

The characteristics of low androgenism or Hypogonadism are divided into 2 stages as follows:

 

• Primary Hypogonadism or Hypergonadotropin Hypogonadism Normally, the sex glands are responsible for producing male sex hormonesand sperm when they receive a signal called gonadotropin, which is sent from the pituitary gland. But when the sex glands are abnormal, they will not respond well to those signals. And when sex hormones are not produced, the brain will secrete more gonadotropin hormones to stimulate the sex glands to produce enough sex hormones. For this reason, there is a high level of gonadotropin hormone in the blood.
• Secondary Hypogonadism or Hypogonadotropic Hypogonadism Normally, the hypothalamus produces gonadotropin-releasing hormone to stimulate the pituitary gland to produce follicle-stimulating hormone and luteinizing hormone. Luteinizing hormone acts to send signals to the sex glands to produce sex hormones. However, at this stage, the pituitary gland and hypothalamus may be abnormal, causing them to be unable to stimulate and send signals. Therefore, the sex glands are unable to produce sex hormones as well. People in this stage will have low male hormones and produce less sperm. This is mostly found when patients cannot enter reproductive age according to normal development.

When the body’s male hormones are low, it can cause both physical and emotional abnormalities. The severity of the symptoms depends on the age and the amount of male hormones in the body. The symptoms of Hypogonadism can be divided according to the age range as follows:

A fetus with a male chromosome
may have abnormalities in the genitals, such as slow and defective development of the male genitals, ambiguous genitals, and the baby’s external sex cannot be clearly identified, or a baby with a male chromosome may have genitals that look similar to a female’s, etc.

People who are entering puberty.
The lack of hormones during this period has a great impact on physical development, such as defects in the genitals and reproductive system, abnormal body hair, and reduced muscle mass and strength development. In addition, it may be found that the growth of the arms and legs is not proportional to the body size and the voice may not be as deep as other children of the same age.

Adults
may experience abnormal hair growth, taking longer to grow and producing less hair, and may experience erectile dysfunction and infertility. Adults with this condition may also experience loss of muscle mass, bone mass, and bone mineral density, and in some cases, a reduced sense of smell.

In addition, during puberty and adulthood, patients may experience some symptoms that occur together, such as low male hormones in the body and less sperm production, which are the main symptoms of this disease and lead to fatigue, exhaustion, lack of concentration, hot flashes in the body, reduced sexual feelings and emotions, emotional sensitivity, irritability, and may also occur with the condition of men with breasts, which may affect socializing, etc.

As for the symptoms of Hypogonadism in women, there are abnormal symptoms that may be found, such as reduced sexual feelings, irregular and absent menstruation, abnormal and slow-developing breasts, reduced body hair, abnormal milk flow, and hot flashes, etc.

Causes of Hypogonadism

Low testosterone can occur in people of all ages and genders. It is caused by abnormalities of the sex glands, causing the body to produce less sex hormones. It can also be caused by abnormalities of the brain that cannot send signals to the sex glands. Both types of abnormalities can have different causes, such as diseases and illnesses, injuries, and accidents that damage the testicles or brain.

The causes of hypogonadism can be divided according to the stage of hypogonadism as follows:

Causes of Primary Hypogonadism or low male hormones due to gonad disorders

• Congenital diseases such as Klinefelter syndrome, Turner syndrome, undescended testicles or retained testicles,varicose veins of the testicles, mytonic dystrophy, genetic mutations, and chromosomal abnormalities, etc.
• Illness from other diseases and conditions such as diabetes, liver disease, kidney disease, mumps, autoimmune diseases such as Addison’s disease, hyperthyroidism, testicular torsion, iron overload , diseasesrelated to genital infections, and chronic diseases, etc.
• Side Effects of Cancer Treatment Although radiation or chemotherapy to treat cancer often temporarily affects the production of sex hormones and sperm, it can cause permanent infertility.
• Use of certain substances or drugs ,such as ketoconazole, glucocorticoids  , methadone, cyproterone , anabolic steroids, spironolactone, cortisol hormones , and  use of drugs such as marijuana,
• Surgery or injury to the testicles, including surgery involving the reproductive system.

Causes of Secondary Hypogonadism or low male hormones due to pituitary gland disorders

• Illnesses caused by congenital diseases such as hormone deficiency syndrome, Prader-Willi syndrome, Lawrence- Moon syndrome, Bardet-Beedle syndrome, and Gaucher disease, etc.
• Illness from other diseases and conditions such as pituitary tumors, hyperprolactinemia, HIV infection or AIDS,inflammatory diseases such as sacroiliosis, tuberculosis, leukemia, obesity, anorexia, and malnutrition ,
• Side effects from secondary cancer treatment, radiation therapy and chemotherapy can also be the cause of this condition, as these methods can cause abnormalities in the treated part of the body.
• Other factors such as rapid weight loss, aging, and stress can also cause hypogonadism. In addition, brain injuries, brain surgery, and chronic use of steroids, opioids, or opiates can also cause hypogonadism.

Diagnosis of Hypogonadism

Doctors usually diagnose this condition based primarily on blood test results and symptoms. Therefore, when you visit your doctor, you should inform and describe your symptoms in detail to them. Other tests may also be performed, such as:

Physical examination
After asking about symptoms, the doctor will perform a physical examination to look for abnormal external characteristics, such as muscle mass, body hair, testicle size, etc.

Blood tests:
Your doctor may test your blood for medical conditions and assess the various components of your blood, including:

• Sex hormones: Blood test results are taken in the morning before 10 am because this is the time when sex hormones are at their highest levels. Therefore, this is the time when results can be measured effectively. In males, testosterone is measured, while in females, estrogen is measured.
• Follicle stimulating and luteinizing hormones, which play an important role in sending signals to the gonads.
• Prolactin hormone, which affects breast development and milk production in females.
• Thyroid hormones Since thyroid hormone disorders and hypogonadism have similar symptoms.
• Iron overload and diseases such as HIV infection or AIDS, diabetes, liver disease, etc.

Semen test:
As a result of abnormalities in the production of sex hormones, the body will produce less sperm. Therefore, a semen test will show the amount of sperm the body produces at what level, which may indicate hypogonadism.

A scan of the pituitary gland
may use an MRI scan, which uses a strong electromagnetic field, radio waves, and a computer to produce images, or a CT scan  , which uses a computerized tomography machine to produce images of the inside of the body. Both types of scans can be used to find tumors in the pituitary gland that may be causing the abnormal symptoms.

In addition to the above diagnostic methods, your doctor may order genetic testing to look for congenital abnormalities and examine your testicular tissue to determine your sperm count.

Treatment of Hypogonadism

Since hypogonadism has a wide range of causes and symptoms, treatment for the condition also varies, including:

Testosterone Replacement Therapy (TRT) is the introduction of male
hormones into the body to replace the missing parts and treat the abnormalities that occur. This results in better symptoms in various aspects such as sexual performance recovery, reduced infertility, stronger muscle mass and bone mass, increased sexual feelings and emotions, as well as affecting the mind and improving mood. However, taking hormone replacement therapy also has a risk of complications. Patients should consult a doctor about the possible risks.

In boys with late puberty, hormone replacement therapy is given gradually in small doses and gradually increased to simulate the increase in sex hormones in boys of this age and to avoid negative side effects. This method stimulates the development of sexual characteristics such as muscle and bone development, body hair growth, and normal testicular development.

There are several forms of treatment using male hormone replacement therapy, as follows:

Hormone replacement therapy in external dosage form

• Using a hormone patch is an easy and convenient method. Apply it on the back, lower abdomen, upper arm or thigh. However, using a hormone patch may cause skin allergies, so you should change the area where the patch is applied every day.
• Applying the gel is applied to the shoulders, armpits, upper arms, and thighs. This method takes a long time to absorb the hormones and may cause side effects such as headaches, insomnia,high blood pressure, mood swings , and more skin irritation than the sheet type. Therefore, you should avoid touching yourself and others. Do not shower and allow the gel to fully absorb into the skin after applying for several hours.
• Intranasal injection : The hormone must be injected into each nostril two times, three times a day.
• Gum patches are a method of giving hormone replacement therapy by inserting or applying a bitter-tasting gel patch to the gums above the front teeth. Gum patches can cause temporary gingivitis, toothache,dry mouth, mouth inflammation, and difficulty speaking.

Hormone replacement therapy in oral form

• Intramuscular injection is an effective, safe and inexpensive method. Hormones must be injected into the muscle every 2-4 weeks. Patients should see their doctor regularly to adjust the hormone levels in the body to the appropriate level.
• Testosterone implants are a method that can replace testosterone for several months, with maximum effectiveness of up to 6 months. The procedure involves implanting testosterone in pill form into the skin. However, this method can have side effects such as minor bleeding and scarring at the wound site.
• Hormone replacement therapy (HRT) is a cheap, oral, oral, or oral hormone replacement therapy. However, it requires the liver to process the hormones before they enter the bloodstream, which can damage the liver over time. It can also cause side effects, such as increased liver enzymes, acne, intoleranceto sugar, and men with breast cancer.

However, treatment of low male hormone levels by hormone replacement therapy may have side effects such as decreased sperm, enlarged prostate, swelling of  some parts of the body, heart failure, or men with breasts, sleep apnea, and blood clots in blood vessels, etc. In addition, hormone replacement therapy also increases the risk of prostate cancer and the risk of coronary heart disease.

In addition to hormone replacement therapy, doctors may treat low testosterone in other ways, including:

Treatment of Hypogonadism Caused by Tumors
If it is found that the cause of low testosterone is a tumor in the pituitary gland that is causing the abnormality, the doctor may need to treat with surgery, radiation therapy, or give the patient medication to eliminate or reduce the size of the tumor.

Treatment for infertility due to Hypogonadism:
Men who suffer from low testosterone and want to have children but are experiencing this condition which may cause infertility or sterility may need to rely on medical technology such as ICSI or Intracytoplasmic Sperm Injection, which involves removing a small piece of testicular tissue to examine and select good sperm to inject into the female egg to cause pregnancy.

Complications of Hypogonadism

Hypogonadism affects the body both externally and internally, and also affects the mind. If left untreated, it can lead to serious complications and other symptoms, as follows:

• Low libido
• Sensitive, depressed, and irritable, which are the effects of low testosterone.
• The condition of male breast development
• Affects feelings, may cause feelings of alienation, shame and lack of self-confidence.
• Social impairments occur due to one’s own physical condition, such as the body not developing like children of the same age, arms and legs not being in proportion to the body, or having a condition where men have breasts, etc.
• Loss of strength and muscle mass, fatigue
• Unable to enter puberty or enter puberty later than normal, and have defects in the development of the genitals and testicles, limbs are disproportionate to the body, and there is no body hair.
• Difficulty in having children
• Erectile dysfunction
• The fetus has ambiguous and abnormal genitals.
• Osteoporosis is a disease caused by loss of bone mass and minerals in the bones, causing the bones to become fragile and easily broken.
• If left untreated, this condition can lead to rheumatic diseases such as rheumatoid arthritis and lupus.

Hypogonadism Prevention

Hypogonadism is a condition that cannot be prevented. In some cases, it is caused by diseases or congenital defects. In cases of injuries from treatment or accidents, it is also unavoidable. However, people in general should always take care of their health in various ways, such as eating nutritious food, exercising appropriately, maintaining a healthy weight, and avoiding alcoholic beverages or taking certain medications. This is to maintain normal sex hormone levels and reduce the risk of low testosterone.

However, if hypogonadism occurs, patients should also take precautions to prevent other complications to avoid negative physical and mental effects, such as:

Prevent osteoporosis.
Hypogonadism in adults causes loss of bone mass and bone mineral density. Therefore, osteoporosis should be prevented by changing the way you eat, increasing your intake of calcium and vitamin D, which help build strong bones, and exercising appropriately and regularly.

Relieve stress
. Hypogonadism can cause stress to patients in both children and adults. Stress can have negative effects on the body and mind. People who experience stress from this condition should vent and release their thoughts and feelings through talking to people close to them, such as family, lovers, or friends. They should also consult a doctor to receive proper advice on managing their thoughts and living with this condition. They may also join a therapy group to meet people who face similar problems to exchange ideas and help relieve stress. In addition, after receiving physical treatment, the mind should also be treated. They should always adjust their mood and attitude to be good. When the body is healthy, it will make them feel better about themselves and have better mental health. This helps reduce emotional problems and increases confidence in socializing.

Maintaining a relationship
Erectile dysfunction, which may be caused by low testosterone, can have a significant impact on a relationship. Erectile dysfunction or premature ejaculation may prevent a person from being able to satisfy or provide sexual pleasure to their partner, which can lead to dissatisfaction and relationship problems. Therefore, it is important to understand and find ways to deal with this condition from the beginning. Initially, you should talk to your partner and make them understand the abnormality. Then, you may see a doctor to consult on a suitable solution or find ways to create other forms of pleasure to compensate for the lack of it. You should also maintain good physical and emotional health at all times, as this may help improve your relationship.

Family planning
Infertility is a major problem for couples who want to have children to create an ideal family. When faced with this condition, some couples may feel distressed and discouraged in their relationship. These feelings may lead to other family problems. However, there are many safe and modern medical technologies that can help conceive. Therefore, consulting a doctor may be the best option. However, if these methods do not help, you should find other options to help complete your family, such as raising animals or adopting children as appropriate. Also, understand the symptoms of this condition and your loved one to reduce stress and anxiety and help you happily adjust to this condition.