Hypogonadism is a syndrome in which insufficient production of sex hormones is disturbed or observed.
Depending on the level of damage, they distinguish:
- Primary (hypergonadotropic) hypogonadism
Primary (testicular) hypogonadism - occurs as a result of damage to the testicular tissue, which leads to impaired testicular function as the main organ responsible for the production of male sex hormones;
With primary hypogonadism by the feedback principle, there is an increase in the level of gonadotropic hormones (LH, FSH), therefore it is called hypergonadotropic hypogonadism.
- Secondary (hypogonadotropic) hypogonadism
Secondary (central, hypothalamic-pituitary) hypogonadism - a violation of the function of the gonads arises from a violation of the hypothalamic-pituitary system. This disrupts the production of hormones responsible for the synthesis of androgens by the testes.
With secondary hypogonadism, the levels of gonadotropic hormones are reduced, which leads to a decrease in the secretion of hormones by the testes, which is why it is called hypogonadotropic hypogonadism.
- Normogonadotropic hypogonadism
Normogonadotropic hypogonadism (hyperprolactinemic hypogonadism, hyperprolactinemia) is a violation of the hypothalamic-pituitary function, in which the level of gonadotropic hormones is normal, and the level of prolactin is elevated.
Recently, they also distinguish:
- Age-related hypogonadism associated with age-related androgen deficiency;
- Hypogonadism due to obesity.
Depending on the timing of occurrence, they distinguish:
- Congenital hypogonadism;
- Acquired hypogonadism.
Etiology and pathogenesis
The cause of primary hypogonadism may be:
- Congenital underdevelopment of the gonads (anorchism, monorchism, cryptorchidism);
- Chromosomal pathologies (Klinefelter syndrome, de la Chapelle syndrome, XYY syndrome);
- Injuries, diseases of the testicles;
- Endocrine diseases;
- Infectious diseases;
- Diseases of the liver, kidneys, lungs, gastrointestinal tract;
- Medicines, radiation, poisoning by toxic fumes.
The causes of secondary hypogonadism can be:
- Hereditary pathologies (Kalman syndrome, Lawrence – Moon – Barde – Beadl syndrome, Prader – Willi syndrome);
- Tumor processes;
- Post-traumatic changes;
- Systemic diseases.
Regardless of the causes of the development of the pathology, a marked decrease in androgens in the patient’s blood is observed.
Symptoms of hypogonadism strongly depend on the timing of its occurrence, in connection with which they distinguish pre-puberty (before puberty of the boy (11-12 years)) and post-puberty forms of hypogonadism.
Features of the symptoms of pre-puberty form of hypogonadism:
- Eunuchoidism (high growth, long limbs, lack of pronounced muscle mass, high voice);
- Lack of secondary sexual characteristics (enhanced hair on the body and face, the presence of muscle mass, low voice, etc.);
- Underdevelopment of the genitals;
Features of the symptoms of the post-puberty form of hypogonadism:
- The presence of symptoms of androgen deficiency against the background of normal sizes of the genitals (see normal penis size and testicular size );
- The main complaints: decreased sexual desire and impaired sexual function.
General symptoms of hypogonadism, characteristic of pre-pubertal and post-puberty forms of hypogonadism:
- Decrease in muscle mass;
- Pubic hair on the female type;
- Deposition of excess adipose tissue;
- Mood decline, depressive states;
- Violation of lipid and carbohydrate metabolism;
- Cognitive impairment (decreased mental ability and memory, loss of concentration, etc.);
- Vegetative-vascular disorders;
- Testicular contraction.
General examination includes:
- Determining the nature of pubic hair. With severe hypogonadism in men, pubic hair growth is typical for the female type (there is a horizontal line of hair growth);
- Determining the nature of secondary sexual characteristics (body hair and face, the presence of muscle mass, etc.);
- Measurement of the difference between the width of the shoulders and pelvis. For measurements, a measuring tape is used, the readings of which are compared to each other - normally the width of the shoulders should be 10-12 cm greater than the width of the pelvis;
- Determination of waist circumference and body mass index;
- Assessment of genital development. Includes measurement of the penis (in an erect and / or relaxed stretched state), palpation and measurement of testicular volume (ochidometer);
- Determining the presence of gynecomastia in a patient.
- Hormone analysis: testosterone, LH, FSH, prolactin, estradiol, gonadoliberin (GnRH);
Regardless of the etiology of the disease, in each case, hormone therapy is prescribed.
Primary Hypogonadism Treatment
The only possible treatment is therapy with exogenous hormonal drugs (Table 1).
Table 1 - Exogenous testosterone preparations (S. Yu. Kalinchenko, I. A. Tyuzikov, 2009)
|GROUP OF DRUGS||CHEMICAL NAME||TRADENAME||DOSAGE|
|Injection Forms||Testosterone cypionate||Depot Testosterone Cypionate||200-400 mg every 3-4 weeks|
|Testosterone enanthate|| Delasteryl |
|200-400 mg every 2-4 weeks|
|A mixture of testosterone esters|| Sustanol-250 |
|250 mg every 2–3 weeks|
|Testosterone undecanoate||Nebido||1000 mg once every 3 months|
|Oral form||Fluoxymesterone *||Halotestin||5-20 mg daily|
|Methyltestosterone *||Metadren||10-30 mg daily|
|Testosterone undecanoate||Andriol||120-200 mg daily|
|Mesterolone ***|| Proviron |
|25-75 mg daily|
|Buccal pills||Striant||30 mg 3 times a day|
|Subcutaneous forms||Implants||Testosterone implants||1200 mg every 6 months|
|Transdermal forms||Testosterone gel||Androgel||25-75-100 mg daily|
|Patches with testosterone (scrotal and cutaneous) **|| Androderm |
|2.5-7.5 mg daily|
|Testosterone cream||Andromen||10-15 mg daily|
|Dihydrotestosterone Gel (DHT Gel)||Andraktim||Individually|
Notes: * - hepatoxic and banned in a number of countries; ** - not registered in Russia; *** - discontinued.
Treatment of secondary hypogonadism:
- therapy with exogenous hormonal drugs;
- stimulating therapy with chorionic gonadotropin (CG).
Stimulant therapy of CG is aimed at stimulating the production of testosterone and spermatogenesis. Conducting stimulating therapy is considered possible if, after three-day injections of CG at a dose of 1500-2000 PIECES, the level of initial testosterone in a patient increases by 50-60%.
CG products: Chorionic gonadotropin , Bigonadil, Horagon, Putril, Profazi, Ovitrel, Luveris.
|DRUGS OF CHORIONIC GONADOTROPINE|
|Chorionic gonadotropin (500, 1000, 5000 PIECES in 1 bottle)||Profazi (500, 1000, 2000, 5000 PIECES in 1 bottle)|
|Rotten (100, 500, 1500, 3000 PIECES in 1 bottle)||(6500 ЕД в 1 флаконе) Ovitrel * (6500 PIECES in 1 bottle)|
* Not reserved for use in men