Hypogonadism in men: primary and secondary, types and treatment

Very few people think about the huge role hormones play in our body. The endocrine system is second only to the nervous system in importance; it is responsible for the normal functioning of the whole body, including the continuation of the species. With her pathology, diseases such as diabetes mellitus, gigantism, hypothyroidism and even hypogonadism are observed.

What is hypogonadism in men?

Hypogonadism syndrome refers to the underdevelopment of the gonads or a decrease in their function. Basically, its pathogenesis is characterized by a decrease in the production of male steroids, signs of infantilism appear, that is, there is a reverse development from a man to a boy, due to a decrease in the level of testosterone in the body.

IMPORTANT: the concentration of androgens depends not only on the normal state of the organs directly producing it - the testes, but also on the endocrine system located in the brain. According to the International Classification of Diseases 10 revision (ICD 10), hypogonadism can be assigned the E29 code if it is associated with testicular dysfunction and E23 if it is a consequence of the pituitary gland pathology.

Views

There are many disorders that lead to the described symptom complex, however, for convenience, it is classified into 3 main types.

Hypergonadotropic hypogonadism

Caused by damage to the hypothalamic-pituitary system, which dominates the rest of the endocrine glands. That is, in fact, she is responsible for the production of absolutely all hormones in our body and the vitality of a person depends on her work.

The hypothalamus controls the pituitary gland, and the second synthesizes gonadotropins: follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which regulate the entire activity of the reproductive system. With this hypogonadism, excessive or improper production of these hormones occurs.

Normogonadotropic hypogonadism

This type differs from the previous one in that the pituitary gland works normally, but the problem arises directly in the gonads

Hypogonadotropic hypogonadism

It is characterized by a decrease in the secretory function of the dominant endocrine system - the synthesis of gonadotropins in the structures of the brain decreases, which entails underdevelopment of the testicles and, as a result, a decrease in the production of steroids.

Reasons

Many researchers divide the causes of hypogonadism into two large groups.

Congenital (primary):

• complete absence of testicles;
• keeping them out of the scrotum;
• Klinefelter syndrome (extra X chromosome in males, formula 47, XXY);
• Heller-Nelson syndrome (abnormal development of Leydig cells in the testes, which leads to a decrease in testosterone production);
• de la Chapelle disease (violation of the divergence of sex chromosomes, as a result of which a person looks like a man, but has a female set of chromosomes 46, XX);
• Morris symptom complex (complete insensitivity of receptors in the body to androgens) and Reifenstein syndrome (partial insensitivity);
• Jacobs syndrome (47, XYY);
• myotonic dystrophy (a genetic disorder characterized by weakness of the muscles of the face and arms, as well as changes in the thyroid, pancreas and gonads);
• Del Castillo's disease (during development, the primary cells of the gonads are not laid in the womb);
• underdevelopment of Leydig cells and, as a result, insufficient production of the main male hormone;
• Kallman syndrome (hereditary decrease in the production of FSH and LH);
• adrenogenital symptom complex (genetic deficiency of the enzyme that forms steroids).

Purchased (secondary):

• castration;
• bilateral atrophy, that is, a decrease in volume and loss of function;
• excess estrogens inhibit FSH synthesis through a feedback mechanism;
• orchitis;
• exposure to radiation;
• strokes in the pituitary gland;
• tumors of the hypothalamus, pituitary gland or testicles;
• injury;
• slowing down the breakdown of estrogen;
• uncontrolled use of drugs (cytostatics);
• hyperprolactinemic symptom complex (sustained increase in prolactin, which inhibits the secretion of testosterone);
• for chronic renal failure;
• with cirrhosis of the liver;
• for anorexia nervosa;
• for other endocrinological diseases (diabetes, thyrotoxicosis, etc.);
• for injuries of the lumbar spine with spinal cord injury;
• age-related androgenic deficiency in men.

Symptoms and signs

Testosterone and gonadotropins affect not only the reproductive system, but also the musculoskeletal system.Accordingly, if pituitary hypogonadism is congenital or acquired during sexual maturation, then there are changes in the normality of proportions.

A eunuch-shaped skeleton is being formed: tall and long limbs. Bones become thin and fragile. Skeletal muscles are poorly expressed, fat is deposited on the thighs and buttocks (female type). There are no changes in the larynx, the voice remains high, like that of a child. Beard, mustache, pubic hair and armpits are poorly expressed. The genitals are reduced, the penis is small, there are no folds on the scrotum, there are no morning emissions and erection. Obesity and gynecomastia (benign enlargement of the mammary glands in men) are common.

If hypogonadism began to progress in adulthood, then changes are observed mainly in the reproductive system:

• increasing impotence;
• disappearance of adequate and spontaneous erections;
• testicular shrinkage.

Hair on the face, armpits and groin stops growing. Sexual attraction weakens, however, does not disappear altogether. Very often, such men suffer from depression, neuroses, and frequent mood swings appear. Gynecomastia can also form.

Diagnosis of hypogonadism in men

The diagnosis by the attending physician is based on the medical history, examination and palpation of the genitals. The first step is to analyze the hormonal background and identify indicators of FSH, LT, prolactin, estrogens. All species are characterized by a decrease in serum testosterone levels. The average indicator of its norm for adult men is 12-33 nmol / l.

However, in rare cases, testosterone values are within normal limits, while the content of sex-hormone-binding protein in the blood increases.

Spermogram is another necessary examination to fully understand the patient's androgenic status. For congenital forms, diagnosis includes the detection of genetic abnormalities by DNA screening using the polymerase chain reaction (PCR) method. If the cause cannot be found, then an MRI of the brain and a biopsy of the testicular tissue are necessary to exclude pituitary tumors.

Treatment

The main approach is the use of testosterone replacement therapy: Mesterolone, T-cyclodextrin, Andractim. Since androgens have a provocative effect on the formation of benign prostatic hyperplasia, before prescribing them, it is necessary to conduct a digital examination and ultrasound diagnostics to exclude the possibility of its development.

The timing of treatment with testosterone drugs is finally determined only by the attending physician based on analyzes and the clinical course of the disease. In the absence of contraindications and good tolerance, the treatment of hypogonadism in men can be continued for several years, in the future it is possible to repeat the courses.

With a hypogonadotropic form, stimulating therapy with human chorionic gonadotropin (hCG) and its preparations (Choriogonin, Horagon) is carried out. Medicines are administered 2 times a week by intramuscular injections. The course is 1 month, with monthly breaks, constantly, under the control of testosterone levels. If it returns to normal, a maintenance dose of up to 75 U is prescribed.

In some cases, the clinical recommendation is testicular transplantation. If a tumor is detected, surgical intervention is used to remove it. If the cause of the disease is inflammatory processes in the testes, then orchitis is treated with antibiotics, non-steroidal anti-inflammatory drugs.

It is imperative to treat the primary disease that led to this syndrome (cirrhosis of the liver, chronic renal failure, etc.).

Aftermath

Testosterone is the most important hormone in the male body, it is responsible for the transformation of a boy into a real man. It is he who determines sexual desire and behavior, therefore, with its lack, frigidity will be expressed. However, its main function is to participate in the formation and maturation of spermatids.

He is responsible not only for the quantitative composition of the semen, but also for the quality and motility of sperm. The worst consequences of hypogonadism are complete impotence and infertility. The imbalance in hormonal balance affects not only sexual and reproductive function, but also leads to serious mental illness.

Prevention of hypogonadism

All men need to be regularly examined so as not to miss the tumor and inflammatory processes of the genitourinary and endocrine systems. After all, even a general blood test taken during a routine examination will help, in which case, early to suspect some kind of violation. Particular attention should be paid to the health of boys in puberty, since it is at this age that the musculoskeletal system is formed.

Do not get carried away with anabolic steroids, since synthetic androgens, which enter our body from the outside, inhibit the production of their own. Problems begin to appear after the cessation of testosterone use, because there is a "withdrawal syndrome" when their own steroids have not yet begun to be synthesized, since it takes at least several months to normalize this process. In this regard, there will be signs of hypogonadism.

And of course, you should adhere to a healthy lifestyle, choose your partner responsibly, get enough physical activity and eat right.