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Hypogonadism
Hypogonadism is a condition characterised by the body’s inability to produce adequate amounts of sex hormones. In males, this predominantly pertains to testosterone, while in females, it relates to oestrogen and progesterone. These hormones play a role in sexual development and reproduction.
Hypogonadism can manifest at any stage in life, from fetal development to puberty or adulthood.
Dr Daphne Lee
MBBS
MRCP(UK)
FAMS
Types of Hypogonadism
Hypogonadism can be classified into two main types, each with distinct pathophysiological mechanisms and clinical implications.
Primary Hypogonadism (Hypergonadotropic Hypogonadism)
This type is marked by an issue in the gonads themselves, leading to inadequate hormone production. The brain responds to this deficiency by increasing the levels of stimulating hormones. Elevated levels of gonadotropins, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), are typically observed.
Secondary Hypogonadism (Hypogonadotropic Hypogonadism)
In secondary hypogonadism, the problem originates in the brain, specifically the hypothalamus or the pituitary gland. This leads to reduced or inappropriate secretion of the hormones that stimulate the gonads. Lower than normal levels of LH and FSH, despite insufficient sex hormone levels, may indicate secondary hypogonadism.
Symptoms
The symptoms of hypogonadism can vary depending on the age of onset, the severity of hormone deficiency, and whether the condition is primary or secondary.
In Adults
- Reduced Libido: A noticeable decrease in sexual desire is often one of the earliest signs of hypogonadism.
- Erectile Dysfunction: In males, the inability to achieve or maintain an erection can be a symptom.
- Menstrual Irregularities: In females, hypogonadism may lead to irregular menstrual cycles or amenorrhea.
- Muscle Weakness and Loss of Bone Mass: A deficiency in sex hormones can lead to decreased muscle strength and osteoporosis.
In Adolescents
- Delayed Puberty: Lack of development of secondary sexual characteristics, such as breast development in females and testicular enlargement in males, can indicate hypogonadism.
- Growth Impairment: Hypogonadism in adolescents can result in short stature due to the delayed onset of puberty.
General Symptoms
- Fatigue: Persistent tiredness and lack of energy are common complaints.
- Mood Changes: Fluctuations in mood, including increased irritability or depression, can be associated with hormonal imbalances.
- Hot Flashes and Sweating: Similar to menopausal symptoms, these can occur in both males and females.
Causes
The causes of hypogonadism can be broadly categorised into primary and secondary types, each associated with distinct endocrine-related abnormalities.
Primary Hypogonadism
- Genetic Disorders: Conditions like Klinefelter syndrome in males, where an extra X chromosome leads to the underdevelopment of testes, can lead to reduced testosterone production.
- Autoimmune Disorders: Diseases where the immune system mistakenly attacks the gonads can lead to reduced hormone production.
- Infections: Certain infections, notably mumps, can affect the gonads and impair their ability to produce hormones.
Secondary Hypogonadism
- Pituitary Disorders: Tumours or other abnormalities in the pituitary gland can impede the production of gonadotropins, which help stimulate the gonads.
- Hypothalamic Dysfunction: Conditions that impact the hypothalamus can disrupt the release of gonadotropin-releasing hormone (GnRH). This is necessary for the normal functioning of the pituitary-gonadal axis.
- Medications and Unhealthy Lifestyle Choices: Certain medications, excessive alcohol use, and obesity can also affect the hypothalamus or pituitary gland function, leading to secondary hypogonadism.
Complications
Hypogonadism, if left untreated, can lead to complications affecting aspects of health and well-being.
- Osteoporosis: Reduced sex hormone levels, particularly testosterone and oestrogen, are closely linked to bone density. Hypogonadism can lead to weakened bones or osteoporosis, increasing the risk of fractures.
- Infertility: Hypogonadism can impact fertility. In males, low testosterone levels can lead to reduced sperm production. In females, inadequate oestrogen levels can disrupt the menstrual cycle, affecting ovulation.
- Cardiovascular Diseases: Hypogonadism is a risk factor for many cardiovascular diseases. In males, low testosterone levels may be associated with cardiovascular risks.
- Sexual Health Issues: In males, hypogonadism can lead to erectile dysfunction, reduced libido, and other sexual health challenges. In females, it can cause vaginal dryness, hot flashes, and reduced sexual desire.
- Metabolic Syndrome: Hypogonadism is often associated with metabolic syndrome, which includes a cluster of conditions like increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels.
Diagnosis
Diagnosis of hypogonadism involves a combination of clinical assessment, medical history evaluation, and specific diagnostic tests.
- Clinical Assessment: Initial evaluation includes a discussion of symptoms, medical history, and a physical examination. Your endocrinologist will look for signs consistent with hormone deficiencies, such as changes in hair growth, muscle strength, and breast tissue.
- Blood Tests: Blood tests are used to measure hormone levels. For males, this primarily includes testosterone levels. In females, oestrogen, progesterone, and follicle-stimulating hormone (FSH) levels are indicators.
- Pituitary Imaging: In cases of suspected secondary hypogonadism, an MRI may be used to examine the pituitary gland for abnormalities.
- Genetic Studies: Genetic testing might be used if there’s a suspicion of chromosomal abnormalities, especially in cases of primary hypogonadism.
Treatment Options
The treatment of hypogonadism is tailored based on the underlying cause, type of hypogonadism, and the patient’s individual health needs. The primary goal is to restore hormone levels to normal or near-normal levels, thereby alleviating symptoms and preventing long-term complications.
Hormone Replacement Therapy
For males with primary or secondary hypogonadism, testosterone replacement therapy is often conducted. This therapy may address symptoms including reduced libido, fatigue, and muscle weakness. This can be administered in various forms, including gels, patches, injections, or pellets.
For females, particularly those with primary hypogonadism, a combination treatment with both oestrogen and progesterone is commonly used. These can normalise menstrual cycles and alleviate menopause-like symptoms.
Gonadotropin Therapy
If fertility is a concern, especially in secondary hypogonadism where the issue stems from the pituitary gland or hypothalamus, treatment may involve gonadotropins like human chorionic gonadotropin (hCG) and recombinant FSH. This can stimulate the gonads to produce more sex hormones and improve fertility.
Dr Daphne Lee
MBBS
MRCP(UK)
FAMS
Dr Daphne Lee has special interests in the comprehensive management & treatment of diabetes, adrenal and pituitary conditions.
Qualifications
- MBBS (National University of Singapore, Singapore) 2006
- MRCP (Royal College of Physicians, United Kingdom)
- Fellow, Academy of Medicine, Singapore (FAMS)
- Registered with Specialist Accreditation Board (SAB)
- Registered with Singapore Medical Council (SMC)
Before private practice, Dr Daphne Lee was a consultant endocrinologist at Khoo Teck Puat Hospital. During her time there, she also ran the pituitary and adrenal clinics.
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Mount Elizabeth Novena Specialist Center
38 Irrawaddy Road, #07 - 63,
Singapore 329563
Gleneagles Medical Centre
6 Napier Road, #03 - 10,
Singapore 258499
Frequently Asked Questions (FAQ)
Can Hypogonadism Be Cured?
In cases where hypogonadism is a result of reversible factors, such as certain medications or lifestyle-related issues, addressing these factors can lead to improvement. In instances of genetic or permanent damage to the gonads, while symptoms can be effectively managed with treatment, a complete cure may not be feasible. Ongoing management with an endocrinology specialist is often necessary to maintain optimal health and hormone balance.
Can Lifestyle Changes Help Treat Hypogonadism?
Lifestyle modifications can play a role in the management of hypogonadism, particularly when it is related to factors like obesity or high alcohol consumption. Regular exercise, a balanced diet, and a reduced alcohol intake can improve overall hormone levels and health. Consult with our endocrinologist for personalised guidance on effective lifestyle strategies.
How Long Do I Need to Take My Medication for Hypogonadism?
For many, treatment may be a long-term process, potentially lifelong, especially in cases of primary hypogonadism. Regular monitoring and consultation with an endocrinology specialist can help assess the need for ongoing medication and make any necessary adjustments over time.
Can Hypogonadism Be Prevented?
Certain risk factors for hypogonadism may be mitigated by maintaining a healthy weight, managing chronic health conditions, and limiting alcohol consumption. Some causes of hypogonadism, like genetic factors or certain medical treatments, may not be preventable. If you have concerns or symptoms, seek help from our endocrinology specialist for early intervention and care.