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.
Congenital and acquired hypogonadism occurs in both primary and secondary 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.

Symptomatology

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.

Гипогонадизм

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;
  • Osteoporosis.

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.

Diagnostics

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.

Laboratory research:

  • Hormone analysis: testosterone, LH, FSH, prolactin, estradiol, gonadoliberin (GnRH);
  • Spermogram.

Hypogonadism Treatment

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
Testosterone Depot
200-400 mg every 2-4 weeks
A mixture of testosterone esters Sustanol-250
Omnadren 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
Vistinon
Vistimon
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
Testoderm
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) gonadotropin Profazi (500, 1000, 2000, 5000 PIECES in 1 bottle) profasi
Rotten (100, 500, 1500, 3000 PIECES in 1 bottle) pregnil (6500 ЕД в 1 флаконе) Ovitrel * (6500 PIECES in 1 bottle) ovitrel

* Not reserved for use in men

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