Male hypogonadism is a condition in which the body does not produce enough testosterone, sperm, or both. It can be congenital, or acquired: presenting before puberty or during adulthood. This condition is classified as primary and secondary, with secondary hypogonadism being the focus of this article. Often underdiagnosed, secondary hypogonadism has a significant impact on the quality of life of men.
What is secondary hypogonadism?
The pituitary gland and the hypothalamus, located in the brain, control hormone production. Secondary hypogonadism refers to a problem in one of these two organs, which are responsible for sending signals to the testes to produce hormones. testosterone, the male hormone involved in sexual performance. On the other hand, the primary hypogonadism, or primary testicular failure, originates from a problem in the testicles. Both types of hypogonadism can be present at birth or acquired during life through injury or infection, and are not mutually exclusive; they can occur together.
Testosterone plays a crucial role in a variety of functions in the male body, from regulating sexual desire to producing sperm and preserving muscle and bone mass. When levels of this hormone decrease, a number of physical and mental health problems arise.
Main causes
The causes of secondary hypogonadism are varied, among them are:
Hypothalamic disorders
Particularly “Kallmann Syndrome,” which consists of an abnormal development of the area of the brain that controls the secretion of hormones from the pituitary gland (hypothalamus).
Pituitary disorders
An abnormality in the pituitary gland affects the release of hormones from the pituitary gland to the testicles, which impairs normal testosterone production. A pituitary tumor or other brain tumor located near the pituitary gland may be the cause of insufficient testosterone or other hormones. Additionally, treatment of a brain tumor, with surgery or radiation therapy, may affect the pituitary gland and cause hypogonadism.
Aging
The passing of the years does not pass in vain, causing a progressive decrease in the levels of sexual hormones.
Obesity
Hypogonadism is related to excessive overweight.
inflammatory diseases
Certain inflammatory diseases affect the hypothalamus and pituitary gland, thus influencing normal testosterone production.
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It causes low testosterone levels by affecting the testicles, hypothalamus, and pituitary gland.
Pharmaceutical products
The indiscriminate use of some medications, such as opioid painkillers and certain hormones, can affect testosterone production.
What does a man with secondary hypogonadism look like?
When hypogonadism appears in adulthood, it interferes with normal reproductive functioning or other physical characteristics, such as erectile dysfunction and decreased sexual desire, which negatively impacts relationships and self-esteem. Changes in body composition are also observed, such as increased fat, loss of muscle mass, gynecomastia, decreased body and facial hair, and even osteoporosis. In some cases, a lack of energy and permanent fatigue are observed.
On an emotional level, many men experience depression and anxiety, which translate into mood swings, irritability or sadness. They may also have cognitive difficulties, such as concentration and memory problems. It is important to note that the intensity of these symptoms varies between individuals, and not all men with secondary hypogonadism will present all of these signs.
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Differences between primary and secondary hypogonadism
It is sometimes difficult to differentiate between primary and secondary hypogonadism because they have similar symptoms, such as decreased sexual desire, erectile dysfunction, and decreased or lost strength. However, there are several differences:
Origin
This is the main difference between the two types of male hypogonadism: primary hypogonadism originates from a problem in the testicles while secondary hypogonadism originates from a problem in the pituitary gland or hypothalamus.
Variable serum chemistry
Both hypogonadisms present variable serum chemistry. In the primary, sperm count and serum testosterone concentration are below average, and serum FSH and testosterone concentrations are elevated. LH hormone are excessively high. While problems related to secondary hypogonadism present a sperm count and serum testosterone concentration below normal, as well as serum concentrations of the FSH hormone and LH not elevated.
Treatment
In either case Hypogonadism can be treated with testosterone hormone replacement therapy, a process in which the patient will be administered testosterone through injections, gel, patches, nasal or implantable pills, with very good results.
On the other hand, primary hypogonadism could also be treated with the help of assisted reproduction techniques, while secondary hypogonadism would be administered pituitary hormones to stimulate sperm production and restore fertility, or it would also be treated with surgical removal of the pituitary tumors.
Diagnostics and medical tests
To diagnose secondary hypogonadism, your doctor will begin with a complete clinical evaluation and symptom analysis. Medical tests he or she will order include:
Blood Tests
This blood test checks the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These reproductive hormones are also called gonadotropins. Testing these levels helps determine whether hypogonadism is primary or secondary.
semen analysis
This test checks sperm count.
Pituitary function tests
Before the If a problem with the pituitary gland is suspected, additional tests will be requested to evaluate its functions.
Images
With imaging studies such as MRI or CT scans examine the pituitary gland and hypothalamus, looking for abnormalities or tumors.
It is important that the diagnosis is made by an experienced health professional, as the symptoms of testosterone deficiency or hypogonadism are often similar to those of other medical conditions.
Treatment for secondary hypogonadism
Treatment for secondary hypogonadism aims to restore testosterone levels to normal ranges and address the underlying causes of the condition. Treatment options include:
Testosterone Replacement Therapy (TRT)
Between 80% – 90% of men respond successfully to this therapy, making it the most common and effective option. TRT It is administered through injections, transdermal patches, gels or subcutaneous implants; this is done to normalize testosterone levels and relieve associated symptoms.
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Treatment of underlying causes
In cases where hypogonadism is due to a pituitary disorder, options such as surgery or drug therapy are considered to address the problem.
Supplements
It has been shown that the use of zinc, vitamin D and other nutrient supplements helps hormonal health.
Changes in lifestyle
Maintaining a balanced diet, exercising regularly and reducing stress also improve testosterone production naturally.
It is essential that any treatment be supervised by a physician, who will adjust the dosage and approach according to the patient's individual needs.
Recommendations for prevention
Regarding the prevention of hypogonadism, as long as it does not involve genetic causes or chronic diseases, action should be taken on the risk factors by maintaining a good physical condition and healthy eating habits. Here are some recommendations:
Monitor general health
The best way to control your health is with regular medical check-ups, which will help you proactively address any chronic diseases and prevent hormonal problems.
Education
Doing what you are doing right now, reading and learning about hormonal health and risk factors, will help you make informed decisions about your health.
keep a healthy weight
Obesity is the mother of many diseases. Maintaining a healthy weight through a balanced diet and regular exercise is beneficial for your sexual health and overall health.
Regular exercise
A combination of strength training and aerobic exercises will help you increase testosterone levels and improve overall health.
Stress management
Everyday life generates high levels of stress that negatively influences general health. Meditation or yoga will help you control it, contributing to maintaining a healthy hormonal balance.
Avoid excessive use of drugs and alcohol
These substances negatively affect hormonal production and testicular function.
Can hypogonadism affect fertility?
Certainly, one of the possible consequences of hypogonadism is infertility. Insufficient testosterone production causes a decrease in sperm production and affects semen quality, resulting in difficulties in fertilization.
If you are interested in fatherhood and are experiencing symptoms of hypogonadism, it is important to consult a specialist. A sex hormone deficiency due to a failure of the testicles can be treated by external injections of LH and FSH. However, if the problem is at the level of the pituitary gland, this procedure will not be effective. Treatment will vary depending on the underlying cause of the testosterone deficiency.
What complications can secondary hypogonadism cause if left untreated?
Testosterone deficiency in adults, depending on the degree and duration of the deficiency, can lead to some health complications, for example, increasing the risk of coronary heart disease and prostate cancer. Likewise, failure to treat this condition in time can lead to a decrease in bone density, increasing the risk of fractures.
With regard to sexual health, decreased libido or low libido and erectile dysfunction, which is extremely serious for a man's life as a couple and his self-esteem. Furthermore, cognitive abilities such as concentration and memory are reduced, which, combined with sleep disorders, affects daily life and work performance. Mood swings, such as depression and outbursts of anger, become more pronounced, significantly impairing the patient's quality of life without treatment.
Other problems, such as increased visceral fat, decreased lean body mass, testicular atrophy, gynecomastia, and sparse body hair, will take months or years to appear.
Conclusion
It is critical for men to educate themselves about their hormonal health and seek medical attention if they experience symptoms related to hypogonadism. With a proactive approach and the right support, it is possible to live a full and healthy life, minimizing the risks and complications associated with this condition. If you suspect you may be suffering from secondary hypogonadism, do not hesitate to consult a hormonal health specialist for a complete evaluation and personalized treatment options.
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