Hypogonadism in men and women: symptoms and treatment
Hypogonadism is a disease characterized by hypofunction of the sexual glands with a decrease in the synthesis of sex hormones. The syndrome is accompanied by underdevelopment of the organs of the reproductive system, the absence or regression of secondary sexual characteristics, and the disturbances in the metabolism of proteins and lipids.
The treatment of hypogonadism is the responsibility of endocrinologists, as well as andrologists or gynecologists( depending on the gender of the patient ).Obligatory replacement therapy with hormones is necessary, and if necessary, resort to surgical correction of the genitals.
According to medical statistics, hypogonadism is diagnosed in about half of patients with infertility.Table of contents:
Types of hypogonadism in men
Hypogonadism in men is divided into primary and secondary .Both can be congenital and acquired in origin.
Primary is due to the defect and dysfunction of the testicle tissue.The glands do not produce testosterone or synthesize it in insufficient quantities.
Secondary variety occurs in cases of disorders from the hypothalamic-pituitary system.
According to another classification, three types of hypogonadism are distinguished:
- is normogonadotropic;
- is hypergonadotropic.
Hypogonadotropic form is caused by a decreased secretion of gonadotropins, on which the synthesis of androgens directly depends.The reason for the development of normogonadotropic type of pathology is an excess of prolactin.
With a hypergonadotropic variety of the syndrome, the primary lesion of the gonads is accompanied by an elevated level of gonadotropins.
Androgen deficiency can develop in embryonic, pre-pubertal and post-pubertal periods.
Pathologies leading to congenital primary hypogonadism:
- Klinefelter's syndrome( true);
- false male hermaphroditism;
- Shereshevsky-Turner syndrome;
- sertoli-cell syndrome.
Note: anarchism is the absence of testicles and their appendages due to pathologies of intrauterine development.Gonadal dysfunction is also possible against a background of cryptorchidism( testicular uncooperation in the scrotum) and ectopia( an abnormal testicle location under the skin of the femoral region or perineum).
Reasons for acquired secondary hypogonadism:
- false Klinefelter syndrome;
- traumatic damage testicles;
- tumors of the gonads.
Causes of congenital secondary( hypogonadotropic) form:
- damage to the hypothalamus;
- pituitary dwarfism;
- tumor at the time of birth( craniopharyngioma).
Reasons for acquired secondary hypogonadism:
- adiposogenital dystrophy;
- a pathological increase in the level of prolactin;
- Prader-Wil syndrome;
- syndrome of Lawrence-Moon-Barde-Bil.
Etiological factors contributing to the development of primary hypogonadism include genetic defects, mother intoxication during pregnancy, infections and chemotherapy of oncological diseases .Dysfunction of the testicles is affected by radiation, hormonal drugs in large doses, traumatic injuries, as well as varicocele( varicose veins of spermatic cord).
In the etiology of the secondary variety, tumors and pathologies of intrauterine development, which affect hypothalamic-pituitary regulation, are of great importance.Hypogonadism is often due to an age-related decline in the synthesis of androgens.
Symptoms of hypogonadism in men
Symptomatic disease is determined by the degree of severity of the androgen deficiency and the age at which the pathology developed.
Important: if the androgen deficiency occurred during the period of intrauterine development, the child can appear with the primary signs of both sexes.
Symptoms of hypophysea in the adipose period:
- no secondary traits;
- disproportionately long limbs;
- muscle weakness;
- underdeveloped thorax;
- true gynecomastia;
- underdevelopment of the prostate;
- undeveloped phallus( less than 5 cm);
- lack of hair in the pubic area;
- fiber deposition by female type.
For secondary hypofunction of the sex glands, obesity, lack of libido and erectile dysfunction are characteristic.
With hypogonadism of the post-pubertal period, all the signs are not so pronounced.Testicules decrease in size( a symptom is observed in all forms of pathology). Patients have a decrease in skin turgor;Vegeto-vascular dysfunction is also common.Secondary sexual characteristics have the property of regressing.
Sperm production is significantly reduced or absent .Against the background of a decrease in the synthesis of testosterone a man becomes sterile.Generalized clinical signs include general weakness and increased fatigue.
Detection of male hypogonadism and methods of its treatment
Endocrinologist diagnoses a patient based on a patient's complaints, history, examination and laboratory tests on serum testosterone, gonadoliberin, estradiol and prolactin a.With the help of a testicle biopsy, neoplasms are detected and their character is established;In general, this research is not very informative.
Note: when hypogonadism is analyzed spermogram, but it is not always possible to obtain biomaterial from the patient.
Treatment is primarily aimed at eliminating the cause of pathology.Its main goals - prevention of delayed sexual development, prevention of degeneration of the sex glands and the fight against infertility.
With congenital or hypothetical hypogonadism, reproductive function can not be restored.
Primary form shows stimulation with non-hormonal agents( before puberty) or androgens and gonadotropins( in adults). If full absence of testicular tissue reserves is established, testosterone patients are forced to take regularly throughout their life.
Secondary hypogonadism is an indication for the administration of gonadotropins( often combined with androgens).
In some cases, is surgically treated.It can presuppose transplantation of testicles( with anarchism), reduction of testicles( with cryptorchidism) or plasticity of the phallus( with its underdevelopment).
Complex adequate therapy reduces the severity of underlying and accompanying symptoms.
What is female hypogonadism?
In women, this pathology is caused by low functional activity of the ovaries.Primary hypogonadism is caused by intrauterine pathologies of development of these organs or their damage at an early age. With this form of the disease, the level of estrogen is sharply reduced, resulting in the hypersecretion of gonadotropins.
Reasons for the primary form:
- genetic mutations;
- congenital hypoplasia;
- radiation injury;
- autoimmune process;
- polycystic ovary.
Symptoms of significant estrogen deficiency:
- atrophic changes in the organs of the reproductive system and mammary glands;
- primary amenorrhea;
The secondary form of pathology is caused by dysfunction of the hypothalamic-pituitary system.At them sharply the synthesis of gonadotropins, responsible for the regulation of the functions of the gonads, is reduced or blocked.
Possible causes of secondary female hypogonadism:
- tumor neoplasms in the brain( benign or malignant);
Symptoms of gonadal hypofunction in women
Amenorrhea( absence of menstrual periods) or dysmenorrhea( cycle disorders) are the leading clinical signs of hypogonadism in patients of fertile age.
When estrogen deficiency is noted:
- underdevelopment of genital organs and mammary glands;
- sparse hair;
- subcutaneous subcutaneous tissue disorder.
Note: if the pathology is congenital, the pelvis in the patients is narrow, but the buttocks are flat.
Diagnosis and treatment of female hypogonadism
When diagnosed, the level of gonadotropins and estrogens, as well as the anthropometric characteristics of are taken into account.Underdevelopment of the uterus and ovaries is detected during ultrasound scanning.X-ray examination allows revealing the underdevelopment of the skeleton and pathological changes in the structure of bone tissue( osteoporosis).
Treatment of primary ovarian hypofunction involves the appointment of ethinyl estradiol as hormone replacement therapy.
Patients are advisable to take birth control pills with gestagens and estrogens.
Contraindications to the intake of hormonal drugs - oncological diseases of the reproductive system, as well as thrombophlebitis, renal pathology and liver failure.
Vladimir Plisov, doctor, medical reviewer