Exploring The Symptoms, Causes, And Treatments Of Primary Hypogonadism

Male hypogonadism is a condition where the body doesn't produce enough testosterone, an essential male sex hormone. This can happen at any age but is more common in men who are middle-aged or older. Studies show that 35% of men over 45 have primary hypogonadism.

There are two main types of hypogonadism: primary and central (secondary). In this article, you'll learn about primary hypogonadism, including its symptoms, causes, and treatments.

What Is Primary Hypogonadism?

Primary hypogonadism happens when your testes don't produce testosterone even though the brain sends signals to them. This condition can be something you're born with (congenital) or develops later (acquired).

Symptoms Of Primary Hypogonadism

The signs of hypogonadism depend on when it starts and how much testosterone is lacking.

If it starts during fetal development, a baby who is genetically male might have:

• Female genitals
  
  
• Underdeveloped male genitals
  
  
• Ambiguous genitals (genitals that don't look male or female)
  
  

If it starts before puberty, it can delay average growth and puberty. Symptoms might include:

• Low muscle mass
  
  
• Delayed growth of sex organs
  
  
• Development of breast tissue
  
  
• Long arms and legs
  
  
• Delay in secondary sex characteristics (like facial hair and deepening voice)

You might notice changes in your masculine traits and reproductive system if it starts after puberty. Common symptoms include:

• Low sperm count
  
  
• Low bone density
  
  
• Erectile dysfunction (ED)
  
  
• Reduced muscle mass
  
  
• Tiredness
  
  
• Low libido
  
  
• Infertility
  
  
• Hot flashes
  
  
• Accumulation of body fat
  
  
• Depression
  
  
• Irritability
  
  
• Low energy level
  
  
• Difficulty concentrating

What Causes Primary Hypogonadism?

There are many causes of primary hypogonadism, including:

Genetic Disorders

Men can be born with abnormal genes that lead to genetic disorders and primary hypogonadism. Some genetic disorders that cause this condition include:

Klinefelter Syndrome: This condition occurs when men are born with an extra X chromosome, making them XXY instead of XY. Usually, men are XY, and women are XX.

The extra X chromosome in Klinefelter syndrome affects physical and intellectual development. Men with this condition may have broader hips, larger breasts, less body and facial hair, smaller testicles, and low testosterone levels.

Autoimmune Disorders

Autoimmune disorders happen when the body's immune system, which usually attacks foreign cells, mistakenly attacks the body's healthy cells. Some autoimmune disorders that cause primary hypogonadism include:

Addison’s Disease occurs when the immune system attacks the adrenal glands. When 90% of the adrenal gland is damaged, it can't produce essential hormones like aldosterone and cortisol. Sometimes, very long-chain fatty acids (VLCFA) build up in the adrenal cortex and testes, producing low testosterone.

Undescended Testes

This congenital disorder occurs when the testes do not move down into the scrotum (their permanent place) from the abdomen during fetal development or shortly after birth. As a result, they can't function properly, leading to low testosterone.

Infections

Mumps orchitis: This infection occurs when the mumps virus attacks men after puberty. The testicles become painful and swollen and may get damaged, reducing their size and testosterone production.

Injuries

Testicles are located outside the abdomen, making them more prone to injuries. Any injury to the testicles, whether minor or severe, can cause problems, including low or no testosterone production.

Certain Diseases

Hypoparathyroidism: This endocrine disease is caused by mutations in several genes. It affects the parathyroid glands, which don't produce enough parathyroid hormone, causing high blood calcium levels. Hypoparathyroidism also affects the testicles' ability to produce testosterone.

Liver and kidney diseases: These diseases increase the risk of primary hypogonadism. Studies show that 44% of men with kidney failure have low testosterone levels.

Chemotherapy Or Radiotherapy

Cancer treatments can reduce the ability of the testicles to produce testosterone and sperm, leading to temporary infertility. Most men regain their fertility after the treatment ends. Doctors often suggest preserving sperm before starting chemotherapy or radiotherapy.

Ageing

As men age, their testosterone levels naturally decrease. Studies show that over 30% of men older than 75 have low testosterone levels.

What Is The Role Of Testosterone?

Testosterone is important for men's body, brain, and sexual development. Its most noticeable effects start around puberty, including deepening the voice, growing body and facial hair, developing body odour, and causing acne.

Testosterone has these critical roles in men:

Sexual Functions

• Regulates the formation of sex organs
  
  
• Increases sex drive
  
  
• Helps produce sperm
  
  
• Maintains fertility

Cognitive Development

• Affects mood and behaviour (can cause aggression and reduce depression)
  
  
• Improves specific cognitive skills (like spatial orientation)
  
  
• Maintains a feeling of happiness and well-being

Body Development

• Maintains bone density
  
  
• Helps muscles grow
  
  
• Stimulates body hair growth and other male secondary sexual characteristics

How To Diagnose Primary Hypogonadism?

Your doctor will start by doing a physical exam to look for visible signs and symptoms. Then, they'll ask for some blood tests, including hormone tests.

Your blood sample will be taken early in the morning when testosterone levels are highest for a testosterone test. This test will be done two to three times on different days. Healthy men have 300 to 1,000 nanograms of testosterone per deciliter (ng/dL). If your level is below 300 ng/dL, you might have testosterone deficiency.

The doctor may perform other tests to determine if something else is causing the problem. Since thyroid hormone levels can affect testosterone, your doctor will also measure them.

They will also check follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels to determine whether it is primary or secondary hypogonadism. Your iron levels might also be checked because low iron can reduce testosterone production.

How Is Primary Hypogonadism Treated?

Testosterone replacement therapy (TRT) is the most common treatment for male hypogonadism. It involves giving you bioidentical testosterone to increase your blood testosterone levels.

Benefits of TRT include:

• Restoring sex drive, fertility, and sexual function
  
  
• Increasing bone density and reducing the risk of osteoporosis
  
  
• Improving body fat distribution and preventing fat accumulation
  
  
• Possibly boosting growth hormone production in adults
  
  
• Increasing energy levels
  
  
• Improving mood

There are several ways to get testosterone through TRT. Your doctor will explain the pros and cons of each method to help you choose the best one for your condition, lifestyle, and budget.

How To Administer Testosterone?

Topical Gels:

It is applied directly to the skin once a day. Doctors advise letting the gel dry entirely before skin-to-skin contact to prevent transferring testosterone to others. The best places to apply the gel are the shoulders, upper arms, and abdomen.

Transdermal Patches:

They are placed on the skin to give a steady supply of testosterone. A new patch is applied every 24 hours, usually on the back, abdomen, thighs, or upper arms. Using a new spot each time is essential to avoid skin irritation.

Intramuscular Injections:

These come in different doses. Your doctor will choose the correct dose for your testosterone levels and may adjust it over time to ensure the best results.

Pellets:

They are inserted under the skin through a small cut, usually near the hip. They need to be replaced every six months.

Oral Tablets:

They are taken 1 to 3 times a day but are less common because they can cause side effects like bloating, loss of appetite, diarrhoea, and headaches.

What Are The Risks Associated With TRT?

Like other treatments, TRT can have side effects, so it’s not suitable for everyone. Doctors will first review your medical history and conduct tests to evaluate your overall health before deciding if you should receive testosterone.

Common side effects of TRT include:

• Worsening of pre-existing prostate cancer
  
  
• Worsening of sleep apnea symptoms
  
  
• May cause congestive heart failure

Conclusion

Primary hypogonadism impacts the sexual and physical health of men worldwide. If you have this condition, getting timely treatment to improve your quality of life is essential.

TRT is the most effective treatment to reduce the signs and symptoms of hypogonadism. Contact a hormone specialist to get started and improve your overall well-being. If you're considering testosterone replacement therapy, we can help. Our specialists will guide you through the process and provide the support you need for effective treatment.