Hypogonadism (Decreased Testosterone)

Definition

Hypogonadism is defined as little or no secretion of sex gland hormones. In men, this is essentially a failure of the testes to secrete the male hormone testosterone that is responsible for male development including sexual maturation at the time of puberty and becoming fertile due to sperm production in the testes. Primary hypogonadism indicates that the male has never produced testosterone to provide normal blood levels. This might be due to genetic abnormalities such as Klinefelter’s syndrome. Besides genetic causes, other factors that contribute to secondary hypogonadism include tumors, surgery, radiation exposure, infections, trauma/ bleeding, nutritional deficiencies, or iron excess (iron deposits in the liver known as hemochromatosis). Testosterone production in the testes depends upon the production of Leutinizing Hormone (LH) which is secreted from the pituitary gland. When testosterone blood levels are low, LH secretion increases leading to increased testosterone production. When serum levels of testosterone reach normal levels, LH production decreases.

Diagnosis

History and physical exam may suggest the diagnosis, but ultimately blood is analyzed for levels of testosterone to determine if testosterone is normal or low. If the testosterone is low, the pituitary gland function must be tested to distinguish between low testosterone in the testes (hypogonadism) v. low LH production in the pituitary gland (hypogonadotrophic hypogonadism).

Treatment

In men who no longer care to father (more) children, low testosterone can be treated with either testosterone injection (depo testosterone injection every 3 weeks) or topical testosterone (patches or lotion which provides testosterone on a daily basis avoiding the dramatic swings in behavior that may accompany testosterone injection therapy). In men who desire children, neither injection nor topical applications of testosterone are appropriate, as these treatments will suppress sperm production. Testicular production of testosterone must be achieved for fertility, and this is best accomplished by simulating the LH production of the pituitary gland by injecting an LH substitute.

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