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Endocrine Disorders
Adrenal Hypofunction
Adrenogenital Syndrome
Cushing's Syndrome
Diabetes Insipidus
Diabetes Mellitus
Hypothyroidism in Adults
Hypothyroidism in Children
Male Infertility
Precocious Puberty in Females
Precocious Puberty in Males
Turner's Syndrome


What is Hypogonadism?

Hypogonadism - resulting from decreased androgen production in males - usually causes infertility and inhibits the development of normal secondary sex characteristics. Primary and secondary forms exist, and the disorder is classified by the age of onset (prepuberty or postpuberty) or the location of the causative lesion. In primary (hypergonadotropic) hypogonadism, the lesion is in the testes; in secondary (hypogo­nadotropic) hypogonadism, the lesion is in the hypothalamic-pituitary area.

Causes of Hypogonadism

Primary hypogonadism results directly from interstitial (Leydig's cell) cellular or seminiferous tubular damage due to faulty development or mechanical damage. This causes increased secretion of gonadotropins (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) by the pituitary gland in an attempt to increase the testicular functional state. It includes the following disorders: Klinefelter's syndrome, Reifenstein's syndrome, male Turner's syndrome, Sertolicell-only syndrome, anorchism, orchitis, and sequelae of irradiation.

Secondary hypogonadism results from faulty interaction within the hypothalamic-pituitary axis, resulting in failure to secrete normal levels of gonadotropins. It includes the following disorders: hypopituitarism, isolated FSH deficiency, isolated LH deficiency, prolactinomas, Kallmann's syndrome, and Prader-Willi syndrome.

Signs & Symptoms of Hypogonadism

Signss and symptoms vary depending on if hypogonadism develops at birth or if it occurs down the road during adulthood. In most cases, children with hypogonadism do not realize they have the condition until they hit puberty. It's during puberty where the normal changes in the male body fail to occur and when a problem is usually detected. Signs and symptoms include:

  • Failure of the voice to deepen
  • Lack of muscle development
  • Lack of growth in the penis and testes
  • Lack of body hair growth
  • Pituitary tumors will cause prolactia where men's breasts produce a milky discharge.
  • Tumors, headaches and vision loss

Diagnostic tests

Serum gonadotropin levels increase in primary hypogonadism but decrease in secondary hypogonadism.

Serum testosterone levels are low.

Other hormonal studies are used to assess neuroendocrine functions, such as thyrotropin, adrenocorticotropin, growth hormone, prolactin, and vasopressin levels.

Chromosomal analysis may be used to detect the specific cause.

Testicular biopsy and semen analysis are used to determine sperm production and identify impaired spermatogenesis.

X-rays and bone scans may show delayed closure of the epiphyses and immature bone age.


In primary hypogonadism, treatment may consist of hormone replacement, especially with testosterone, FSH, methyltestosterone, or human chorionic gonadotropin (HCG). Treatment for secondary hypogonadism is HCG alone. Fertility can't be restored after permanent testicular damage, but eunuchism resulting from hypothalamic-pituitary lesions can be corrected with gonadotropins to stimulate testicular function.

Prevention Tips

This is maintain normal body weight and healthy eating habits to prevent anorexia nervosa. Other causes may not be preventable.

Hypogonadism prevention is dependent on the common cause. Genetic counseling may be appropriate for individuals with heritable disorders that are associated with hypogonadism. Prevention of serious head injuries reduces the risk of pituitary injury associated hypogonadism.

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