Complex treatment of hypogonadism in men. Hypogonadism in men: symptoms and treatment What is it

Men suffer from various diseases of an infectious and non-infectious nature. Often in men you can find a condition in which the function of the male gonads (testes) is impaired. This reduces the production of sex hormones (androgens). This condition is called hypogonadism.

Separately, it is necessary to highlight hypogonadotropic hypogonadism. Its difference is that in this condition, the production of gonadotropic hormones, which regulate the synthesis of androgens, in particular, testosterone, decreases. Gonadotropic hormones are produced in the brain. This condition is called secondary hypogonadism.

It should be noted that the violation of the male hormonal background negatively affects health. In this condition, metabolism is disturbed, various organs and systems can be affected. Of great importance is the fact that the development of secondary sexual characteristics in men is disturbed. All this has a certain mental effect on men, disrupts their sexual development. Let us consider in more detail what is hypogonadotropic hypogonadism, what is the etiology, clinic and treatment of this disease.

Definition and classification of hypogonadism

The gonads in men not only contribute to the synthesis of germ cells (spermatozoa), but also synthesize a very important hormone - testosterone. The latter is involved in potency, the formation of the genital organs and their function. An interesting fact is that the synthesis of testosterone in men is under the direct influence of the so-called gonadotropic hormones. These include follicle-stimulating, luteotropic hormones and prolactin.

If there is a decrease in the production of the first two and an increase in the latter, then this is the cause of a violation of testosterone synthesis. Hypogonadism is a pathological condition caused by insufficient production of testosterone and a decrease in the work of the testes.

In men, there are primary and secondary hypogonadism. Secondary is due precisely to a violation of the function of the central nervous system resulting in the production of gonadotropic hormones. Any hypogonadism can be congenital or acquired. In the latter case, the causes lie in both endocrine and non-endocrine diseases. Secondary hypogonadotropic hypogonadism occurs at any age. This largely depends on the list. clinical manifestations in men. The most important in the etiology of secondary hypogonadism is the pathology of the hypothalamic-pituitary system.

Congenital hypogonadotropic hypogonadism

This pathology in men occurs with various diseases and conditions. It may be due to a congenital tumor. The latter is the cause of panhypopituitarism. In such a situation, with a significant size of the tumor, compression of the pituitary gland tissues occurs, which serves as a trigger for disrupting the production of gonadotropic hormones. Pathology is observed immediately after the birth of the child.

At the same time, he begins to lag significantly behind in physical development. The reproductive organs do not develop properly. Secondary hypogonadism in men occurs with Maddock's syndrome. This is a very rare pathology characterized by impaired production of gonadotropic hormones and ACTH.

With this syndrome, hypocorticism develops. In adolescence, hypogonadism begins to manifest itself. During this period, boys have insufficient development of male sexual characteristics. They have a eunuchoid physique, reduced sexual desire. Often all this becomes the cause of infertility. Secondary hypogonadism is characteristic of pituitary dwarfism. This disease has a second name - dwarfism. Its difference is that the production of ACTH, TSH, STH, FSH, LH is reduced.

All this leads to dysfunction of various organs. The thyroid gland, kidneys, adrenal glands suffer. Males have infertility, short stature (about 130 cm). Hypogonadotropic hypogonadism in men may be associated with dysfunction of the hypothalamus only. In this case, there is a sharp decrease in the production of gonadotropic hormones. Secondary hypogonadism is an integral part of the Cullman syndrome.

Acquired hypogonadotropic hypogonadism

Hypogonadism syndrome in men can be acquired. If in childhood or adolescence there is such a pathology as hyperprolactinemia, then hypogonadism may develop. In this situation, it is combined with a delay in sexual development.

Hypogonadism in men is one of the manifestations of adiposogenital dystrophy. It is manifested not only by a violation of the production of androgens, but also by obesity. This pathology most often occurs in males aged 10-12 years. It is important that with dystrophy, the hypothalamus and pituitary gland are not involved in the process. Dystrophy in men is manifested by eunuchoidism, sexual dysfunction and infertility.

Of great importance is the fact that dystrophy disrupts the work of other important organs. In some cases, myocardial dystrophy is observed. You need to know that hypogonadism in men is one of the manifestations of various syndromes. The latter include Laurence-Moon-Barde-Biedl, Prader-Willi syndrome. The first is characterized by such symptoms as mental retardation, obesity, polydactyly.

The most striking manifestations of this syndrome are an increase in the mammary glands, hypoplasia of the testicles, an abnormal location of the testicles (cryptorchism). In addition, erectile function suffers, male-type hair growth is underdeveloped.

Common manifestations of hypogonadism in men

The clinical symptoms of secondary male hypogonadism largely depend on the age at which it occurs. If changes in the production of male sex hormones occur even before the birth of a male child, then at birth the presence of bisexual organs may be observed. If hypogonadism developed in childhood before puberty, then sexual development changes.

If in normal conditions in adolescents, secondary male characteristics are gradually formed (male type of hair growth, rough voice, changes in the skeleton), then in this situation this process is disrupted. There is eunuchoidism, large growth, a change in the formation of the skeleton.

Adolescents have weak muscle development, true gynecomastia. The function of the scrotum is also impaired. Characterized by hypogenitalism. In some cases, adolescents develop obesity. Its peculiarity is that it happens according to the female type, that is, fat is deposited in parts of the body that are atypical for a man. Very often, the secondary form of pathology is manifested by a violation of the function of the thyroid gland. The most serious manifestation of this condition is infertility. As for the gonads themselves, they are almost always smaller in size than in a healthy man.

Diagnostics and therapeutic measures

In order to prescribe the appropriate treatment for men, it is necessary to correctly diagnose. It is based on the patient's complaints, the history of life and the history of the disease. The period of bearing a child is of some importance. External examination is of great importance. In addition, laboratory and instrumental studies are carried out. The first include the study of the level of testosterone and gonadotropic hormones.

With secondary hypogonadism, they are reduced. Determination of bone age is of no small importance. This allows you to identify a violation of the ossification process. For determining possible cause pathology, an x-ray of the brain is performed. MRK or CT can be used. These methods allow to identify the pathology of the pituitary gland and hypothalamus. With their help, you can determine the presence of a tumor.

Treatment of hypogonadism involves addressing the underlying cause. Hypogonadism is not the main disease, but only a manifestation. If hypogonadism is congenital, then treatment is more aimed at eliminating the symptoms of the disease and normalizing the hormonal background.

If there is infertility that developed in adolescence, then this process is not amenable to therapy.

Treatment of children includes the use of hormonal drugs, in particular gonadotropins. They give the best result in combination with sex hormones. Treatment must be comprehensive. It involves physiotherapy, exercise therapy.

In severe cases, when there is cryptorchidism or underdevelopment of the penis, surgery is performed. It includes phalloplasty, testicular transplantation. Thus, hypogonadotropic hypogonadism is a manifestation of various pathologies. It is most dangerous at a young age, when sexual function is being formed.

hypogonadism

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A syndrome accompanied by insufficiency of the functions of the gonads and a violation of the synthesis of sex hormones. Hypogonadism, as a rule, is accompanied by underdevelopment of the external or internal genital organs, secondary sexual characteristics, a disorder of fat and protein metabolism (obesity or cachexia, changes in the skeletal system, cardiovascular disorders). Diagnosis and therapy of hypogonadism is carried out by the joint work of endocrinologists, gynecologists and gynecologists-endocrinologists (in women), andrologists (in men). Hormone replacement therapy is the mainstay of treatment for hypogonadism. If necessary, surgical correction, plastic surgery and prosthetics of the genital organs are performed.

Classification of hypogonadism in men

Hypogonadism is divided into primary and secondary.

Primary hypogonadism is caused by dysfunction of the testicular tissue due to a defect in the testicles themselves. Chromosomal disorders can lead to aplasia or hypoplasia of the testicular tissue, which is manifested by the absence of androgen secretion or their insufficiency for the normal formation of the genital organs and secondary sexual characteristics.

The occurrence of secondary hypogonadism is due to a violation of the structure of the pituitary gland, a decrease in its gonadotropic function or damage to the hypothalamic centers that regulate the activity of the pituitary gland. Primary hypogonadism, which develops in early childhood, is accompanied by mental infantilism, secondary - by mental disorders.

There are also hypogonadotropic, hypergonadotropic and normogonadotropic hypogonadism. Hypergonadotropic hypogonadism is manifested by a primary lesion of the testicular tissue of the testicles in combination with an increased level of pituitary gonadotropic hormones. Hypogonadotropic and normogonadotropic hypogonadism occur when the hypothalamic-pituitary system is affected. Hypogonadotropic hypogonadism is associated with a decrease in the secretion of gonadotropins, resulting in a decrease in androgen production by the testicular tissue of the testicles. Normogonadotropic hypogonadism is caused by hyperprolactinemia, manifested by normal levels of gonadotropins and decreased testicular function of the testicles.

Both primary and secondary hypogonadism can be congenital or acquired. Some forms of male infertility (from 40 to 60% of all cases of male infertility) can serve as a manifestation of hypogonadism. Depending on the age of development of insufficiency of sex hormones, embryonic, pre-pubertal (from 0 to 12 years) and post-pubertal forms of hypogonadism are distinguished.

Congenital primary (hypergonadotropic) hypogonadism occurs:

with anorchism (aplasia) of the testicles;
in violation of the omission (cryptorchism and ectopia) of the testicles;
with true chromatin-positive Klinefelter syndrome (combines testicular hypoplasia, hyalinosis of the walls and dysgenesis of the seminiferous tubules, gynecomastia, often accompanied by azoospermia (absence of spermatozoa). Testosterone production is reduced by about 50%.
with Shereshevsky-Turner syndrome ( chromosomal disease with characteristic disorders of physical development: short stature and lack of sexual development, rudimentary testes);
with sertoli cell syndrome or del Castillo syndrome (underdevelopment of the testicles with a normal or increased amount of gonadotropins). With this syndrome, spermatozoa are not formed, patients are infertile. Physical development occurs according to the male pattern;
with the syndrome of incomplete masculinization - false male hermaphroditism. The reason is a decrease in tissue susceptibility to androgens.
Acquired primary hypogonadism develops as a result of exposure to the testicles of internal or external factors after birth.
with injuries, tumors of the testicles and early castration - manifested by a picture of a typical eunuchism - total hypogonadism;
with insufficiency of the germinal epithelium (false Klinefelter's syndrome). Characterized by high growth, eunuchoid physique, gynecomastia, underdeveloped secondary sexual characteristics, small size of the genitals. By puberty, patients develop eunuchoid features, and subsequently reduced fertility.
Congenital secondary (hypogonadotropic) hypogonadism develops under the following conditions:
associated with damage to the hypothalamus - an isolated form with damage to only the reproductive system. It is characterized by a total deficiency of gonadotropic hormones, while there may be a deficiency of lutropin or folitropin;
with Cullman's syndrome - characterized by a deficiency of gonadotropins, underdevelopment of the genitals and secondary sexual characteristics, a decrease or absence of smell (hyposmia or anosmia). Eunuchoidism is noted (often in combination with cryptorchidism), various malformations: splitting of the upper lip and hard palate, shortening of the frenulum of the tongue, facial asymmetry, six-fingeredness, gynecomastia, cardiovascular disorders.
with pituitary dwarfism (pituitary dwarfism). There is a sharp decrease in somatotropic, luteinizing, follicle-stimulating, thyroid-stimulating and adrenocorticotropic hormones, which is manifested by impaired function of the testicles, adrenal glands and thyroid gland. It is characterized by insufficiency of sexual characteristics, dwarf growth of less than 130 cm, infertility.
with congenital panhypopituitarism (craniopharyngioma) caused by a congenital brain tumor. Growing, it compresses the tissues of the pituitary gland, disrupting its functions. The production of gonadotropins, as well as hormones that regulate the functions of the adrenal cortex and the thyroid gland, decreases. It leads to a lag in the physical and sexual development of the child.
with Maddock's syndrome - an extremely rare form of hypogonadism that occurs when the gonadotropic and adrenocorticotropic functions of the pituitary gland are insufficient. It is characterized by a gradual increase in hypocorticism. After passing puberty there is a lack of function of the sex glands - eunuchoidism, hypogenitalism (underdevelopment of the genital organs and secondary sexual characteristics), decreased libido, infertility.
Acquired secondary hypogonadism develops when:
adiposogenital dystrophy - manifested by obesity and hypogenitalism. There is a lack of gonadotropic function of the pituitary gland. Appears at 10-12 years of age. Hypothalamo-pituitary pathology with pronounced clinical symptoms is not observed. Characterized by eunuchoid proportions of the skeleton, usually sexual dysfunction and infertility. Due to dystrophic changes in the heart and vascular hypotension, shortness of breath, biliary dyskinesia, and flatulence may develop.
Laurence-Moon-Barde-Biedl syndrome (LMBB), Prader-Willi syndrome. LMBB syndrome is manifested by obesity, low intelligence, retinitis pigmentosa and polydactyly. There is cryptorchidism, testicular hypoplasia, gynecomastia, erectile dysfunction, scanty facial hair, armpits, pubis, and kidney development defects are possible. The Prader-Willi syndrome, in contrast to the LMBB syndrome, has multiple anomalies (“Gothic” palate, epicanthus, etc.), pronounced muscle weakness against the background of a decrease in the amount of androgens and gonadotropins in the blood. Both syndromes are classified as functional disorders of the pituitary and hypothalamus.
hypothalamic syndrome due to damage to the hypothalamic-pituitary region as a result of an infectious-inflammatory, tumor process, traumatic brain injury.
hyperprolactinemic syndrome - accompanies infertility and disorders of sexual function, and arising in childhood and adolescence, causes delayed sexual development and hypogonadism.
Causes and mechanisms of development of hypogonadism in men
Androgen deficiency can be caused by a decrease in the amount of hormones produced or a violation of their biosynthesis as a result of the pathology of the testicles themselves or a violation of the hypothalamic-pituitary regulation.
The etiological factors of primary hypogonadism are often:
congenital underdevelopment of the gonads that occurs with genetic defects - for example, dysgenesis (violation of the tissue structure) of the seminiferous tubules; testicular dysgenesis or aplasia (anorchism, monorchism). In the occurrence of congenital pathology, a negative role is played by harmful effects on the body of a pregnant woman. A hypogonadal state can be caused by impaired testicular descent.
toxic effects (chemotherapy of malignant tumors, organic solvents, nitrofurans, pesticides, alcohol, tetracyclines, hormonal drugs in large doses, etc.)
infectious diseases (mumps, measles orchitis, epididymitis, deferentitis, vesiculitis)
radiation injury (by contact with x-rays, radiotherapy)
acquired damage to the testicles - trauma, torsion of the spermatic cord, varicocele, testicular volvulus; atrophy and hypoplasia of the testicles after operations of orchidopexy, hernia repair, surgical interventions on the organs of the scrotum.

Some cases of primary hypogonadism are idiopathic. Modern endocrinology does not have sufficient data on the etiology of idiopathic hypogonadism.

With primary hypogonadism, there is a decrease in the level of androgens in the blood, the development of a compensatory reaction of the adrenal glands to hypoandrogenization, and an increase in the production of gonadotropins.

Violations of the hypothalamic-pituitary regulation (inflammatory processes, tumors, vascular disorders, pathology of embryonic development) lead to secondary hypogonadism. The development of hypogonadism can be caused by pituitary adenomas that produce growth hormone (with acromegaly) or adrenocorticotropic hormone (with Cushing's disease), prolactinoma, postoperative or post-traumatic hypothalamic-pituitary dysfunction, hemochromatosis, aging processes, accompanied by an age-related decrease in blood testosterone levels.

With secondary hypogonadism, there is a low level of gonadotropins, leading to a decrease in the secretion of androgens by the testicles.

One form of male hypogonadism is a decrease in sperm production with normal testosterone levels, as well as extremely rare cases of a decrease in testosterone levels without a decrease in sperm production.

Symptoms of hypogonadism in men

Clinical manifestations of hypogonadism are due to the age of onset of the disease and the degree of androgen deficiency. Violation of androgen production in the prenatal period can lead to the development of bisexual external genitalia.

If testicular damage occurs in boys in the prepubertal period, there is a delay in sexual development, typical eunuchoidism is formed: disproportionately high growth associated with delayed ossification of the epiphyseal (growth) zones, undeveloped chest and shoulder girdle, long limbs, underdeveloped skeletal muscles. There may be a development of female-type obesity, true gynecomastia, hypogenitalism, which manifests itself in a small size of the penis, lack of pigmentation and folding of the scrotum, testicular hypoplasia, underdevelopment of the prostate gland, lack of facial and pubic hair, underdevelopment of the larynx, high voice.

In cases of secondary hypogonadism, obesity often occurs, symptoms of hypofunction of the adrenal cortex, thyroid gland, manifestations of panhypopituitarism, lack of sexual desire and potency are possible.

If a decrease in testicular function develops after puberty is completed, then the symptoms of hypogonadism are less pronounced. There is a decrease in the size of the testicles, slight facial and body hair, female-type fat deposits, loss of elasticity and thinning of the skin, infertility, decreased sexual function, and vegetative-vascular disorders.

Reducing the testicles is observed in almost all cases of male hypogonadism (exception - if the disease has begun recently). Reducing the size of the testicles is usually closely associated with a decrease in sperm production. With the loss of the sperm-producing function of the testicles, infertility develops with the cessation of testosterone production, libido decreases, regression of secondary sexual characteristics occurs, erectile dysfunction, generalized symptoms are noted (decrease in muscle strength, fatigue, general weakness).

Diagnosis of hypogonadism in men

It is based on the patient's complaints, anamnesis data, a general status study using anthropometry, examination and palpation of the genitals, an assessment of the clinical symptoms of hypogonadism, and the degree of puberty.

According to the X-ray examination, bone age is estimated. To determine the mineral saturation of the bones, densitometry is performed. When radiography of the Turkish saddle is determined by its size and the presence of a tumor. Evaluation of bone age makes it possible to accurately determine the onset of puberty by the timing of ossification of the wrist joint and hand. The onset of puberty is associated with the formation of a sesamoid bone in the I metacarpophalangeal joint (approximately at 13.5-14 years). Full puberty is evidenced by the appearance of anatomical synostoses. This feature makes it possible to distinguish between prepubertal and pubertal age. When evaluating bone age, it is necessary to take into account the possibility of earlier (for patients from the southern regions) and late (for patients from the northern regions) ossification, as well as the fact that osteogenesis impairment may be due to other factors. With pre-pubertal hypogonadism, there is a lag of several years of "bone" age from the passport one.

A laboratory study of sperm analysis (spermogram) in hypogonadism is characterized by azo- or oligospermia; sometimes ejaculate can not be obtained. The level of sex and gonadotropins is measured: serum testosterone (total and free), luteinizing, follicle-stimulating hormone and gonadoliberin, as well as serum anti-Müllerian hormone, prolactin, estradiol. The content of testosterone in the blood is reduced.

With primary hypogonadism, the level of gonadotropins in the blood is increased, with secondary hypogonadism it is lowered, sometimes their content is within the normal range. Determination of the level of serum estradiol is necessary for clinically pronounced feminization and secondary hypogonadism, in the case of estrogen-producing tumors of the testicles or adrenal glands. The level of 17-KS (ketosteroids) in the urine with hypogonadism may be normal or reduced. If Klinefelter's syndrome is suspected, a chromosomal analysis is indicated. Testicular biopsy rarely provides information for diagnosis, prognosis, or treatment.

Treatment of hypogonadism in men

Therapy of hypogonadism is carried out strictly individually, and is aimed at eliminating the cause of the disease. The purpose of the treatment is to prevent the retardation of sexual development, in the future - malignancy of the testicular tissue of the testicles and infertility. Treatment of hypogonadism should be carried out under the supervision of a urologist and an endocrinologist.

Treatment of hypogonadism depends on its clinical form, the severity of disorders in the hypothalamic-pituitary and reproductive systems, comorbidities, the time of onset of the disease and the age of diagnosis. Therapy of hypogonadism begins with the treatment of the underlying disease. Treatment of adult patients consists in correcting androgen deficiency and sexual dysfunction. Infertility that occurs against the background of congenital and prepubertal hypogonadism is incurable, especially in the case of aspermia.

In the case of primary congenital and acquired hypogonadism (with preserved reserves of endocrinocytes in the testicles), stimulating therapy is used: in boys - with non-hormonal drugs, and in adult patients - with hormonal agents (small doses of gonadotropins, androgens). In the absence of the reserve capacity of the testicles, the replacement intake of androgens (testosterone) is shown constantly, throughout life. In secondary hypogonadism, both in children and adults, it is necessary to use stimulating hormonal therapy with gonadotropins (if necessary, combining them with sex hormones). It is also shown to conduct general strengthening therapy, physiotherapy exercises.

Surgical treatment of hypogoandism consists of testicular transplantation, bringing down the testicle in case of cryptorchidism, and phalloplasty in case of underdevelopment of the penis. For cosmetic purposes, a synthetic testicle is implanted (in the absence of an undescended testicle in the abdominal cavity). Operations are performed using microsurgical techniques with control of the immunological and hormonal status of the patient and the transplanted organ. In the process of systematic treatment of hypogonadism, androgen deficiency decreases: the development of secondary sexual characteristics resumes, potency is partially restored, the severity of concomitant manifestations decreases (osteoporosis, lagging "bone age", etc.).

Very few people think about the huge role hormones play in our body. The endocrine system is second only to the nervous system in importance, it is responsible for the normal functioning of the whole body, including procreation. With her pathology, diseases such as diabetes, gigantism, hypothyroidism and even hypogonadism.

Hypogonadism - what is it in men?

Hypogonadism syndrome refers to the underdevelopment of the gonads or a decrease in their function. Basically, its pathogenesis is characterized by a decrease in the production of male steroids, signs of infantilism appear, that is, there is a reverse development from a man to a boy, due to.

IMPORTANT: the concentration of androgens depends not only on the normal state of the organs directly producing it - but also on the endocrine system located in the brain. According to the international classification of diseases of the 10th revision (ICD 10), hypogonadism can be assigned the code E29 if it is associated with testicular dysfunction and E23 if it is a consequence of the pathology of the pituitary gland.

Kinds

There are many disorders that lead to the described symptom complex, however, for convenience, it is classified into 3 main types.

Hypergonadotropic hypogonadism

Caused by damage to the hypothalamic-pituitary system, which dominates the rest of the endocrine glands. That is, in fact, it is responsible for the production of absolutely all hormones in our body, and human viability depends on its work.

The hypothalamus controls the pituitary gland, and the second synthesizes gonadotropins: follicle-stimulating hormone (FSH) and luteinizing (LH) hormone, which regulate all the activities of the reproductive system. With this hypogonadism, there is an excessive or incorrect production of these hormones.

Normogonadotropic hypogonadism

This type differs from the previous one in that the pituitary gland is working normally, but the problem occurs directly in the sex glands. The formation of testosterone in the Leydig cells of the testicles is disrupted, usually this is caused by inflammatory or cicatricial changes.

Hypogonadotropic hypogonadism

It is characterized by a decrease in the secretory function of the dominant endocrine system - the synthesis of gonadotropins in the structures of the brain decreases, which leads to underdevelopment of the testicles and, as a result, a decrease in the production of steroids.

Causes

Many researchers divide the causes of hypogonadism into two large groups.

Congenital (primary):

complete absence of testicles;
not lowering them into the scrotum;
Klinefelter's syndrome (additional X chromosome in males, formula 47, XXY);
Heller-Nelson syndrome (improper development of Leydig cells in the testes, which leads to a decrease in testosterone production);
de la Chapelle disease (violation of the divergence of sex chromosomes, as a result of which a person looks like a man, but has a female set of chromosomes 46, XX);
Morris symptom complex (complete insensitivity of receptors in the body to androgens) and Reifenstein's syndrome (partial insensitivity);
Jacobs syndrome (47, XYY);
myotonic dystrophy ( genetic disease characterized by weakness of the muscles of the face and hands, as well as changes in the thyroid, pancreas and gonads);
Del Castillo disease (during development in the womb, the primary cells of the gonads are not laid);
underdevelopment of Leydig cells and, as a result, insufficient production of the main male hormone;
Kallman's syndrome (hereditarily determined decrease in the production of FSH and LH);
adrenogenital symptom complex (genetic deficiency of the enzyme that forms steroids).

Acquired (secondary):

castration;
bilateral atrophy, that is, a decrease in volume and loss of function;
excess estrogens inhibit the synthesis of FSH due to the "feedback" mechanism;
orchitis;
exposure to radiation;
in the area of the pituitary gland;
tumors of the hypothalamus, pituitary gland or testicles;
trauma;
slowing down the breakdown of estrogens;
uncontrolled use of drugs (cytostatics);
hyperprolactinemic symptom complex (which inhibits testosterone secretion);
with chronic renal failure;
with cirrhosis of the liver;
with anorexia nervosa;
with other endocrinological diseases (, thyrotoxicosis, etc.);
with injuries lumbar spine with spinal cord injury;
age-related androgen deficiency in men.

Symptoms and signs

Testosterone and gonadotropins affect not only the reproductive system, but also the musculoskeletal system. Accordingly, if pituitary hypogonadism is congenital or acquired during sexual maturation, then changes in the normal proportions are observed.

A eunuchoid skeleton is formed: tall and long limbs. The bones become thin and brittle. Skeletal muscles are poorly expressed, fat is deposited on the hips and buttocks (according to the female type). There are no changes in the larynx, the voice remains high, like that of a child. Beard, mustache, pubic hair and in the armpits are weakly expressed. The genitals are reduced, the penis is small, there are no folds on the scrotum, and there is no erection. Often observed and gynecomastia (benign breast enlargement in men).

If hypogonadism began to progress in adulthood, then changes are observed mainly in the reproductive system:

increasing impotence;
the disappearance of adequate and spontaneous erections;
reduction of testicles.

Stop growing hair on the face, in the armpits and groin. Weakens, however, does not disappear completely. Very often, such men suffer from depression, neurosis, there is a frequent change of mood. Gynecomastia may also develop.

Diagnosis of hypogonadism in men

If you're struggling with hypogonadism, you already know that it's a devastating condition that reduces your quality of life. People with this disease are characterized by a loss muscle mass, low libido, infertility and depressed mood. Fortunately, there are ways to balance hormones using replacement therapy, which is a common practice for treating this condition. A physical exercise, dietary changes and lifestyle changes will help to cope with the disease as effectively as possible.

What is primary hypogonadism

Hypogonadism (synonyms: gonadal insufficiency, hypogenitalism) occurs when a person's sex glands, also called gonads, produce little or no sex hormones. The disease can be both congenital and acquired due to various conditions. This happens as a result:

congenital underdevelopment of the glands;
damage by toxic substances;
infections;
radiation therapy.

First of all, the sex glands are the testicles (testicles) in men and the ovaries in women, which produce testosterone and estrogen, respectively. Sex hormones help control secondary sex characteristics such as breast formation in women, testicular development, and pubic hair growth in men. Sex hormones also play a role in the menstrual cycle and sperm production.

Primary hypogonadism - secretory insufficiency of the sex glands in women and men

Primary hypogonadism means that the body does not have enough sex hormones due to a defect directly in the sex glands. The hypothalamus and pituitary gland - the parts of the brain that control them - continue to send signals to produce hormones, but the gonads, for various reasons, are unable to produce them.

In men with hypogonadism, low testosterone negatively affects the development and maintenance of male reproductive organs, including:

testicles;
penis;
prostate.

In fact, a lack of testosterone can lead to problems such as decreased muscle strength, hair loss, and impotence.

In women, hypogonadism occurs when the ovaries do not produce enough estrogen. This hormone is responsible for maintaining the functions of the genital organs, such as:

uterus;
vagina;
fallopian tubes;
mammary gland.

Low levels of the female sex hormone in the body can lead to infertility, loss of sex drive, mood swings, cessation of menstruation, and osteoporosis.

Hypogonadism is also called andropause or low serum testosterone when it comes to male health. Most cases of this disease respond well to appropriate treatment.

Causes of pathology

Causes of hypogonadism common to both sexes include:

congenital underdevelopment of the sex glands;
severe infections (mumps, tuberculosis, syphilis);
autoimmune disorders such as Addison's disease and hypoparathyroidism;
some genetic disorders (Turner's syndrome);
diseases of the liver and kidneys;
radiation exposure (chemotherapy);
surgery on the genitals.

In addition, polycystic ovaries is one of the causes of hypogonadism in women.

Polycystic ovary in women often causes insufficiency of the sex glands

Causes of the disease in men include:

Symptoms of the disease

Symptoms that may affect women include:

lack of menstruation;
slow or absent breast growth;
hot flashes (paroxysmal sensation of heat);
loss of body hair;
low or no sex drive (libido);
milky discharge from the chest.

Testosterone deficiency in men triggers a series of severe changes in the body

The most characteristic symptoms of hypogonadism in men are:

female type obesity (buttocks, hips, abdomen);
loss of body hair;
decrease in muscle mass;
gynecomastia - abnormal growth of the mammary gland (similar to a woman's);
decreased growth of the penis and testicles;
erectile disfunction;
osteoporosis;
low libido;
infertility (due to decreased spermatogenesis);
chronic fatigue;
hot flashes;
difficulty concentrating.

If the waist circumference of a man exceeds 102 cm, then this indicates not only obesity, but also a low level of testosterone. Its production is blocked by a special substance called leptin, which is produced in adipose tissue. With a low level of male sex hormones, the representatives of the stronger sex not only grow the stomach, but also increase the breasts according to the female type. But the most dangerous thing is that atherosclerotic plaques appear in the vessels, which carry with them the risk of cardiovascular diseases - heart attack or stroke.

A man's waist size over 102 cm means low testosterone production in his body

Video: hypogonadism in men

Diagnostic methods

Diagnosis of the disease is carried out jointly: an endocrinologist with a gynecologist (in women) or with an andrologist-urologist (in men). The doctor performs a physical examination. He needs to make sure that the sexual development of the patient is at the proper level in accordance with age. The doctor examines the patient's muscle mass, the presence of body hair and genitals.

Signs of hypogonadism can be seen even in childhood by the weak development of skeletal muscles, the distribution of subcutaneous adipose tissue according to the female type

Tests for hormones

If a doctor suspects hypogonadism, the first stage of testing will include determining levels of sex (gonadotropic) hormones. You will need to do a blood test to check your follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. They are produced by the pituitary gland.

Also, women need to determine the level of estrogen, and men - testosterone levels. These tests are usually taken in the morning when hormone levels are highest. For men, an andrologist may additionally prescribe a spermogram to check the sperm count. With hypogonadism, the norm is significantly reduced.

A blood test for sex hormones is taken in the morning, when the hormonal level is highest.

Iron levels can affect sex hormones. The increased content of this microelement (hemochromatosis) negatively affects the work of the sex glands, more often in men. The most practical screening test is the determination of serum iron, saturation of the so-called transferrin and ferritin. If the indicator is higher than 50% for men and 45% for women, this indicates an increased supply of the trace element.

Hemochromatosis in men negatively affects the production of testosterone and is dangerous testicular loss

Your doctor may suggest checking your prolactin levels. It is a hormone that promotes breast development and production breast milk in women, but it is present in the body in both sexes. Thyroid disorders can cause symptoms similar to hypogonadism. To exclude such a scenario, the endocrinologist sends specific hormones - thyroxine and triiodothyronine - for testing.

Imaging research methods

Imaging tests are often helpful in diagnosing hypogonadism:

Treatment of primary hypogonadism

The simplest and most successful treatment for men and women with primary hypogonadism is hormone replacement therapy. But this does not provide lost fertility (fertility) in women, and in men it does not stimulate the growth of the testicles. First of all, therapy is aimed at preventive measures in order to prevent a lag in the patient's sexual development.

Medical therapy in women

Drug treatment of women consists in increasing the level of female sex hormones in the body. After a hysterectomy (amputation of the uterus), estrogen therapy is prescribed. The hormone is taken in pills or as a patch.

Because elevated estrogen levels can increase the risk of endometrial cancer, women who have not had a hysterectomy are given a combination of estrogen and progesterone.

Other treatments target specific symptoms. If the patient has a decrease in sexual desire, then low doses of testosterone are prescribed to her as therapy. In case of violations menstrual cycle or problems with conception, a doctor may be prescribed:

injections of human chorionic gonadotropin (hCG) - a hormone that normally begins to be produced 6–8 days after embryo implantation;
pills containing FSH - follicle stimulating hormone to induce ovulation.

Medication treatment for men

Testosterone replacement therapy (TRT) is a widely used treatment for hypogonadism in men. TRT restores muscle strength and prevents bone loss. In addition, men receiving TRT experience increased energy, sex drive, erectile function, and a sense of well-being.

In boys, testosterone replacement therapy stimulates puberty and the development of secondary sexual characteristics, such as increased muscle mass, the appearance of a beard and pubic hair, and penis growth. An initial low dose of the hormone with a gradual increase will avoid side effects and more accurately mimic the slow increase that occurs during puberty.

Types of Testosterone Replacement Therapy

There are several methods for delivering testosterone to the body. The choice of a particular method of therapy depends on patient preference, side effects and cost. Methods include:

Injections. Testosterone injections (Testosterone cypionate / Testosterone cypionate, Testosterone enanthate / Testosterone enanthate, Omnadren, Nebido, Sustanon) are safe and effective. They are done intramuscularly. Symptoms may vary between doses depending on the frequency of injections. The patient or family member can learn how to inject TRT at home.

Omnadren 250 - testosterone preparation for intramuscular injections
Patch. A patch containing testosterone (Androderm) is applied every night to the back, abdomen, upper arm, or thigh. The area of application is changed in order to maintain a seven-day pause between applications on the same place to reduce skin reactions.
Testosterone patch - a convenient way to deliver the hormone to the body
Gel. There are several drugs with different ways their applications. Depending on the brand, testosterone must either be rubbed into the skin on the upper arm or upper arm (AndroGel / Androgel, Testim / Testim), applied with an applicator under each armpit (Axiron / Axiron) or squeezed onto the front and inside of the thigh (Fortesta / Fortesta). When the gel dries, the body absorbs the testosterone through the skin. Do not shower or bathe for several hours after applying the gel to make sure it is absorbed. Potential side effect gel is the possibility of transferring the medicine to another person. Avoid skin-to-skin contact until the gel is completely dry after application.
Androgel - testosterone preparation in the form of a gel for external use
Transbuccal means. A putty-like tablet (Striant / Striant) is placed between the upper lip and gum in the oral cavity (buccal cavity), where it is until completely resorbed. This product quickly adheres to the mucous membrane and allows testosterone to enter the bloodstream.

Strianta tablet is glued to the gum for a period of 12 hours
nasal gel. Testosterone can be dripped into the nostrils in the form of a gel. This option reduces the risk that the medicine will be transferred to another person through skin contact. Nasal testosterone must be applied twice in each nostril, three times a day, which can be more inconvenient than other treatments.
implantable granules. Testosterone-containing granules (Testopel/Testopel) are surgically implanted under the skin every three to six months.

Testosterone therapy comes with a variety of risks, including:

promotes apnea (stopping breathing during sleep);
stimulates uneven growth of the prostate gland;
enlarges the mammary glands;
limits sperm production;
activates the growth of existing prostate cancer;
causes blood clots to form in the veins.

Surgery

In the absence of an effective result of conservative therapy in men, surgical treatment may be required. Procedures include transplantation (transplantation) of the testicles. Surgical intervention requires the use of microsurgical techniques using optical means and constant monitoring of the hormonal and immunological status of the patient.

Surgery for gynecomastia in men is recommended

Gynecomastia is also recommended for men to operate with liposuction of the chest area, if excess adipose tissue is present. This surgical procedure leads to a decrease in the amount of estrogen-producing tissue, which increases testosterone levels. Laboratory studies and clinical observations confirm the improvement in well-being, mood and erection in patients after surgery for gynecomastia.

Transplantation of female ovaries has not yet been introduced into wide practice, although research and trials are underway in this area.

Folk remedies

Two essential oils that help regulate hormone levels and improve symptoms of hypogonadism are clary sage and sandalwood oils.

Clary sage contains natural phytoestrogens, so it helps to balance estrogen levels in women.

Application of sage oil:

Combine 5 drops of sage oil with ½ teaspoon of coconut oil.
Massage the mixture into the abdomen, wrists and soles of the feet.

Clary sage essential oil helps relieve symptoms of estrogen deficiency in women

Sandalwood essential oil can be used to relieve symptoms of hypogonadism in men such as low sex drive, mood swings, stress, and cognitive problems.

A study conducted at the University of South Dakota (USA) in 2015 found that sandalwood oil also has anti-cancer mechanisms due to its antioxidant and anti-inflammatory properties. Sandalwood has been found to have antitumor effects in breast and prostate cancer.

Sandalwood essential oil has an antitumor effect in prostate and breast cancer

You can use sandalwood oil by diffusing a small amount at home, inhaling it directly from the bottle, or applying 2-3 drops to the soles of your feet.

Lifestyle and prevention

If hypogonadism occurs in adulthood, it is important to make lifestyle and dietary changes to prevent osteoporosis. Regular exercise and sufficient calcium and vitamin D to maintain bone strength are important in reducing the risk of osteoporosis.

Specifically, the US National Academy of Medicine recommends 1,000 milligrams (mg) of calcium and 600 international units (IU) of vitamin D per day for men aged 19 to 70. This recommendation increases to 1200 mg of calcium and 800 IU of vitamin D per day for men 71 years of age and older. Individual advice nutrition is provided by the attending physician.

Hypogonadism often causes erectile dysfunction or infertility. In this regard, the patient may experience psychological problems, as well as difficulties in relationships with the family. In this case, support groups, including thematic online communities, can help sick people and their loved ones cope with various situations and problems associated with the disease. Many men use psychological or family counseling.

Although often non-existent effective treatment to restore lost fertility in a person with primary hypogonadism, the use of reproductive technologies may be useful. They cover a variety of methods designed to help couples who have been unsuccessfully trying to become parents.

Congenital hypogonadism requires lifelong treatment, which is important to start at early age

Adolescents with hypogonadism may feel as if they do not fit into the social environment. Testosterone replacement therapy induces puberty. That is why it is important to control its gradually increasing pace, which will allow time to adjust for physical changes and new sensations, then the likelihood of social and emotional problems is significantly reduced.

stress reduction

A study conducted at the University of Massachusetts School of Medicine (USA) showed a link between testosterone levels and stress. For more effective treatment of hypogonadism, it is useful to practice simple ways stress relief such as:

spending time outdoors;
meditation;
sports;
social activity.

Weight management and diet

Being overweight or underweight can contribute to low sex hormone levels.

The epidemic of childhood obesity in developed countries is causing serious health problems among children, including problems with growth and sexual development.

Power training And proper nutrition increase testosterone levels in men

If a person has low testosterone and at the same time he is struggling with excess weight, first of all he needs to remove from his diet all processed foods and fast food, refined carbohydrates and artificial sweeteners. Focus on natural and organic products, including:

healthy fats such as coconut and olive oils
fermented dairy products, including kefir, yogurt, cottage cheese;
organic protein, such as salmon, chicken, beef, which have been grown without the use of synthetic growth regulators and other additives;
fresh fruits and vegetables, such as leafy greens, avocados, broccoli, celery, carrots, and artichokes
high-fiber foods such as pumpkin, nuts (almonds, walnuts), chia and flax seeds, legumes.

If question healthy eating the patient is not able to decide on his own, a trainer-nutritionist can help him with this, who will become a mentor in the matter of healthy weight correction and help him achieve the desired result.

Regular workouts

There are many studies that prove that exercise can regulate or increase low testosterone levels. The best forms of exercise:

strength training (30 minutes 3 times a week);
high intensity interval training - alternating intervals (30–60 seconds) of high and low intensity, such as jogging and sprinting.

Optimal testosterone levels in men are the key to men's health and overall well-being

Studies show that even moderate light and weightlifting increases serum testosterone levels compared to no additional physical activity at all.

Exercise can also be helpful for women with hypogonadism because it helps reduce stress and normalize weight. Being underweight or overweight are factors that can cause low estrogen levels. Yoga and Pilates are also quite helpful in relieving the symptoms of hypogonadism.

Pilates and yoga classes are a great way to normalize weight and hormonal levels in women and men

Prognosis and complications

Hypogonadism is a chronic disease that requires lifelong treatment. The level of sex hormone will decrease to the previous level if the treatment is stopped.

If left untreated, hypogonadism can lead to various complications, depending on age and gender. If the disease affects children before they are born (for genetic reasons), hypogonadism can lead to abnormal genital development. As a consequence, adolescent puberty may be delayed, meaning that girls do not menstruate or grow breasts, and boys have little body hair and no increase in muscle mass.

Adults with hypogonadism may experience more severe complications. In both men and women, the disease can cause infertility. In women, menstruation stops and hot flashes appear. Men in this condition experience sexual dysfunction and are at increased risk of developing osteoporosis, as well as heart attack and stroke. To avoid these complications, the patient should definitely consult a doctor to discuss treatment options.

So let's see what is hypogonadism?

From a medical point of view, hypogonadism (ICD-10 code: E23.0) is testicular failure due to various factors and defects in their development.

Against the backdrop of all this disruption of testosterone production- the main male sex hormone. At the same time, the concentration of female sex hormones in the body is growing (more precisely, their ratio with male ones), since in the representatives of the stronger sex they are produced by the adrenal glands. There are significantly fewer of them than in women, but still they have a place to be.

But a drop in testosterone levels provokes obesity, delayed sexual development, the absence (or late appearance) of secondary sexual characteristics.

All this leaves its mark on appearance a patient with hypogonadism syndrome (photo below):

In addition, male hypogonadism syndrome is one of the most common causes of male infertility. Until the mid-90s, it was generally believed that hypogonadism (primary and secondary) is a 100% guarantee that a man will never be able to have children again.

To date, there are therapies that can help him become active in the reproductive plan. IVF is also used, that is, artificial insemination by extracting active spermatozoa and forcibly placing them in an egg.

The most important thing about hypogonadism is that it is treatable. Accordingly, all unpleasant symptoms can be avoided, but only with timely seeking medical help. The longer such a visit is postponed, the higher the likelihood of complete atrophy of the testes, in which the production of testosterone (and spermatozoa) completely stops.

Unfortunately, there is no practice of early detection of hypogonadism in the Russian Federation, although the Ministry of Health has such plans.

Classification of hypogonadism

According to the etiology (clinical signs), hypogonadism is divided into:

or testicular hypogonadism (develops against the background of testicular dysfunction);
or gonadotropic hypogonadism (implies problems with the pituitary gland, which regulates the production of androgens, which provoke the synthesis of testosterone).

With secondary hypogonadism, the functionality of the testes is conditionally not impaired, so the man retains reproductive function, but only if there is no testicular atrophy (and it develops over time).

With tertiary (hyperprolactinemic) hypogonadism, a pathology of the central nervous system is detected, due to which the production of gonadotropin-releasing hormone (GnRH) is disrupted. It is he who is responsible for the development of the testicles. Due to the lack of the hormone, the testes begin to work defectively, which in the future leads to a sharp decrease in the concentration of testosterone. And even later, testicular atrophy and infertility develop.

Age-related hypogonadism in men is a natural process for a man. Over time, testosterone production slows down, or even stops altogether, due to the natural wear and tear of the gonads. The disease is especially active in those patients who live in ecologically unfavorable regions.

According to experts, signs of age-related hypogonadism can make themselves felt from 25 to 75 years. To one degree or another, it occurs in 30% of men, mostly of retirement age.

Unfortunately, it is impossible to counteract this process - this is the natural aging of the body. It can be compared with the female menopause and the onset of menopause, when the body simply loses its ability to reproduce.

Still conditionally divided congenital and acquired hypogonadism. The latter occurs against the background of physiological damage to the ovaries, or their defeat by infection, radiation (after radiation therapy). More common is congenital,.

The proportion acquired from all cases of the disease is only 25-35% (more accurate WHO studies have not been conducted).

Male hypogonadism is testicular failure

How is hypogonadism in an adult male? With its implicit course, the disease can be diagnosed, for example, after multiple unsuccessful attempts to conceive a child.

The culprit here is testicular failure and subsequent poor sperm quality.(low sperm count). Against this background, a man can also be found overweight, general lethargy, low libido (sexual attraction to girls), too small size penis.

Pay attention to the typical external manifestations hypogonadism in a man (photo):

Testosterone is involved in many physiological processes in the male body. It is partially responsible for the breakdown of fats, for tone, immunity, external beauty, and so on. And all this is violated or damaged in hypogonadism in one way or another.

In adolescents, this is less noticeable, since they have puberty on average after 12 years. Up to this point, their testosterone levels are relatively low. But in an adult male, the concentration of the hormone is always at a relatively high level (in the range of 12-33 nmol / l for total testosterone).

Treatment of male hypogonadism

The basis is hormonal replacement and attempts to determine the primary factor in the manifestation of the disease.

Hypogonadism is a disease from the category that in no case should you try to cure yourself. Self-medication is unacceptable, and the main therapy and the name of the drugs that a man should take are indicated exclusively by the attending physician.

The so-called "folk" methods of treatment should also be further discussed with him.

As during treatment, the patient is prescribed a synthetic analogue of testosterone. As a rule, this is:

Sustanon;
Omnadren;
Propionate Testosterone;
Andriol (for oral use);
Testim.

For the most part, it is prescribed in the form of injections for intramuscular and intravenous administration (at the discretion of the attending physician). The final choice depends only on the type of hypogonadism and the primary concentration of testosterone in the blood of a man.

Among folk methods treatment worth mentioning inclusion in the diet of natural aphrodisiacs. Among them, for example, ginger, ginseng root (taken in the form of tea), carrots, lemon, gooseberries, currants. But in this regard, it is better to consult with a nutritionist.

Surgery for hypogonadism it is used either for phalloplasty and elimination of other "feminine" features in development (for example, elimination of breast enlargement), or for transplantation of healthy testis cells.

Operations are also carried out with IVF, that is, artificial insemination. In this case, spermatozoa are extracted using a specialized endoscope. But such therapy is prescribed only in cases where the functionality of the testicles is not impaired.

Hypogonadism and bodybuilding

In addition, this sport uses diets designed to stimulate the production of testosterone. And some athletes even inject themselves with hormones indicated for hypogonadism. This accelerates the growth of muscle mass, stimulates metabolic processes and, as a result, a decrease in fat mass.

We should not forget that it is excess weight that can become the main provoking factor of hypogonadism.

Regarding bodybuilding and hormonal injections, you should also consult with your doctor.

Hypogonadism is one of the most severe diseases of the male reproductive system. But it is treatable. Therefore, at the slightest suspicion of pathology, you should seek medical help.

In some cases, short-term replacement therapy will be sufficient, while in others, lifelong control of testosterone in the blood and surgery will be required. The development of the disease for each man in this regard is purely individual.