is when the sex glands produce little or no hormones. In men, these
glands (gonads) are the testes; in women, they are the ovaries.
Causes, incidence, and risk factors
cause of hypogonadism may be "primary" or "central." In primary
hypogonadism, the ovaries or testes themselves do not function properly.
Some causes of primary hypogonadism include:
- Certain autoimmune disorders
- Genetic and developmental disorders
- Liver and kidney disease
The most common genetic disorders that cause primary hypogonadism are Turner syndrome
(in women) and Klinefelter syndrome
central hypogonadism, the centers in the brain that control the gonads
(hypothalamus and pituitary) do not function properly. Some causes of
central hypogonadism include:
- Certain medications, including steroids and opiates
- Genetic problems
- Nutritional deficiencies
- Iron excess(hemochromatosis)
- Rapid, significant weight loss
A genetic cause of central hypogonadism that also takes away the sense of smell is Kallmann syndrome
(males). The most common tumors affecting the pituitary are craniopharyngioma
(in children) and prolactinoma
who have hypogonadism during childhood will not begin menstruating. The
condition can affect girls' breast development and height. If
hypogonadism occurs after puberty, symptoms include:
- Hot flashes
- Loss of body hair
- Low libido
- Menstruation stops
boys, hypogonadism in childhood affects muscle and beard development
and leads to growth problems. In men the usual symptoms are:
- Breast enlargement
- Decreased beard and body hair
- Muscle loss
- Sexual problems
If a brain tumor is present (central hypogonadism), there may be:
- Headaches or vision loss
- Milky breast discharge (from a prolactinoma)
- Symptoms of other hormonal deficiencies (such as hypothyroidism)
People with anorexia nervosa
(who diet to the point of starvation) and those who lose a lot of weight very quickly (such as after gastric bypass surgery
) also may have central hypogonadism.
Signs and tests
Tests may be done that check:
Other tests may include:
Sometimes imaging tests are needed, such as a sonogram
of the ovaries. If pituitary disease is suspected, an MRI
or CT scan of the brain
may be done.
Hormone-based medicines are available for men and women. Estrogen
comes in the form of a patch or pill. Testosterone
can be given using a patch, a product soaked in by the gums, a gel, or by injection.
For women who have not had their uterus removed, combination treatment with estrogen
is often recommended to decrease the chances of developing endometrial cancer
. Women with hypogonadism who have a low sex drive can also take low-dose testosterone
some women, injections or pills can be used to stimulate ovulation.
Injections of pituitary hormone may be used to help male patients
produce sperm. Other people may need surgery and radiation therapy.
Expectations (prognosis)Many forms of hypogonadism are treatable and have a good outlook.
In women, hypogonadism may cause infertility
Menopause is a form of hypogonadism that occurs naturally and can cause
hot flashes, vaginal dryness, and irritability as a woman's estrogen
levels fall. The risk of osteoporosis
and heart disease increase after menopause.
Some women with hypogonadism take estrogen therapy
especially those who have early menopause (premature ovarian failure).
However, there is a small but significant increase in risk for breast
cancer and possibly heart disease when hormone therapy is used to treat
In men, hypogonadism results in loss of sex drive and may cause:
Men normally have lower testosterone
as they age, but the decline is not as dramatic or steep as the decline in sex hormones that women experience.
Calling your health care provider
Talk to your doctor if you notice:
- Breast discharge
- Breast enlargement (men)
- Hot flashes (women)
- Loss of body hair
- Loss of menstrual period
- Problems getting pregnant
- Problems with your sex drive
Both men and women should call their health care provider if they have headaches or vision problems.
Maintain normal body weight and healthy eating habits to prevent anorexia nervosa. Other causes may not be preventable.