What is hypogonadism ?



Hypogonadism is a name given to a condition where the gonadal organs (testes in men and ovaries in women) do not function in the correct manner.

 

Normally the testes will produce testosterone and the ovaries will produce oestrogen and progesterone. These hormones are required both for fertility and for a wide range of other functions around the body including the development of the secondary sexual characteristics normally seen in puberty. In hypogonadism these hormones are not produced at their usual levels or not at all.



 

Hypogonadism can be classed as primary or secondary.

 

 




Primary hypogonadism:

This is the most common type of hypogonadism. In this type the cause of the problem are the testes or ovaries directly. Usually they have functioned correctly in the past but have since stopped working correctly at some stage during life.

There are a wide number of reasons for the testes or ovaries to stop functioning correctly and your doctor will have to determine the exact cause.

Common reasons include:

Old age

Exposure to heat or ionizing radiation

Certain medications

Smoking

Alcohol

Liver or kidney problems

Physical damage to testes

Certain viral conditions such as mumps

 

Symptoms of primary hypogonadism vary a lot in adults, but fatigue and weakness are common. In men loss of sexual potency and libido are also common.

These symptoms need to be investigated by a doctor to determine the underlying cause of the drop in hormone production. The hypogonadism can, in most cases be treated with hormone replacement therapy.

 



Secondary hypogonadism:

 

Secondary hypogonadism is a lot rarer. In this type the problem lies elsewhere than the testes or ovaries.

In most cases the testes and ovaries would function correctly if they had received the correct hormone signals from the brain.

A person with secondary hypogonadism will not start puberty or will not finish it completely.

Secondary hypogonadal conditions are also known as hypogonadotrophic hypogonadism. 

This term indicates that the problem lies with the hormone signals from the pituitary and hypothalamus glands within the brain and not with the testes or ovaries.

Kallmann's syndrome and idiopathic hypogonadotrophic hypogonadism are both secondary hypogonadism conditions.

There are some even rarer conditions that also fall into this category. This is why any case of delayed puberty should be investigated by a specialist endocrinologist in order to discover the true cause of delayed puberty.



There are genetic conditions such as Turner's syndrome and Kleinfelter's syndrome which are more common than Kallmann's syndrome. These are classed as hypergonadotrophic hypogonadisms.

Gonadotrophin: a hormone produced by the pituitary gland to stimulate the tests or ovaries to produce the sex hormones. The two gonadotrophins are called follicle stimulating hormone (FSH) and luteinising hormone (LH).

Hypo: below or low

Hyper: above or high

 

Hypogonadotrophic: the levels of LH or FSH are lower than normally expected, due usually to lack of hormone signals from the hypothalamus gland. In as lot of cases the testes and ovaries would be able to functionally normally, but are unable to do so without the correct hormonal signal from the pituitary.

Hypergonadotrophic: the levels of LH and FSH are higher than normal, usually due to the lack of sex hormones being produced. This is usually due to some sort of problem with the development of the testes or ovaries. Normally the sex hormones provide a 'negative feedback' to the pituitary to allow it only to release its hormones when required. Without the production of sex hormones the pituitary does not know when to stop producing FSH or LH, so the levels go up above expected levels.