Hypogonadism in men results from a systemic shortage of the primary male hormone, testosterone. It can definitely be treated by hormone replacement therapy. To understand how this shortage of testosterone occurs, you must first learn a little more about the function of the body’s master gland, the pituitary. The pituitary gland is located in the brain. It’s often referred to as the master gland. It instructs all the other organs what to do and when to do it. To do this, the pituitary sends out its own hormones, which act like chemical messengers to the target organs.
Primary and Secondary Hypogonadism
There are two main types of hypogonadism, primary and secondary. In the primary form, the testes themselves are malfunctioning. This can be caused by a number of things:
- Faulty genes
- Surgery and trauma
- Kidney and liver disease
When the cause is genetic, it’s usually due to Klinefelter’s syndrome. These men are born with an extra X chromosome. A normal male has XY sex chromosomes. A man with Klinefelter’s has XXY sex chromosomes. Unlike many other genetic diseases, this one isn’t inherited. Rather, it’s the result of a mutation, or genetic error, that happens soon after conception. Males with this syndrome may have enlarged breasts, less muscle and hair and extremely poor sperm production. Many Klinefelter’s syndrome males produce no sperm at all. Treatment includes testosterone replacement, but even with that, many afflicted men still have great difficulty with fathering a child. Another possible cause of primary hypogonadism is autoimmune disease. This means that the body is attacking its own cells. Autoimmune diseases take many forms. Most are poorly understood.
Secondary hypogonadism occurs when the pituitary fails to function properly. It doesn’t send out the appropriate signals to the testes to tell them to produce testosterone and sperm. Causes of this condition include:
- Certain drugs, especially opioids and steroids
- Too much iron
- Trauma, radiation and surgery
- Anorexia and drastic weight loss
- Pituitary tumors
Treatment of Hypogonadism
Secondary hypogonadism treatment is often focused on the pituitary. If it can be corrected, then it should begin to once again signal the testes to produce their own testosterone. If not, then testosterone replacement therapy may be necessary. Secondary hypothyroidism can also be treated with a class of drugs called SERMs. This stands for selective estrogen receptor modulator. This may help to raise systemic testosterone levels without the need for replacement therapy. SERMs do this by inducing the pituitary to produce more LH, or luteinizing hormone, and FSH, or follicle-stimulating hormone. Both of these act as signaling cues to the testes to produce more testosterone. Another class of drugs used to treat secondary hypogonadism is called aromatase inhibitors. Aromatase is an enzyme that helps to convert testosterone precursors into estrogens. When this enzyme is inhibited, more testosterone may be available, and the blood levels of this hormone rise.
As men age, particularly around the age of 40 or so, testosterone levels begin to steadily decline. This condition is sometimes called andropause, or more commonly, Low T. Low T is a normal part of aging and should not be confused with hypogonadism. For both hypogonadism and Low T, however, testosterone replacement therapy may be appropriate. Blood tests will reveal what the hormone levels are and how much they need to be corrected. Testosterone may be administered in several different ways:
- Skin gel
- Long-lasting injection
- Skin patch
Skin gels and patches applied to the skin are highly effective. Testosterone passes readily through the skin and into the bloodstream.
When hypogonadism is suspected, your physician will order some tests to determine exactly what is causing the problem. This may include blood tests for iron, testosterone and prolactin levels and to check for anemia. Expect a sperm count and thyroid function tests. If there is any suspicion about Klinefelter’s syndrome, your doctor may also order a karyotype. This is a study of the chromosomes. If Klinefelter’s syndrome is present, this test will reveal it.
If you’re wondering about testosterone replacement therapy for any reason, we can help you. We offer many different kinds of hormone replacement therapy. Call us at 205-352-9141. A member of our professional team will be happy to answer any questions you may have and set up an appointment for you if you wish. We look forward to hearing from you.