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
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?
- Idiopathic
- Functional
Too vigorous Exercise
Weight changes at both ends
Stress
Severe Systemic illness - Structural
Pituitary tumour
Head trauma
Radiotherapy
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