Hypogonadism

All men undergoing fertility testing will be checked for hormonal imbalances that could be contributing to their infertility. One important hormone necessary for proper sexual functioning in men is testosterone. When a man is found to have a testosterone deficiency, it can signal a common disorder known as hypogonadism.

What Does Testosterone Do?
Testosterone, often referred to as the male hormone although females do produce small amounts of the hormone as well, is a hormone that is produced in the testicles. It is responsible for the growth and development of the sex and reproductive organs in men. Additionally, testosterone contributes to the deepening of a man’s voice during puberty, fat distribution, and bone mass. Testosterone also helps to keep a man’s energy levels up as well as encourage his sex drive and fertility.

Much like women, whose production of estrogen and progesterone taper off as they age, testosterone levels begin to decline as a man gets older. These naturally-occurring low testosterone levels can contribute to a decreased sex drive in older men. Yet, low testosterone levels earlier in life are not natural and can produce many unwanted physical changes, including infertility. A common culprit for these falling testosterone levels: hypogonadism.

What is Hypogonadism?
Thought to be one of the main causes of male fertility problems, hypogonadism occurs in an estimated 13 million men in the United States. However, the exact figure is unknown as less than 10% of those affected will seek treatment for the disorder. Hypogonadism refers to a lack of production of the gonadotropin hormone, which can occur when the pituitary gland, testicles or hypothalamus has been damaged or affected by disease. Because of the lack of gonadotropins, men with hypogonadism produce insufficient amounts of testosterone.

Deficient testosterone production can happen at any point during a man’s life. In some men, it is a congenital abnormality as the deficiency has been present from birth. For other men, the deficiency does not present itself until the onset of puberty. In some cases, a man may not develop the testosterone disorder until well into adulthood.

Hypogonadism affects a man’s fertility because the lack of testosterone makes it difficult for men to properly produce sperm. Furthermore, a low testosterone level can contribute to a low sex drive as well as erectile dysfunctions.

Causes of Hypogonadism
A man may be diagnosed with one of two types of hypogonadism: primary or secondary. In cases of primary hypogonadism, the testosterone deficiency is the result of abnormal testicular function. Reasons for primary hypogonadism are numerous and can include:

• Injury resulting in damage to the testicles
• Undescended testicles
• Chemotherapy or radiation therapy
• Excess iron in the blood (a condition known as hemochromatosis)

In some cases, primary hypogonadism can be caused by Klinefelter’s syndrome, a condition in which a male is born with an extra ‘x’ chromosome. Because of the additional chromosome, a variety of problems can arise including impaired testicular growth and difficulties producing sperm.

In men with secondary hypogonadism, the secretion of pituitary hormones is inhibited due to a problem residing in the hypothalamus or pituitary gland. Because of the lack of stimulating hormones from the pituitary, the testicles fail to receive the appropriate signals thereby compromising their performance. Reasons for secondary hypogonadism may be attributed to pituitary disorders or inflammatory diseases that affect the pituitary gland. Men with Kallman’s syndrome will also likely have a testosterone deficiency as this disorder interferes with the proper development of the hypothalamus. The use of certain medications can also lead to improper production of testosterone.

Symptoms of Hypogonadism
Symptoms of low testosterone in men are generally very obvious as proper production of this hormone is necessary for normal male development. However, hypogonadism symptoms do vary and are particular to when the disorder develops.

In instances of congenital hypogonadism, insufficient amounts of testosterone are produce by the gonads. This causes the developing fetus to have improperly formed external genitals and internal reproductive organs, resulting in the birth of a child whose sex is not entirely clear.

Males starting puberty with a testosterone deficiency will suffer from a variety of symptoms affecting almost every part of their normal growth and development. Because the body does not produce enough testosterone, the voice does not deepen and very little muscle mass increase occurs although there may be some development of the breasts. The penis and testicles also do not develop and mature while the growth of facial hair is inhibited and arms and legs grow out of proportion to the trunk of the body.

When hypogonadism presents itself in adulthood, the physical appearance of the man can be significantly altered. Moreover, normal reproductive functioning may cease while emotionally a man can exhibit changes similar to menopausal women. Symptoms of this type of hypogonadism can include:

• Loss of muscle mass
• Increase in body fat
• Development of male breasts
• Failure of facial and body hair to grow
• Shrinking and softening of the testicles
• Loss of energy and sexual desire
• Erectile dysfunction
• Menopausal emotions including hot flashes, irritability and mood swings
• Depression
• Onset of osteoporosis

Hypogonadism Treatment
If you suspect that you may have hypogonadism, it is important to discuss the issue with your health care provider or fertility doctor. A simple blood test can evaluate your testosterone levels and indicate whether your testosterone production is deficient. However, for a proper diagnosis to be made, it will be necessary to be assessed by an endocrinologist. Once the disorder has been confirmed, you can begin treatment for hypogonadism.

Testosterone replacement therapy (TRT) is the main form of treatment used in men with hypogonadism. TRT looks to replace your diminished testosterone levels with synthetic testosterone supplements. How effective testosterone therapy will be, though, depends on what type of hypogonadism you have.

Those men affected by primary hypogonadism will be able to increase their testosterone production through the use of TRT. However, it is unlikely that your fertility will return, making it necessary to utilize ART in order to conceive. Men with secondary hypogonadism usually respond better to testosterone treatment and are often able to recover their fertility through the use of a testosterone supplement.

TRT can be administered a variety of ways with testosterone gel and the testosterone patch being two of the most popular methods. However, injectable testosterone is also available as are oral testosterone supplements, although this particular method is often avoided nowadays due to the undesirable side effects associated with it.

In addition to TRT, psychological counseling may also be beneficial for both you and your partner. In many areas, support groups are available that will allow you to meet other men dealing with the same difficulties as you.

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