Male hypogonadism

Male hypogonadism is a condition in which the body doesn't make enough of the hormone testosterone or enough sperm or both. Testosterone plays a key role in male growth and maturing during puberty.

People can be born with male hypogonadism. Or it can start later in life, often from injury or infection. The cause of the condition and when it starts affect what can be done about it. Testosterone replacement therapy can treat some types of male hypogonadism.

Male hypogonadism means the testicles don't make enough of the male sex hormone testosterone. There are two basic types of hypogonadism:

• Primary. This type of hypogonadism comes from a problem in the testicles. It's also called primary testicular failure.
• Secondary. This type of hypogonadism means there's a problem in the parts of the brain that tell the testicles to make testosterone. These parts of the brain are the hypothalamus and the pituitary gland.

  The hypothalamus makes gonadotropin-releasing hormone, which signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then tells the testes to make testosterone.

A trait passed through families, also called inherited, can cause either type of hypogonadism. Something that happens later in life, such as an injury or infection, also can cause either type. This is called acquired hypogonadism. At times, primary and secondary hypogonadism occur together.

Primary hypogonadism

Common causes of primary hypogonadism include:

• Klinefelter syndrome. This condition results from a problem of the sex chromosomes X and Y. It's present at birth, called congenital. A male typically has one X and one Y chromosome. In Klinefelter syndrome, there are two or more X chromosomes plus one Y chromosome.

  The Y chromosome holds the genes that controls the sex of a male child and how the child develops. The extra X chromosome in Klinefelter syndrome causes unusual growth of the testicles. This results in too little testosterone.

• Testicles that don't move into place, called undescended. Before birth, the testicles develop inside the belly and move down into their place in the scrotum. Sometimes one or both testicles haven't moved into place by birth.

  This condition often fixes itself within the first few years of life. If not fixed in early childhood, it can cause the testicles not to work correctly or make enough testosterone.

• Mumps orchitis. A mumps infection as a teenager or as an adult can harm the testicles.
• Hemochromatosis. Too much iron in the blood can cause the testicles to fail or the pituitary gland not to work as it should.
• Injury to the testicles. Because they're outside the belly, the testicles can be injured easily. Harm to both testicles can cause hypogonadism. If one testicle is harmed or removed, the other will take over and make the testosterone that's needed.

• Cancer treatment. Chemotherapy or radiation therapy to treat cancer can affect how well the body makes testosterone and sperm. The effects of both treatments often are short-lived. But they can cause lifelong inability to have children.

  Many men get their fertility back within a few months after treatment. But storing sperm before starting cancer therapy is an option for those who want to have children.

Secondary hypogonadism

In secondary hypogonadism, the testicles look typical but don't work the way they should due to a problem with the pituitary or hypothalamus. Several conditions can cause secondary hypogonadism, including:

• Kallmann syndrome. This is an unusual development of the area of the brain called the hypothalamus, which controls the pituitary hormones. This problem also can affect the ability to smell, called anosmia. And it can cause red-green color blindness.

• Pituitary conditions. A condition in the pituitary gland can keep hormones from going from the pituitary gland to the testicles. This affects the making of testosterone. A pituitary tumor or other type of brain tumor near the pituitary gland can cause there to be too little of the hormones needed to spur the making of testosterone and sperm.

  Also, treatment for a brain tumor, such as surgery or radiation therapy, might affect the pituitary gland and cause hypogonadism.

• Inflammatory disease. Certain diseases that cause the immune system to attack healthy tissue, called inflammatory, can affect the making of testosterone. Examples are sarcoidosis, histiocytosis and tuberculosis.
• HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
• Medicines. The use of certain medicines, such as opiates for pain and some hormones, can affect testosterone levels.
• Obstructive sleep apnea. If untreated, this sleep-related breathing condition can cause hypogonadism. The hypogonadism might improve after sleep apnea treatment.
• Obesity. Being significantly overweight at any age might be linked to hypogonadism.
• Aging. Testosterone levels lessen with age. How fast they go down varies from person to person.

Risk factors for hypogonadism include:

• HIV/AIDS.
• Having had chemotherapy or radiation therapy.
• Aging.
• Obesity.
• Not having a good diet, called malnutrition.
• Obstructive sleep apnea.

Hypogonadism can be passed through families, called inherited. If any of these risk factors are in your family health history, tell a member of your healthcare team.

The complications of untreated hypogonadism differ depending on whether it starts in the womb, at puberty or in adulthood.

Complications might include:

• Unusual genitals.
• Growth of breast tissue, called gynecomastia.
• Not being able to have children, called infertility.
• Not being able to get or keep an erection, called erectile dysfunction.
• The bone-weakening disease called osteoporosis.
• Poor self-image.