Disease Description (Causes and Symptoms)
Hypogonadism is a condition in which the secretion of gonadal hormones (testosterone, estrogen, etc.) decreases due to abnormalities in the gonad-stimulating axis (hypothalamus–pituitary–gonad) or reduced function of the ovaries or testes themselves.
- Pathophysiology: It is classified as primary (LH/FSH are elevated due to problems with the testes or ovaries) or secondary/central (LH/FSH are decreased or abnormal due to problems with the hypothalamus or pituitary gland). Other causes include abnormalities of other endocrine glands, such as the thyroid and adrenal glands; genetic disorders (Klinefelter, Turner); pituitary tumors; radiation; chemotherapy; infections; and trauma.
- Main symptoms:
- Men: Erectile dysfunction, decreased libido, reduced penis and testicular size, decreased body hair (face, armpits, and pubic area), reduced muscle strength, fatigue, infertility, and decreased bone density
- Women: Amenorrhea, oligomenorrhea, irregular menstruation, decreased menstrual flow, menopause-like symptoms (hot flashes and sweating), decreased libido, breast changes, and infertility
- If onset occurs before adolescence: Delayed puberty and delayed growth and development of secondary sexual characteristics
- Other: Mood changes, anemia, increased risk of osteoporosis and fractures, and possible metabolic abnormalities
Treatment Methods
- Principle: Treatment according to the cause (correction of the underlying condition → hormone replacement if necessary)
- Medication (hormone replacement):
- Men: Testosterone replacement therapy (skin gel/patches, intramuscular injections, oral formulations, etc.) — improves symptoms (sexual function, muscle strength, and mood) and bone density
- Women: Estrogen ± progestin for menopausal symptoms and hormone deficiency (considering age and whether the uterus is present)
- Infertility treatment (when pregnancy is desired): In secondary (central) cases, administration of pulsatile GnRH or human gonadotropins (hCG, FSH); assisted reproductive technology (IVF, etc.) may be considered in cases of primary testicular or ovarian damage
- Surgery/procedures: If caused by a pituitary tumor, tumor resection (such as an endoscopic transsphenoidal approach) and, if necessary, radiation therapy
- Adolescents: Gradual induction of puberty with low-dose sex hormones (considering growth and epiphyseal closure)
- Lifestyle management: Regular aerobic and strength training, weight management, smoking cessation and moderation of alcohol intake, calcium and vitamin D supplementation (to prevent osteoporosis), and bone density testing
- Monitoring/precautions: Before and during treatment, blood hormone levels (LH, FSH, testosterone/estrogen), liver function, lipids, hematocrit (especially during testosterone treatment in men), and PSA testing (in middle-aged and older men) are necessary
- Contraindications/precautions: Hormone therapy in men and women requires caution in the presence of active prostate cancer or breast cancer; estrogen use may increase the risk of blood clots
- Complications: If left untreated, infertility, osteoporosis and fractures, increased risk of metabolic syndrome and cardiovascular disease, and psychosocial effects (depression and sexual dysfunction) may occur
Checklist Before an Outpatient Visit (Including Example Questions)
Items to bring and things to check
- List of currently taken medications (including prescription drugs, over-the-counter drugs, and supplements) — medications that affect hormones, such as steroids, progestins, antipsychotic drugs, and anti-estrogen agents, are especially important
- Previous test results (recent blood hormone tests: LH, FSH, testosterone/estradiol, TSH, etc.), imaging (brain MRI, testicular/ovarian ultrasound), and chromosome testing (karyotype)
- Record when symptoms began, how they have progressed (e.g., when menstruation stopped, when decreased libido began, and changes in erectile function), and their severity
- Information related to growth and puberty (for adolescents, growth charts and growth and development history)
- Pregnancy and childbirth history and whether pregnancy is desired in the future (fertility preservation plans)
- Lifestyle habits (smoking, alcohol consumption, and exercise) and occupational history (exposure to radiation or toxic substances)
Examples of questions to prepare to ask during the outpatient visit (things to bring up with the doctor first) - “I will show you my recent test results (hormone levels, MRI, etc.).”
- “If I want to become pregnant (or preserve sperm or eggs), what options are available?”
- “Could my current medications be changing my hormone levels?”
Examples of General Questions to Ask the Doctor
- What is the suspected cause of this condition, and what additional tests are needed?
- What hormone treatment do you recommend, and what are the expected benefits and side effects?
- How long does it usually take for symptoms to improve after starting treatment?
- If I want to become pregnant, what procedures (fertility preservation, assisted reproductive technology, etc.) do you recommend?
- What tests should be monitored long term (bone density, cardiovascular function, liver function, etc.)?
Examples of Disease-Specific Questions
- In my case, how can it be determined whether this is primary (a testicular/ovarian problem) or secondary (a hypothalamic/pituitary problem), and how would the treatment options (hormone replacement versus attempts to restore reproductive function) differ accordingly?
- If I want to preserve my current fertility (pregnancy or sperm production), what methods are available and what is the likelihood of success? (e.g., whether sperm freezing, egg freezing, artificial insemination/in vitro fertilization is recommended)