Hypogonadism

What is secondary hypogonadism?

Lack of gonadal hormones (Testorterone in men and Oestrogen in women) is called Hypogonadism and when this happens due to lack of Pituitary hormone it is called secondary Hypogonadism. Normally two Pituitary hormones known as LH and FSH are responsible for stimulating Testes and Ovarian in men a and women respectively.

Flow chart for Diagnosis of Hypogonadism in men

pituitary-7

What are the symptoms ?

Menstrual irregularities, vaginal dryness, loss of libido, infertility in women & impotence , loss of secondary sexual characterstics & infertility in men are the common symptoms.

What are the causes?

  1. Idiopathic
  2. Functional
    Too vigorous Exercise
    Weight changes at both ends
    Stress
    Severe Systemic illness
  3. Structural
    Pituitary tumour
    Head trauma
    Radiotherapy

pituitary-8

Absence of secondary sexual characterstisc

What are the clinical features?

In men

Symptoms

  • Physical fatigue
  • Depression & Irritability
  • Lethargy
  • Impotence
  • Loss of libido
  • Muscular weakness
  • Decreased shaving frequency
  • Failure to progress through puberty

Signs

  • Loss of body, facial and pubic hair
  • Increased breast tissue (gynaecomastia)
  • Smooth, fine wrinkly skin, especially on the face
  • Reduced testicular size

Long Term Risk

Osteoporosis can occur, leading to increased risk of hip and spine fractures, if no treatment is given.

In women

  • Absence of secondary sexual characterstics
  • Amennorrhoea

What are the investigations required?

  • Blood Investigations
    • LH, FSH, Prolactin
    • Testosterone/ Estradiol
  • Imaging
    • Ultra Sound
    • MR scan
  • Gene studies

What are the treatment options ?

For men

Preparation Dose Advantage Problems
IM Testosterone 250mg 2/3 weeks 2/3 weekly dosageEffective IM inj
Wide variations in levels ass. With symptoms
Implants 200-600mg 3-6 mths Physiological levels acheived · Minor surg.procedure
· Risk of infection & pellet extrusion
TransdermalNon-scrotal 2.5-7.5 mg daily Physiological levels acheived Skin reactions
Oral 40 mg TDS25 mg TDS Oral preaparation · Highly variable efficacy
· Rarely acheives therapeutic levels
TransdermalScrotal 4-6 mg daily Physiological levels acheived · Multiple dosing
· Supraphysiological levels
· Ass. with BPH
· Unacceptability of wearing patch

Gonadotrophin replacement is only needed if the person wishes to have a child. Gonadotrophin injections are given until sufficient sperm is present in the ejaculate, which may take up to two years. Sperm can also be frozen for future use.

For women

  • Cyclical estrogen progesterone preparations
  • Gonadotrophin preparations

This article is prepared along with Dr Menaka