Hypogonadism is a syndrome in which insufficient production of sex hormones is observed or observed.
Depending on the level of damage, there are:
- Primary (hypergonadotropic) hypogonadism
Primary (testicular) hypogonadism - arises from the defeat of testicular tissue, which leads to dysfunction of the testes as the main organ responsible for the production of male sex hormones;
In primary hypogonadism on the basis of feedback, there is an increase in the level of gonadotropic hormones (LH, FSH), so it is called hypergonadotropic hypogonadism.
- Secondary (hypogonadotropic) hypogonadism
Secondary (central, hypothalamic-pituitary) hypogonadism is a dysfunction of the sex glands due to a violation of the hypothalamic-pituitary system. This disrupts the production of hormones responsible for the synthesis of androgens by the testes.
When secondary hypogonadism levels of gonadotropic hormones are reduced, which leads to a decrease in secretion of hormones by the testes, therefore, 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, also emit:
- Age-related hypogonadism associated with age-related androgen deficiency;
- Hypogonadism, due to obesity.
Depending on the timing of occurrence are distinguished:
- Congenital hypogonadism;
- Acquired hypogonadism.
Etiology and pathogenesis
The cause of primary hypogonadism can be:
- Congenital hypoplasia of the gonads (anorchism, monorhism, cryptorchidism);
- Chromosomal pathologies (Klinefelter syndrome, de la Chapelle syndrome, XYY syndrome);
- Injuries, diseases of the testes;
- Endocrine diseases;
- Infectious diseases;
- Diseases of the liver, kidneys, lungs, gastrointestinal tract;
- Medicines, radiation, poisoning with poisonous fumes.
The causes of secondary hypogonadism can be:
- Hereditary pathologies (Kalman syndrome, Lawrence – Moon – Bardé – Beadle syndrome, Prader’s – Willi syndrome);
- Tumor processes;
- Post-traumatic changes;
- Systemic diseases.
Regardless of the causes of the development of pathology, a marked decrease in the androgens in the patient's blood is observed.
Symptoms of hypogonadism strongly depend on the timing of its occurrence, in connection with which there are pre-pubertal (before puberty boy (11-12 years)) and post-pubertal forms of hypogonadism.
Symptoms of the pre-pubertal form of hypogonadism:
- Eunuchoidism (tall, long limbs, lack of pronounced muscle mass, high voice);
- The absence of secondary sexual characteristics (increased hair on the body and face, the presence of muscle mass, low voice, etc.);
- Underdevelopment of the genitals;
Symptoms of post-pubertal form of hypogonadism:
- The presence of symptoms of androgen deficiency on the background of the normal size of the genital organs (see the normal size of the penis and the size of the testicles );
- Main complaints: decreased sexual desire and impaired sexual function.
General symptoms of hypogonadism, characteristic of the pre-pubertal and postpubertal forms of hypogonadism:
- Decrease in muscle mass;
- Hair pubic on the female type;
- The deposition of excess fat tissue;
- Mood decline, depressive states;
- Violation of lipid and carbohydrate metabolism;
- Cognitive impairment (loss of mental ability and memory, loss of concentration, etc.);
- Vegetative-vascular disorders;
- Decreased testicles.
General examination includes:
- Determining the nature of pubic hair distribution. With marked hypogonadism in men, pubic hair growth is characterized by a female type (there is a horizontal hairline);
- Determining the nature of secondary sexual characteristics (body hair and face, the presence of muscle mass, etc.);
- Measure the difference between the width of the shoulders and the 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;
- Evaluation of the development of genitals. Includes penile measurement (in the erect and / or relaxed stretched state), palpation and measurement of the volume of the testicles (ophidometer);
- Determining whether a patient has gynecomastia.
- Analysis of hormones: testosterone, LH, FSH, prolactin, estradiol, GnRH (GnRH);
Regardless of the etiology of the disease, hormone therapy is prescribed in each case.
Treatment of primary hypogonadism
The only possible treatment is therapy with exogenous hormonal drugs (Table 1).
Table 1 - Exogenous testosterone preparations (S. Yu. Kalinchenko, I. A. Tyuzikov, 2009)
|PREPARATION GROUP||CHEMICAL NAME||TRADENAME||DOSAGE|
|Injection forms||Testosterone Cypionate||Depot Testosterone Cypionate||200-400 mg every 3-4 weeks|
|Testosterone Enanthate|| Delasteril |
|200-400 mg every 2-4 weeks|
|Testosterone Ester Blend|| Sustanol-250 |
|250 mg every 2-3 weeks|
|Testosterone Undecanoate||Nebido||1000 mg 1 time in 3 months|
|Oral form||Fluoxymesterone *||Halotestin||5-20 mg daily|
|Methyltestosterone *||Methadren||10-30 mg daily|
|Testosterone Undecanoate||Andriol||120-200 mg daily|
|Mesterolon ***|| Proviron |
|25-75 mg daily|
|Buccal tablets||Striant||30 mg 3 times a day|
|Subcutaneous form||Implants||Testosterone implants||1200 mg every 6 months|
|Transdermal forms||Testosterone gel||Androgel||25-75-100 mg daily|
|Testosterone plasters (scrotal and cutaneous) **|| Androderm |
|2.5-7.5 mg daily|
|Testosterone cream||Andromene||10-15 mg daily|
Notes: * - hepatoxic and in some countries prohibited; ** - not registered in Russia; *** - discontinued.
Treatment of secondary hypogonadism:
- therapy with exogenous hormonal drugs;
- stimulating therapy of chorionic gonadotropin (CG).
Stimulating therapy of chronic hepatitis is aimed at stimulating the production of testosterone and spermatogenesis. Conducting stimulating therapy is considered possible if, after a three-day injection of CG in a dose of 1500-2000 IU, the level of the initial testosterone in a patient increases by 50-60%.
Preparations of CG: Chorionic gonadotropin , Bigonadil, Horagon, Pregnil, Profazi, Ovitrel, Louveris.
|PREPARATIONS OF HORIONIC GONADOTROPIN|
|Chorionic gonadotropin (500, 1000, 5000 IU in 1 bottle)||Profazi (500, 1000, 2000, 5000 IU in 1 bottle)|
|Pregnancy (100, 500, 1500, 3000 IU in 1 bottle)||(6500 ЕД в 1 флаконе) Ovitrel * (6500 IU in 1 bottle)|
* Not approved for use in men.