Male Hypogonadism

What is Male Hypogonadism?

In clinical practice, various terms are used to describe the different disorders that may arise with the gonads: Hypogonadism is the state resulting from defective and deficient production of male hormone (the androgen named testosterone).

Infertility or sterility means a failure of sperm production (or spermatogenesis, to use the technical term).

Eunuch is an anatomically castrated male (the testes have been removed). Eunuehoid means a male who retains his testes but exhibits the characteristics of reduced gonadal (testicular) activity. Infertility is a usual consequence. The male may have been born with a developmental disorder of the gonads, and several rare conditions have this feature (such as Klinefelter’s syndrome and others).

In others it may have become acquired, either through accident, bilateral mumps, torsion of the testis, or cutting off the blood supply and so causing permanent damage to the structure. X-ray irradiation may have been the cause, and many other probable reasons exist.

On the other hand, the pituitary gland may have been defective in its production of the gonadotrophic hormones leading to maldevelopment. Often this is in association with other hormonal defects.

Male Hypogonadism Symptoms

These will depend on the age at onset and the degree of hormonal deficiency. It is rarely recognized in puberty, when the normal secondary sexual characteristics will fail to take place. Often parents will complain about the failure of the lad’s genitals to develop. The voice stays high-pitched, pubic hair is lacking, and facial fair deficient. A slender, poorly developed young man presents. There is a lack of drive and aggressiveness. Libido and erections are either markedly reduced or totally lacking.

If hormonal reduction takes place after puberty, symptoms are less noticeable. However facial and body hair become sparse, the skin is delicate and sallow. Libido is reduced impotence and erections are often reduced or absent.

Male Hypogonadism Treatment

In some instances there may be an underlying condition that may be corrected, such as hypothyroidism (correctable by oral medication) or a pituitary tumor that may be amenable to surgical correction. Sometimes regular injections of gonadotrophins may assist.

Generally, replacement therapy with androgens is the treatment of choice, and testosterone by long-acting intramuscular injection may be dramatic. Once virilization has been established, the patient may be maintained on oral therapy of methyltestosterone —sucked under the tongue, from whence it is readily absorbed. Other synthetic hormones may be used, depending on the decision of the doctor or clinic.

“Androgen therapy causes a striking improvement,” Price states, “in physical, sexual and mental development. However, permanent infertility must be expected.”