Exploring The Symptoms, Causes, And Treatments Of Primary Hypogonadism

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.

Primary hypogonadism is a health problem that happens when the ovaries or the testes do not make enough sex hormones. These hormones are essential for puberty, fertility, bone strength, mood, and overall well-being. When the gonads are not working correctly, the brain keeps sending out signals to try to make them work, but the hormone levels stay low. Doctors can see this in blood tests, where testosterone or oestrogen is low but the signals from the brain (LH and FSH) are high.

Understanding primary hypogonadism matters because it can affect both men and women at different stages of life. It may lead to problems with puberty, fertility, mood, energy, or bone health. In this blog, we will look closely at the main symptoms, the most common causes, and the treatments that can help people manage this condition more effectively.

Understanding Primary Hypogonadism

Primary hypogonadism is a condition where the problem starts in the gonads. The gonads are the testes in boys and men, and the ovaries in girls and women. Their job is to make sex hormones such as testosterone in males and oestrogen in females. These hormones are crucial for puberty, fertility, strong bones, healthy muscles, and overall well-being.

When the gonads do not work as they should, the body cannot make enough of these hormones. The brain notices this and tries to help by sending out more of its controlling hormones. These are called luteinising hormone (LH) and follicle-stimulating hormone (FSH). However, the gonads cannot respond appropriately, so sex hormone levels stay low. This is why doctors sometimes call the condition hypergonadotropic hypogonadism, which means high LH and FSH but low sex hormones.

It is also essential to understand the difference between primary and secondary hypogonadism. In secondary hypogonadism, the gonads are healthy, but the brain does not send enough signals. In primary hypogonadism, the brain is working well, but the gonads themselves are not able to make the hormones.

Symptoms of Primary Hypogonadism

The symptoms of primary hypogonadism can look different in males and females. They can also vary depending on the age at which the condition begins.

Symptoms in Males

In boys before or during puberty:

• Puberty may start late or not happen at all.
  
  
• The penis and testes may stay small.
  
  
• The voice may not deepen.
  
  
• There may be little or no growth of facial or body hair.
  
  
• Muscles may remain underdeveloped.
  
  

In adult men:

• Low interest in sex.
  
  
• Problems with erections.
  
  
• Feeling tired or having low energy.
  
  
• Loss of muscle mass and strength.
  
  
• Increase in body fat.
  
  
• Swelling of breast tissue, called gynaecomastia.
  
  
• Weak bones, which can lead to osteoporosis.
  
  
• Low mood or depression.
  
  

Symptoms in Females

In girls before or during puberty:

• Puberty may not begin as expected.
  
  
• Breasts may not develop fully.
  
  
• Periods may not start.
  
  
• Growth of pubic and underarm hair may be very light or absent.
  
  

In adult women:

• Irregular or missed periods.
  
  
• Inability to get pregnant.
  
  
• Hot flushes and night sweats.
  
  
• Loss of interest in sex.
  
  
• Thinning of bones, which raises the risk of osteoporosis.
  
  
• Low mood, tiredness, or irritability.
  
  

What Causes Primary Hypogonadism?

Primary hypogonadism happens when the testicles (the male sex glands) cannot make enough testosterone. There are many reasons why this can happen:

1. Genetic Conditions

Some men are born with changes in their genes that cause hypogonadism.

• Klinefelter Syndrome: Men are usually born with XY chromosomes, but in this condition, they have an extra X (XXY). This can affect growth and development. Men with Klinefelter syndrome may have wider hips, larger breasts, less body and facial hair, smaller testicles, and lower testosterone levels.
  
  

2. Autoimmune Disorders

The immune system normally protects us by fighting off germs. But sometimes it attacks healthy cells by mistake.

• Addison’s Disease: Here, the immune system damages the adrenal glands, which make essential hormones. This can also affect the testes, leading to low testosterone.
  
  

3. Undescended Testes

Sometimes, the testes don’t move down into the scrotum (their proper place) before or just after birth. If they stay inside the body, they may not work correctly and can produce less testosterone.

4. Infections

• Mumps orchitis: If a man gets mumps after puberty, the virus can spread to the testicles, causing swelling, pain, and sometimes lasting damage. This can reduce testosterone production.
  
  

5. Injuries

Because the testicles hang outside the body, they are more likely to get hurt. A bad injury can damage them and reduce testosterone levels.

6. Certain Diseases

• Hypoparathyroidism: A rare condition where the parathyroid glands don’t make enough hormone. This can also affect how well the testes make testosterone.
  
  
• Liver and kidney disease: Men with severe liver or kidney problems are more likely to have low testosterone. For example, almost half of men with kidney failure have low levels.
  
  

7. Cancer Treatments

Chemotherapy and radiotherapy can temporarily stop the testes from making testosterone and sperm. Many men recover after treatment, but doctors often recommend freezing sperm beforehand.

Ageing

Testosterone levels naturally drop as men get older. Around 1 in 3 men over 75 have low testosterone.

Diagnosis of Primary Hypogonadism

Doctors use a mix of medical history, physical checks, and blood tests to find out if someone has primary hypogonadism.

The first step is usually a talk about symptoms. A doctor may ask about puberty, energy levels, mood, sex drive, or periods. They may also ask about family history and any past illnesses or treatments, such as chemotherapy or infections like mumps.

A physical check can give more clues. In males, this may include looking at the size of the testes, body hair, and muscle strength. In females, it may consist of looking at breast development and the menstrual cycle.

Blood tests are critical. These tests usually show low levels of sex hormones such as testosterone in males or oestrogen in females. At the same time, they show high levels of the brain hormones called luteinising hormone (LH) and follicle-stimulating hormone (FSH). This is a clear sign that the gonads are not working even though the brain is sending a strong signal.

Sometimes extra tests are needed. For example, genetic testing may be used if doctors think the cause is inherited. Imaging tests, such as an ultrasound or MRI scan, can also be used to look at the ovaries or testes if needed.

Clinical Impact and Complications

Primary hypogonadism can affect many parts of the body and can also affect mental health. The problems may be different for each person, but some are very common.

One of the most significant effects is on fertility. In men, the testes may not make enough sperm, which makes it hard to father a child. In women, the ovaries may not release eggs regularly, which makes it hard to get pregnant.

The condition can also weaken the bones. Low hormone levels can lead to osteoporosis, characterised by thinning bones that break more easily. This can happen in both men and women.

There can also be changes in the body. Men may lose muscle and gain more body fat. Women may have hot flushes and other symptoms linked to low oestrogen. Both men and women may feel exhausted, have less energy, or lose interest in sex.

Mental health can also be affected. Some people may feel low, anxious, or have problems with confidence. These feelings are linked to both hormone changes and the stress of dealing with the condition.

What Is the Role of Testosterone?

Testosterone is the primary male sex hormone. It is essential for the body, the brain, and sexual development.

During puberty, testosterone causes significant changes, such as:

• A deeper voice
  
  
• Growth of body and facial hair
  
  
• Stronger body smell
  
  
• Acne (spots)
  
  

Main Jobs of Testosterone

1. Sexual Functions
   
   

• Helps form the male sex organs
  
  
• Increases sex drive
  
  
• Helps make sperm
  
  
• Keeps men fertile
  
  

2. Brain and Mood
   
   

• Affects mood and behaviour (can sometimes make men more aggressive but also helps lower depression)
  
  
• Improves specific thinking skills, like reading maps or shapes
  
  
• Helps with feelings of happiness and well-being
  
  

3. Body Development
   
   

• Keeps bones strong
  
  
• Helps muscles grow and stay firm
  
  
• Encourages body hair and other male features that appear at puberty
  
  

Treatment Options for Primary Hypogonadism

Primary hypogonadism cannot always be cured, but some treatments can help with symptoms and improve quality of life. The proper treatment depends on the person’s age, sex, and whether they want to have children in the future.

The most common treatment is hormone replacement therapy. In men, this is usually testosterone, and in women, it is usually oestrogen, sometimes with progesterone. This helps replace the hormones that the gonads cannot make. It can improve energy, sex drive, mood, and bone health.

Other treatments can help with fertility, bone health, and general well-being. The table below shows some of the main options.

Common Treatments for Primary Hypogonadism

Doctors usually recommend regular check-ups to ensure treatment is safe and effective. For example, men on testosterone need blood tests to check red blood cell levels, and women on oestrogen may need breast and pelvic checks.

How to Take Testosterone

Testosterone can be given in different ways. A doctor will decide what is best for each person.

1. Topical Gels

• Put directly on the skin once a day.
  
  
• Must dry completely before touching others, so the hormone is not passed on.
  
  
• Usually applied to the shoulders, upper arms, or stomach.
  
  

2. Skin Patches (Transdermal Patches)

• It is stuck onto the skin to give a steady supply of testosterone.
  
  
• Changed every 24 hours.
  
  
• It can be placed on the back, stomach, thighs, or upper arms.
  
  
• It is essential to switch to a new spot each time to avoid skin irritation.
  
  

3. Injections (Intramuscular)

• Given into a muscle in different doses.
  
  
• The doctor chooses the correct dose and may change it depending on testosterone levels.
  
  

4. Pellets

• Small pellets are placed under the skin through a tiny cut, usually near the hip.
  
  
• They slowly release testosterone and need to be replaced about every 6 months.
  
  

5. Oral Tablets

• Taken by mouth 1 to 3 times a day.
  
  
• They are not used very often because they can cause side effects such as bloating, loss of appetite, diarrhoea, and headaches.
  
  

What Are the Risks of TRT?

Like all treatments, testosterone replacement therapy (TRT) can have side effects, so it is not suitable for everyone. Before starting, doctors check your medical history and conduct tests to ensure it is safe. TRT can sometimes make prostate cancer grow faster, make sleep apnoea (breathing problems during sleep) worse, or increase the risk of heart failure.

Frequently Asked Questions

What is primary hypogonadism, and how does it affect the body?

Primary hypogonadism is a condition where the ovaries or testes do not make enough sex hormones such as testosterone or oestrogen. This can lead to problems with puberty, fertility, bone health, mood, and overall energy levels.

What is the difference between primary and secondary hypogonadism?

In primary hypogonadism, the problem is in the gonads themselves, so they cannot respond to the brain’s signals. In secondary hypogonadism, the gonads are healthy, but the brain does not send enough hormones to stimulate them.

What are the symptoms of primary hypogonadism in males?

The symptoms of primary hypogonadism in males can include low sex drive, erectile problems, reduced muscle strength, more body fat, breast tissue growth, tiredness, and weak bones. In teenage boys, it can cause delayed puberty and lack of normal development.

What are the symptoms of primary hypogonadism in females?

The symptoms of primary hypogonadism in females can include missed periods, problems with fertility, hot flushes, loss of interest in sex, thinning of bones, and low mood. In young girls it can cause poor breast development and late or absent puberty.

What causes primary hypogonadism in men and women?

Primary hypogonadism can be caused by genetic conditions such as Klinefelter syndrome in men or Turner syndrome in women. Infections like mumps, injuries, cancer treatments, autoimmune disease, or long-term illnesses such as kidney or liver disease can also cause it.

How is primary hypogonadism diagnosed?

Doctors diagnose primary hypogonadism with a mix of medical history, physical checks, and blood tests. The key sign is low testosterone or oestrogen with high levels of LH and FSH, showing that the gonads are not responding to the brain’s signals.

Can primary hypogonadism cause infertility?

Yes, primary hypogonadism can cause infertility in both men and women. Men may not produce enough sperm, and women may not release eggs regularly. Treatments such as gonadotropin therapy or assisted reproduction may help some people.

What treatments are available for primary hypogonadism?

The main treatment for primary hypogonadism is hormone replacement therapy, which replaces missing testosterone in men and oestrogen in women. Other options include gonadotropin therapy, clomifene for men, fertility treatments, and lifestyle support.

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.