Treatment of secondary hypogonadism. Male hypogonadism - clinical forms, classification, diagnosis, treatment

If you're struggling with hypogonadism, you already know that it's a devastating condition that reduces your quality of life. People with this disease are characterized by loss of muscle mass, low libido, infertility, and depressed mood. Fortunately, there are ways to balance hormones using replacement therapy, which is a common practice for treating this condition. And exercise, dietary changes and lifestyle changes will help to cope with the disease as effectively as possible.

What is primary hypogonadism

Hypogonadism (synonyms: gonadal insufficiency, hypogenitalism) occurs when a person's sex glands, also called gonads, produce little or no sex hormones. The disease can be both congenital and acquired due to various conditions. This happens as a result:

• congenital underdevelopment of the glands;
• damage by toxic substances;
• infections;
• radiation therapy.

First of all, the sex glands are the testicles (testicles) in men and the ovaries in women, which produce testosterone and estrogen, respectively. Sex hormones help control secondary sex characteristics such as breast formation in women, testicular development, and pubic hair growth in men. Sex hormones also play a role in the menstrual cycle and sperm production.

Primary hypogonadism - secretory insufficiency of the sex glands in women and men

Primary hypogonadism means that the body does not have enough sex hormones due to a defect directly in the sex glands. The hypothalamus and pituitary gland - the parts of the brain that control them - continue to send signals to produce hormones, but the gonads, for various reasons, are unable to produce them.

In men with hypogonadism, low testosterone negatively affects the development and maintenance of male reproductive organs, including:

• testicles;
• penis;
• prostate.

In fact, a lack of testosterone can lead to problems such as decreased muscle strength, hair loss, and impotence.

In women, hypogonadism occurs when the ovaries do not produce enough estrogen. This hormone is responsible for maintaining the functions of the genital organs, such as:

• uterus;
• vagina;
• fallopian tubes;
• milk glands.

Low levels of the female sex hormone in the body can lead to infertility, loss of sex drive, mood swings, cessation of menstruation, and osteoporosis.

Hypogonadism is also called andropause or low serum testosterone when it comes to male health. Most cases of this disease respond well to appropriate treatment.

Causes of pathology

Causes of hypogonadism common to both sexes include:

• congenital underdevelopment of the sex glands;
• severe infections (mumps, tuberculosis, syphilis);
• autoimmune disorders such as Addison's disease and hypoparathyroidism;
• some genetic disorders (Turner's syndrome);
• diseases of the liver and kidneys;
• radiation exposure (chemotherapy);
• surgery on the genitals.

In addition, polycystic ovaries is one of the causes of hypogonadism in women.

Polycystic ovary in women often causes insufficiency of the sex glands

Causes of the disease in men include:

Symptoms of the disease

Symptoms that may affect women include:

• lack of menstruation;
• slow or absent breast growth;
• hot flashes (paroxysmal sensation of heat);
• loss of body hair;
• low or no sex drive (libido);
• milky discharge from the chest.

Testosterone deficiency in men triggers a series of severe changes in the body

The most characteristic symptoms of hypogonadism in men are:

• female type obesity (buttocks, hips, abdomen);
• loss of body hair;
• decrease in muscle mass;
• gynecomastia - abnormal growth of the mammary gland (similar to a woman's);
• decreased growth of the penis and testicles;
• erectile disfunction;
• osteoporosis;
• low libido;
• infertility (due to decreased spermatogenesis);
• chronic fatigue;
• hot flashes;
• difficulty concentrating.

If the waist circumference of a man exceeds 102 cm, then this indicates not only obesity, but also a low level of testosterone. Its production is blocked by a special substance called leptin, which is produced in adipose tissue. With a low level of male sex hormones, the representatives of the stronger sex not only grow the stomach, but also increase the breasts according to the female type. But the most dangerous thing is that atherosclerotic plaques appear in the vessels, which carry with them the risk of cardiovascular diseases - heart attack or stroke.

A man's waist size over 102 cm means low testosterone production in his body

Video: hypogonadism in men

Diagnostic methods

Diagnosis of the disease is carried out jointly: an endocrinologist with a gynecologist (in women) or with an andrologist-urologist (in men). The doctor performs a physical examination. He needs to make sure that the sexual development of the patient is at the proper level in accordance with age. The doctor examines the patient's muscle mass, the presence of body hair and genitals.

Signs of hypogonadism can be seen even in childhood by the weak development of skeletal muscles, the distribution of subcutaneous adipose tissue according to the female type

Tests for hormones

If a doctor suspects hypogonadism, the first stage of testing will include determining levels of sex (gonadotropic) hormones. You will need to do a blood test to check your follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. They are produced by the pituitary gland.

Also, women need to determine the level of estrogen, and men - testosterone levels. These tests are usually taken in the morning when hormone levels are highest. For men, an andrologist may additionally prescribe a spermogram to check the sperm count. With hypogonadism, the norm is significantly reduced.

A blood test for sex hormones is taken in the morning, when the hormonal level is highest.

Iron levels can affect sex hormones. The increased content of this microelement (hemochromatosis) negatively affects the work of the sex glands, more often in men. The most practical screening test is the determination of serum iron, saturation of the so-called transferrin and ferritin. If the indicator is higher than 50% for men and 45% for women, this indicates an increased supply of the trace element.

Hemochromatosis in men negatively affects the production of testosterone and is dangerous testicular loss

Your doctor may suggest checking your prolactin levels. It is a hormone that promotes breast development and breast milk production in women, but it is present in the body in both sexes. Thyroid disorders can cause symptoms similar to hypogonadism. To exclude such a scenario, the endocrinologist sends specific hormones - thyroxine and triiodothyronine - for testing.

Imaging research methods

Imaging tests are often helpful in diagnosing hypogonadism:

Treatment of primary hypogonadism

The simplest and most successful treatment for men and women with primary hypogonadism is hormone replacement therapy. But this does not provide lost fertility (fertility) in women, and in men it does not stimulate the growth of the testicles. First of all, therapy is aimed at preventive measures in order to prevent a lag in the patient's sexual development.

Medical therapy in women

Drug treatment of women consists in increasing the level of female sex hormones in the body. After a hysterectomy (amputation of the uterus), estrogen therapy is prescribed. The hormone is taken in pills or as a patch.

Because elevated estrogen levels can increase the risk of endometrial cancer, women who have not had a hysterectomy are given a combination of estrogen and progesterone.

Other treatments target specific symptoms. If the patient has a decrease in sexual desire, then low doses of testosterone are prescribed to her as therapy. In case of menstrual irregularities or problems with conception, the doctor may prescribe:

• injections of human chorionic gonadotropin (hCG) - a hormone that normally begins to be produced 6–8 days after embryo implantation;
• pills containing FSH - follicle stimulating hormone to induce ovulation.

Medication treatment for men

Testosterone replacement therapy (TRT) is a widely used treatment for hypogonadism in men. TRT restores muscle strength and prevents bone loss. In addition, men receiving TRT experience increased energy, sex drive, erectile function, and a sense of well-being.

In boys, testosterone replacement therapy stimulates puberty and the development of secondary sexual characteristics, such as increased muscle mass, the appearance of a beard and pubic hair, and penis growth. An initial low dose of the hormone with a gradual increase will avoid side effects and more accurately mimic the slow increase that occurs during puberty.

Types of Testosterone Replacement Therapy

There are several methods for delivering testosterone to the body. The choice of a particular method of therapy depends on patient preference, side effects and cost. Methods include:

1. Injections. Testosterone injections (Testosterone cypionate / Testosterone cypionate, Testosterone enanthate / Testosterone enanthate, Omnadren, Nebido, Sustanon) are safe and effective. They are done intramuscularly. Symptoms may vary between doses depending on the frequency of injections. The patient or family member can learn how to inject TRT at home.
   
   Omnadren 250 - testosterone preparation for intramuscular injections
2. Patch. A patch containing testosterone (Androderm) is applied every night to the back, abdomen, upper arm, or thigh. The area of ​​application is changed in order to maintain a seven-day pause between applications on the same place to reduce skin reactions.
   Testosterone patch - a convenient way to deliver the hormone to the body
3. Gel. There are several drugs with different ways of using them. Depending on the brand, testosterone must either be rubbed into the skin on the upper arm or upper arm (AndroGel / Androgel, Testim / Testim), applied with an applicator under each armpit (Axiron / Axiron) or squeezed onto the front and inside of the thigh (Fortesta / Fortesta). When the gel dries, the body absorbs the testosterone through the skin. Do not shower or bathe for several hours after applying the gel to make sure it is absorbed. A potential side effect of the gel is the possibility of transferring the drug to another person. Avoid skin-to-skin contact until the gel is completely dry after application.
   Androgel - testosterone preparation in the form of a gel for external use
4. Transbuccal means. A putty-like tablet (Striant / Striant) is placed between the upper lip and gum in the oral cavity (buccal cavity), where it is until completely resorbed. This product quickly adheres to the mucous membrane and allows testosterone to enter the bloodstream.
   
   Strianta tablet is glued to the gum for a period of 12 hours
5. nasal gel. Testosterone can be dripped into the nostrils in the form of a gel. This option reduces the risk that the medicine will be transferred to another person through skin contact. Nasal testosterone must be applied twice in each nostril, three times a day, which can be more inconvenient than other treatments.
6. implantable granules. Testosterone-containing granules (Testopel/Testopel) are surgically implanted under the skin every three to six months.

Testosterone therapy comes with a variety of risks, including:

• promotes apnea (stopping breathing during sleep);
• stimulates uneven growth of the prostate gland;
• enlarges the mammary glands;
• limits sperm production;
• activates the growth of existing prostate cancer;
• causes blood clots to form in the veins.

Surgery

In the absence of an effective result of conservative therapy in men, surgical treatment may be required. Procedures include transplantation (transplantation) of the testicles. Surgical intervention requires the use of microsurgical techniques using optical means and constant monitoring of the hormonal and immunological status of the patient.

Surgery for gynecomastia in men is recommended

Gynecomastia is also recommended for men to operate with liposuction of the chest area, if excess adipose tissue is present. This surgical procedure leads to a decrease in the amount of estrogen-producing tissue, which increases testosterone levels. Laboratory studies and clinical observations confirm the improvement in well-being, mood and erection in patients after surgery for gynecomastia.

Transplantation of female ovaries has not yet been introduced into wide practice, although research and trials are underway in this area.

Folk remedies

Two essential oils that help regulate hormone levels and improve symptoms of hypogonadism are clary sage and sandalwood oils.

Clary sage contains natural phytoestrogens, so it helps to balance estrogen levels in women.

Application of sage oil:

1. Combine 5 drops of sage oil with ½ teaspoon of coconut oil.
2. Massage the mixture into the abdomen, wrists and soles of the feet.

Clary sage essential oil helps relieve symptoms of estrogen deficiency in women

Sandalwood essential oil can be used to relieve symptoms of hypogonadism in men such as low sex drive, mood swings, stress, and cognitive problems.

A study conducted at the University of South Dakota (USA) in 2015 found that sandalwood oil also has anti-cancer mechanisms due to its antioxidant and anti-inflammatory properties. Sandalwood has been found to have antitumor effects in breast and prostate cancer.

Sandalwood essential oil has an antitumor effect in prostate and breast cancer

You can use sandalwood oil by diffusing a small amount at home, inhaling it directly from the bottle, or applying 2-3 drops to the soles of your feet.

Lifestyle and prevention

If hypogonadism occurs in adulthood, it is important to make lifestyle and dietary changes to prevent osteoporosis. Regular exercise and sufficient calcium and vitamin D to maintain bone strength are important in reducing the risk of osteoporosis.

Specifically, the US National Academy of Medicine recommends 1,000 milligrams (mg) of calcium and 600 international units (IU) of vitamin D per day for men aged 19 to 70. This recommendation increases to 1200 mg of calcium and 800 IU of vitamin D per day for men 71 years of age and older. Individual nutritional advice is given by the attending physician.

Hypogonadism often causes erectile dysfunction or infertility. In this regard, the patient may experience psychological problems, as well as difficulties in relationships with the family. In this case, support groups, including thematic online communities, can help sick people and their loved ones cope with various situations and problems associated with the disease. Many men use psychological or family counseling.

While there is often no effective treatment to restore lost fertility in a person with primary hypogonadism, the use of reproductive technology may be helpful. They cover a variety of methods designed to help couples who have been unsuccessfully trying to become parents.

Congenital hypogonadism requires lifelong treatment, which is important to start at an early age.

Adolescents with hypogonadism may feel as if they do not fit into the social environment. Testosterone replacement therapy induces puberty. That is why it is important to control its gradually increasing pace, which will allow time to adjust for physical changes and new sensations, then the likelihood of social and emotional problems is significantly reduced.

stress reduction

A study conducted at the University of Massachusetts School of Medicine (USA) showed a link between testosterone levels and stress. For more effective treatment of hypogonadism, it is helpful to practice simple stress relief techniques, such as:

• spending time outdoors;
• meditation;
• sports;
• social activity.

Weight management and diet

Being overweight or underweight can contribute to low sex hormone levels.

The epidemic of childhood obesity in developed countries is causing serious health problems among children, including problems with growth and sexual development.

Strength training and proper nutrition increase testosterone levels in men

If a person has low testosterone and at the same time he is struggling with being overweight, first of all he needs to remove from his diet all processed foods and fast food, refined carbohydrates and artificial sweeteners. Focus on natural and organic products, including:

• healthy fats such as coconut and olive oils
• fermented dairy products, including kefir, yogurt, cottage cheese;
• organic protein, such as salmon, chicken, beef, which have been grown without the use of synthetic growth regulators and other additives;
• Fresh fruits and vegetables, such as leafy greens, avocados, broccoli, celery, carrots, and artichokes
• high-fiber foods such as pumpkin, nuts (almonds, walnuts), chia and flax seeds, legumes.

If the patient is not able to solve the issue of healthy nutrition on his own, a trainer-nutritionist can help him with this, who will become a mentor in the issue of healthy weight correction and help him achieve the desired result.

Regular workouts

There are many studies that prove that exercise can regulate or increase low testosterone levels. The best forms of exercise:

• strength training (30 minutes 3 times a week);
• high intensity interval training - alternating intervals (30–60 seconds) of high and low intensity, such as jogging and sprinting.

Optimal testosterone levels in men are the key to men's health and overall well-being

Studies show that even moderate light and weightlifting increases serum testosterone levels compared to no additional physical activity at all.

Exercise can also be helpful for women with hypogonadism because it helps reduce stress and normalize weight. Being underweight or overweight are factors that can cause low estrogen levels. Yoga and Pilates are also quite helpful in relieving the symptoms of hypogonadism.

Pilates and yoga classes are a great way to normalize weight and hormonal levels in women and men

Prognosis and complications

Hypogonadism is a chronic disease that requires lifelong treatment. The level of sex hormone will decrease to the previous level if the treatment is stopped.

If left untreated, hypogonadism can lead to various complications, depending on age and gender. If the disease affects children before they are born (for genetic reasons), hypogonadism can lead to abnormal genital development. As a result, adolescent puberty can be delayed, meaning that girls do not menstruate or grow breasts, and boys have little body hair and non-increasing muscle mass.

Adults with hypogonadism may experience more severe complications. In both men and women, the disease can cause infertility. In women, menstruation stops and hot flashes appear. Men in this condition experience sexual dysfunction and are at increased risk of developing osteoporosis, as well as heart attack and stroke. To avoid these complications, the patient should definitely consult a doctor to discuss treatment options.

- a syndrome accompanied by insufficiency of the functions of the sex glands and a violation of the synthesis of sex hormones. Hypogonadism, as a rule, is accompanied by underdevelopment of the external or internal genital organs, secondary sexual characteristics, a disorder of fat and protein metabolism (obesity or cachexia, changes in the skeletal system, cardiovascular disorders). Diagnosis and therapy of hypogonadism is carried out by the joint work of endocrinologists, gynecologists and gynecologists-endocrinologists (in women), andrologists (in men). Hormone replacement therapy is the mainstay of treatment for hypogonadism. If necessary, surgical correction, plastic surgery and prosthetics of the genital organs are performed.

General information

- a syndrome accompanied by insufficiency of the functions of the sex glands and a violation of the synthesis of sex hormones. Hypogonadism, as a rule, is accompanied by underdevelopment of the external or internal genital organs, secondary sexual characteristics, a disorder of fat and protein metabolism (obesity or cachexia, changes in the skeletal system, cardiovascular disorders). There are male and female hypogonadism.

Hypogonadism in men

Classification of hypogonadism in men

Hypogonadism is divided into primary and secondary. Primary hypogonadism is caused by dysfunction of the testicular tissue due to a defect in the testicles themselves. Chromosomal disorders can lead to aplasia or hypoplasia of the testicular tissue, which is manifested by the absence of androgen secretion or their insufficiency for the normal formation of the genital organs and secondary sexual characteristics.

The occurrence of secondary hypogonadism is due to a violation of the structure of the pituitary gland, a decrease in its gonadotropic function or damage to the hypothalamic centers that regulate the activity of the pituitary gland. Primary hypogonadism, which develops in early childhood, is accompanied by mental infantilism, secondary - mental disorders.

There are also hypogonadotropic, hypergonadotropic and normogonadotropic hypogonadism. Hypergonadotropic hypogonadism is manifested by a primary lesion of the testicular tissue of the testicles in combination with an increased level of pituitary gonadotropic hormones. Hypogonadotropic and normogonadotropic hypogonadism occur when the hypothalamic-pituitary system is affected. Hypogonadotropic hypogonadism is associated with a decrease in the secretion of gonadotropins, resulting in a decrease in androgen production by the testicular tissue of the testicles. Normogonadotropic hypogonadism is caused by hyperprolactinemia, manifested by normal levels of gonadotropins and decreased testicular function of the testicles.

Both primary and secondary hypogonadism can be congenital or acquired. Some forms of male infertility (from 40 to 60% of all cases of male infertility) can serve as a manifestation of hypogonadism. Depending on the age of development of insufficiency of sex hormones, embryonic, pre-pubertal (from 0 to 12 years) and post-pubertal forms of hypogonadism are distinguished.

Congenital primary (hypergonadotropic) hypogonadism occurs:

• with anorchism (aplasia) of the testicles;
• in violation of the omission (cryptorchism and ectopia) of the testicles;
• with true chromatin-positive Klinefelter syndrome (combines testicular hypoplasia, hyalinosis of the walls and seminiferous tubule dysgenesis, gynecomastia, often accompanied by azoospermia (absence of sperm). Testosterone production is reduced by about 50%.
• with (chromosomal disease with characteristic disorders of physical development: short stature and lack of sexual development, rudimentary testes);
• with sertoli cell syndrome or del Castillo syndrome (underdevelopment of the testicles with a normal or increased amount of gonadotropins). With this syndrome, spermatozoa are not formed, patients are infertile. Physical development occurs according to the male pattern;
• with the syndrome of incomplete masculinization - false male hermaphroditism. The reason is a decrease in tissue susceptibility to androgens.

Acquired primary hypogonadism develops as a result of exposure to the testicles of internal or external factors after birth.

• with injuries, tumors of the testicles and early castration - manifested by a picture of a typical eunuchism - total hypogonadism;
• with insufficiency of the germinal epithelium (false Klinefelter's syndrome). Characterized by high growth, eunuchoid physique, gynecomastia, underdeveloped secondary sexual characteristics, small size of the genitals. By puberty, patients develop eunuchoid features, and subsequently reduced fertility.

Congenital secondary (hypogonadotropic) hypogonadism develops under the following conditions:

• associated with damage to the hypothalamus - an isolated form with damage only to the reproductive system. It is characterized by a total deficiency of gonadotropic hormones, while there may be a deficiency of lutropin or folitropin;
• with Cullman's syndrome - characterized by a deficiency of gonadotropins, underdevelopment of the genitals and secondary sexual characteristics, a decrease or absence of smell (hyposmia or anosmia). Eunuchoidism is noted (often in combination with cryptorchidism), various malformations: splitting of the upper lip and hard palate, shortening of the frenulum of the tongue, facial asymmetry, six-fingeredness, gynecomastia, cardiovascular disorders.
• with pituitary dwarfism (pituitary dwarfism). There is a sharp decrease in somatotropic, luteinizing, follicle-stimulating, thyroid-stimulating and adrenocorticotropic hormones, which is manifested by impaired function of the testicles, adrenal glands and thyroid gland. It is characterized by insufficiency of sexual characteristics, dwarf growth of less than 130 cm, infertility.
• with congenital panhypopituitarism (craniopharyngioma) caused by a congenital brain tumor. Growing, it compresses the tissues of the pituitary gland, disrupting its functions. The production of gonadotropins, as well as hormones that regulate the functions of the adrenal cortex and the thyroid gland, decreases. It leads to a lag in the physical and sexual development of the child.
• with Maddock's syndrome - an extremely rare form of hypogonadism that occurs when the gonadotropic and adrenocorticotropic functions of the pituitary gland are insufficient. It is characterized by a gradual increase in hypocorticism. After the passage of the puberty period, there is a lack of function of the gonads - eunuchoidism, hypogenitalism (underdevelopment of the genital organs and secondary sexual characteristics), decreased libido, infertility.

Acquired secondary hypogonadism develops when:

• adiposogenital dystrophy - manifested by obesity and hypogenitalism. There is a lack of gonadotropic function of the pituitary gland. Appears at 10-12 years of age. Hypothalamo-pituitary pathology with pronounced clinical symptoms is not observed. Characterized by eunuchoid proportions of the skeleton, usually sexual dysfunction and infertility. Due to dystrophic changes in the heart and vascular hypotension, shortness of breath, biliary dyskinesia, and flatulence may develop.
• Laurence-Moon-Barde-Biedl syndrome (LMBB), Prader-Willi syndrome. LMBB syndrome is manifested by obesity, low intelligence, retinitis pigmentosa, and polydactyly. There is cryptorchidism, testicular hypoplasia, gynecomastia, erectile dysfunction, poor facial hair, armpits, pubis, and kidney development defects are possible. The Prader-Willi syndrome, in contrast to the LMBB syndrome, has multiple anomalies (“Gothic” palate, epicanthus, etc.), pronounced muscle weakness against the background of a decrease in the amount of androgens and gonadotropins in the blood. Both syndromes are classified as functional disorders of the pituitary and hypothalamus.
• hypothalamic syndrome due to damage to the hypothalamic-pituitary region as a result of an infectious-inflammatory, tumor process, traumatic brain injury.
• hyperprolactinemic syndrome - accompanies infertility and disorders of sexual function, and arising in childhood and adolescence, causes delayed sexual development and hypogonadism.

Causes and mechanisms of development of hypogonadism in men

Androgen deficiency can be caused by a decrease in the amount of hormones produced or a violation of their biosynthesis as a result of the pathology of the testicles themselves or a violation of the hypothalamic-pituitary regulation.

The etiological factors of primary hypogonadism are often:

• congenital underdevelopment of the gonads that occurs with genetic defects - for example, dysgenesis (violation of the tissue structure) of the seminiferous tubules; testicular dysgenesis or aplasia (anorchism, monorchism). In the occurrence of congenital pathology, a negative role is played by harmful effects on the body of a pregnant woman. A hypogonadal state can be caused by impaired testicular descent.
• toxic effects (chemotherapy of malignant tumors, organic solvents, nitrofurans, pesticides, alcohol, tetracyclines, hormonal drugs in large doses, etc.)
• infectious diseases (mumps, measles orchitis, epididymitis, deferentitis, vesiculitis)
• radiation injury (in contact with x-rays, radiation therapy)
• acquired damage to the testicles - trauma, torsion of the spermatic cord, varicocele, testicular volvulus; atrophy and hypoplasia of the testicles after operations of orchidopexy, hernia repair, surgical interventions on the organs of the scrotum.

Some cases of primary hypogonadism are idiopathic. Modern endocrinology does not have sufficient data on the etiology of idiopathic hypogonadism.

With primary hypogonadism, there is a decrease in the level of androgens in the blood, the development of a compensatory reaction of the adrenal glands to hypoandrogenization, and an increase in the production of gonadotropins.

Violations of the hypothalamic-pituitary regulation (inflammatory processes, tumors, vascular disorders, pathology of embryonic development) lead to secondary hypogonadism. The development of hypogonadism can be caused by pituitary adenomas that produce growth hormone (with acromegaly) or adrenocorticotropic hormone (with Cushing's disease), prolactinoma, postoperative or post-traumatic hypothalamic-pituitary dysfunction, hemochromatosis, aging processes, accompanied by an age-related decrease in blood testosterone levels.

With secondary hypogonadism, there is a low level of gonadotropins, leading to a decrease in the secretion of androgens by the testicles.

One form of male hypogonadism is a decrease in sperm production with normal testosterone levels, as well as extremely rare cases of a decrease in testosterone levels without a decrease in sperm production.

Symptoms of hypogonadism in men

Clinical manifestations of hypogonadism are due to the age of onset of the disease and the degree of androgen deficiency. Violation of androgen production in the prenatal period can lead to the development of bisexual external genitalia.

If testicular damage occurred in boys in the prepubertal period, there is a delay in sexual development, typical eunuchoidism is formed: disproportionately high growth associated with delayed ossification of the epiphyseal (growth) zones, undeveloped chest and shoulder girdle, long limbs, underdeveloped skeletal muscles. There may be a development of female-type obesity, true gynecomastia, hypogenitalism, which manifests itself in a small penis size, lack of pigmentation and folding of the scrotum, testicular hypoplasia, underdevelopment of the prostate gland, lack of facial and pubic hair, underdevelopment of the larynx, high voice.

In cases of secondary hypogonadism, obesity often occurs, symptoms of hypofunction of the adrenal cortex, thyroid gland, manifestations of panhypopituitarism, lack of sexual desire and potency are possible.

If a decrease in testicular function develops after puberty is completed, then the symptoms of hypogonadism are less pronounced. There is a decrease in the size of the testicles, slight facial and body hair, female-type fat deposits, loss of elasticity and thinning of the skin, infertility, decreased sexual function, vegetative-vascular disorders.

Reduction of the testicles is observed in almost all cases of male hypogonadism (exception - if the disease has begun recently). Reducing the size of the testicles is usually closely associated with a decrease in sperm production. With the loss of the sperm-producing function of the testicles, infertility develops with the cessation of testosterone production, libido decreases, regression of secondary sexual characteristics occurs, erectile dysfunction, generalized symptoms are noted (decrease in muscle strength, fatigue, general weakness).

Diagnosis of hypogonadism in men

It is based on the patient's complaints, anamnesis data, a general status study using anthropometry, examination and palpation of the genitals, an assessment of the clinical symptoms of hypogonadism, and the degree of puberty.

According to the X-ray examination, bone age is estimated. To determine the mineral saturation of the bones, densitometry is performed. When radiography of the Turkish saddle is determined by its size and the presence of a tumor. Evaluation of bone age makes it possible to accurately determine the onset of puberty by the timing of ossification of the wrist joint and hand. The onset of puberty is associated with the formation of a sesamoid bone in the I metacarpophalangeal joint (approximately at 13.5 - 14 years). Full puberty is evidenced by the appearance of anatomical synostoses. This feature makes it possible to distinguish between prepubertal and pubertal age. When evaluating bone age, it is necessary to take into account the possibility of earlier (for patients from the southern regions) and late (for patients from the northern regions) ossification, as well as the fact that osteogenesis impairment may be due to other factors. With pre-pubertal hypogonadism, there is a lag of several years of "bone" age from the passport one.

A laboratory study of sperm analysis (spermogram) in hypogonadism is characterized by azo- or oligospermia; sometimes ejaculate can not be obtained. The level of sex and gonadotropins is measured: serum testosterone (total and free), luteinizing, follicle-stimulating hormone and gonadoliberin, as well as anti-Müllerian hormone of blood serum, prolactin, estradiol. The content of testosterone in the blood is reduced.

With primary hypogonadism, the level of gonadotropins in the blood is increased, with secondary hypogonadism it is lowered, sometimes their content is within the normal range. Determination of the level of serum estradiol is necessary for clinically pronounced feminization and secondary hypogonadism, in the case of estrogen-producing tumors of the testicles or adrenal glands. The level of 17-KS (ketosteroids) in the urine with hypogonadism may be normal or reduced. If Klinefelter's syndrome is suspected, a chromosomal analysis is indicated. Testicular biopsy rarely provides information for diagnosis, prognosis, or treatment.

Treatment of hypogonadism in men

Therapy of hypogonadism is carried out strictly individually, and is aimed at eliminating the cause of the disease. The purpose of the treatment is to prevent the retardation of sexual development, in the future - malignancy of the testicular tissue of the testicles and infertility. Treatment of hypogonadism should be carried out under the supervision of a urologist and an endocrinologist.

Treatment of hypogonadism depends on its clinical form, the severity of disorders in the hypothalamic-pituitary and reproductive systems, comorbidities, the time of onset of the disease and the age of diagnosis. Therapy of hypogonadism begins with the treatment of the underlying disease. Treatment of adult patients consists in correcting androgen deficiency and sexual dysfunction. Infertility that occurs against the background of congenital and prepubertal hypogonadism is incurable, especially in the case of aspermia.

In the case of primary congenital and acquired hypogonadism (with preserved reserves of endocrinocytes in the testicles), stimulating therapy is used: in boys - with non-hormonal drugs, and in adult patients - with hormonal agents (small doses of gonadotropins, androgens). In the absence of the reserve capacity of the testicles, the replacement intake of androgens (testosterone) is shown constantly, throughout life. In secondary hypogonadism, both in children and adults, it is necessary to use stimulating hormonal therapy with gonadotropins (if necessary, combining them with sex hormones). It is also shown to conduct general strengthening therapy, physiotherapy exercises.

Surgical treatment of hypogoandism consists in testicular transplantation, bringing down the testicle in case of cryptorchidism, and in case of underdevelopment of the penis - phalloplasty. For cosmetic purposes, a synthetic testicle is implanted (in the absence of an undescended testicle in the abdominal cavity). Operations are performed using microsurgical techniques with control of the immunological and hormonal status of the patient and the transplanted organ. In the process of systematic treatment of hypogonadism, androgen deficiency decreases: the development of secondary sexual characteristics resumes, potency is partially restored, the severity of concomitant manifestations decreases (osteoporosis, lagging "bone age", etc.).

Hypogonadism in women

Female hypogonadism is characterized by underdevelopment and hypofunction of the gonads - the ovaries. Primary hypogonadism is caused either by congenital underdevelopment of the ovaries, or by damage to them during the neonatal period. In the body, there is a deficiency of female sex hormones, which causes an increase in the production of gonadotropins that stimulate the ovaries in the pituitary gland. In the blood serum, there is a high level of follicle-stimulating and luteinizing hormones (hypergonadotropic hypogonadism) and a low concentration of estrogens.

Estrogen deficiency causes underdevelopment and atrophic changes in the female genital organs, mammary glands, primary amenorrhea. If the violation in the ovaries occurred in the prepubertal period, then there are no secondary sexual characteristics.

The causes of primary hypergonadotropic hypogonadism are a congenital genetic disorder (Shereshevsky-Turner syndrome), congenital ovarian hypoplasia, infectious processes (syphilis, tuberculosis, mumps), ionizing radiation (radiation, X-ray), surgical removal of the ovaries, autoimmune ovarian damage (autoimmune oophoritis), testicular feminization syndrome (a congenital condition in which the appearance of a person corresponds to a woman with a male genotype), polycystic ovary syndrome.

Secondary female hypogonadism (hypogonadotropic) occurs with hypothalamic-pituitary pathology, characterized by a deficiency or complete cessation of the synthesis and secretion of gonadotropins that regulate ovarian function. It develops as a result of inflammatory processes in the brain (encephalitis, meningitis, arachnoiditis), the damaging effect of brain tumors and is accompanied by a decrease in the stimulating effect of gonadotropins on ovarian function.

Symptoms of hypogonadism in women

One of the main symptoms of hypogonadism in the childbearing period is menstrual irregularity and amenorrhea. The lack of female sex hormones leads to underdevelopment of sexual characteristics: genitals, mammary glands, violation of the deposition of fatty tissue according to the female type, poor hair growth. If the disease is congenital, or it arose in early childhood, then there are no secondary sexual characteristics. Characterized by a narrow pelvis and flat buttocks. If hypogonadism has developed in the puberty period, the sexual characteristics that have already developed persist, but menstruation stops, the tissues of the female genitalia undergo atrophy.

Diagnosis of hypogonadism in women

With hypogonadism, there is a noticeable decrease in the content of estrogens in the blood, an increase in the level of gonadotropins (follicle-stimulating and luteinizing hormones). Ultrasound examination reveals a uterus, reduced in size (hypoplasia of the uterus), reduced ovaries. X-rays reveal osteoporosis, or delayed skeletal development.

Treatment of hypogonadism in women

With primary hypogonadism in women, drug replacement therapy with female sex hormones (ethinyl estradiol) is prescribed. In the event of a menstrual-like reaction, combined oral contraceptives are prescribed containing two types of hormones - estrogens and gestagens. Women over 40 are prescribed estradiol + cyproterone, estradiol + norethisterone. Hormone replacement therapy is contraindicated in malignant tumors of the mammary glands and genital organs, cardiovascular diseases, diseases of the kidneys, liver, thrombophlebitis, etc.

The prognosis for life with hypogonadism is favorable. Prevention of hypogonadism consists in the health education of the population, the observation of pregnant women and the protection of their health.

- endocrine diseasecharacterized by a violation of the production of sex hormones due to the very low functionality of the gonads. Hypogonadism can be easily recognized by the underdevelopment of the genital organs, both in men and women, the absence of secondary sexual characteristics, metabolic disorders, which is manifested by obesity, heart and vascular diseases, cachexia ...
Hypogonadism in women and men, due to the difference in physiology, manifests itself in different ways.

Hypogonadism in men

Classification

Hypogonadism in men is primary and secondary.

Primary hypogonadism.
It is characterized by dysfunction of the testicular tissue due to testicular defect. Violations in the chromosomal set of men are manifested by underdevelopment or even absence (aplasia) of testicular tissue, which is the reason for the lack of androgen secretion for the normal formation of the reproductive system.
Primary hypogonadism begins to form at an early age and is accompanied by mental infantilism.

Secondary hypogonadism.
It occurs due to the destruction of the pituitary gland, a decrease in its function of regulating the work of the gonads, or dysfunction of the hypothalamic centers that regulate the functionality of the pituitary gland. Secondary hypogonadism is accompanied by mental disorders.

Also, hypogonadism in men is:
- hypogonadotropic;
- hypergonadotropic;
- normogonadotropic.

Hypogonadotropic hypogonadism.
It occurs as a result of reduced secretion of gonadotropic hormones, which is why the production of androgens is markedly reduced.

Hypergonadotropic hypogonadism.
It occurs as a result of a primary lesion of testicular tissue in combination with a high concentration of gonadotropic hormones.

Normogonadotropic hypogonadism.
It is characterized by an optimal concentration of gonadotropic hormones in combination with a reduced testicular function of the testicles.

Based on the age of manifestation of a deficiency of sex hormones, the following forms of hypogonadism are also distinguished:
- embryonic (in the womb);
- pre-pubertal (0-12 years);
- post-pubertal.

Primary and secondary hypogonadism can be either congenital or acquired.

Primary congenital hypogonadism occurs when:
- violation of testicular descent;
- absence of testicles;
- Shereshevsky-Turner syndrome;
- Klinefelter's syndrome;
- del Castillo syndrome;
- false male hermaphroditism.

Primary acquired hypogonadism occurs under the influence of various factors on the testicles after the birth of a person:
- with tumors and injuries;
- at castration;
- with insufficiency of the germinal epithelium.

Secondary congenital hypogonadism manifests itself:
- with Cullman's syndrome;
- damage to the hypothalamus
- with pituitary dwarfism;
- with congenital panhypopituitarism;
- with Maddock's syndrome.

Secondary acquired hypogonadism manifests itself:
- with adiposogenital dystrophy;
- with Prader-Willi syndrome;
- with LMBB syndrome;
- with hyperprolactinemia syndrome;
- with hypothalamic syndrome.

Causes of hypogonadism in men

The most basic cause of androgen deficiency and low levels of sex hormones are testicular pathologies, or failure of the hypothalamic-pituitary regulation.

Causes of primary hypogonadism are:
- congenital defects of the gonads (underdevelopment);
- absence of testicles;
- toxic effects on the body (chemotherapy, alcohol, drugs, hormonal and other medications, pesticides...);
- various infectious diseases (deferentitis, mumps; epididymitis, visculitis...);
- irradiation;
- various damage to the testicles.

The causes of idiopathic hypogonadism have not yet been fully identified.

The development of secondary hypogonadism can be caused by:
- pituitary adenoma, which produces adrenocorticotropic hormone or growth hormone;
- hemochromatosis;
- prolactinoma;
- violation of the hypothalamic-pituitary regulation;
- aging processes, which are accompanied by a decrease in testosterone.
- low levels of gonadotropins, which causes a decrease in androgen secretion.

Symptoms of hypogonadism in men

The manifestation of this disease largely depends on the degree of androgen deficiency and the age stage of the disease.

Violation of androgen production in utero can lead to hemaphrodism.

In pre-adolescent boys, the symptoms of hypogonadism are as follows:
- delayed sexual development;
- high growth;
- long limbs;
- undeveloped shoulder girdle and chest;
- weak muscles;
- signs of obesity according to the female type;
- small size of the penis;
- testicular hypoplasia;
- lack of hair growth on the face and pubis;
- high timbre of voice;
- underdevelopment of the prostate.

In the case of testicular dysfunction after puberty, the symptoms of hypogonadism in men are "softer":
- slight hairiness of the face and body;
- small size of the testicles;
- female type obesity;
- infertility;
- decreased libido;
- vegetative-vascular disorders.

Diagnosis of hypogonadism in men

Diagnosis begins with an external examination of the patient and with the collection of an anamnesis (survey), be sure to examine and palpate the genitals, assess the degree of puberty.

For a mandatory assessment of bone age, X-ray studies are performed (this helps to determine the onset of puberty), and then densitometry is done to determine the mineral composition of the bones.
X-rays are done to determine the presence of an adenoma and the size of the Turkish saddle.

A semen analysis in the form of a spermogram is mandatory. Azo- or oligospermia indicate hypogonadism.

The levels of serum testosterone, gonadoliberin, follicle-stimulating hormone, estradiol, prolactin are measured. The level of gonadotropins in primary hypogonadism is high, and in secondary it is low.

Treatment of hypogonadism in men

Target treatment of hypogonadism in men it is to prevent the lag of sexual development, and then restore the normal functionality of the testicular tissue of the testicles.
Therapy of this disease always begins with the treatment of the main one.

Initially, androgen deficiency is corrected and dysfunction of the genital organs is eliminated. Infertility pre-pubertal or congenital hypogonadism is incurable.

With primary congenital and acquired hypogonadism, they resort to stimulating therapy: for boys with non-hormonal drugs, and for adult men - with hormonal ones.
With secondary hypogonadism in men, gonadotropin therapy should be used.

You need to know that all such drugs have a devastating effect on the human immune system and cause side effects, so they should be taken only under the supervision of an appropriate doctor.

Surgery for hypogonadism consists of testicular transplantation or phalloplasty.

To eliminate the side effects that these drugs cause, and to maintain the immune status, we recommend taking the immune drug Transfer Factor.
The basis of this drug is made up of immune molecules of the same name, which, once in the body, perform three functions:
- eliminate failures of the endocrine and immune systems;
- being information particles (of the same nature as DNA), transfer factors "record and store" all information about foreign agents - pathogens of various diseases that (agents) invade the body, and when they invade again, "transmit" this information to the immune a system that neutralizes these antigens;
- eliminate all side effects caused by the use of other drugs.

There is a whole line of this immunomodulator, of which Transfer Factor Advance and Transfer Factor Glucouch are used in the Endocrine System program for the prevention of endocrine diseases, incl. and hypogonadism in men. According to many well-known scientists, there is no better drug for these purposes.

Hypogonadism in women

This disease in women is characterized by hypofunction due to underdevelopment of the ovaries.
The cause of primary hypogonadism is damage to the ovaries in infancy, or their underdevelopment from the prenatal period. As a result, there is a reduced level of female sex hormones in the body, which causes an "overproduction" of gonadotropins.

A low level of estrogen is manifested in the destruction (underdevelopment) of the genital organs and mammary glands in women, as well as primary aminorrhea. Secondary sexual characteristics will be absent if ovarian dysfunction occurs in the prepubertal period.

Secondary hypogonadism in women (hypogonadotropic) occurs when the production of gonadotropins is stopped or deficient.

Causes of hypogonadism in women

The causes of primary hypogonadism are the following congenital diseases:
- congenital ovarian hypoplasia;
- congenital genetic disorders;
- infectious diseases (tuberculosis, syphilis...);
- autoimmune pathology of the ovaries;
- removal of the ovaries;
- ovarian irradiation;
- polycystic ovary syndrome...

Secondary female hypogonadotropic hypogonadism occurs due to inflammation in the brain:
- arachnoiditis, meningitis, encephalitis.
- Various injuries due to the tumor...

Symptoms of hypogonadism in women

The most basic symptom of this disease is a violation of the menocycle and amenorrhea, but this occurs only in the childbearing period.

In other cases, hypogonadism in women manifests itself in the following symptoms:
- underdevelopment of the mammary glands and genitals;
- sparse hairline;
- Violation of fat deposits according to the female type;
- with a congenital disease, there are no secondary sexual characteristics;
- flat buttocks and narrowed pelvis;
- with hypogonadism in puberty, further atrophy of the female genitalia occurs.

Diagnosis of hypogonadism in women

Diagnosis begins with a blood test, which shows a low level of estrogen and an increase in the concentration of gonadotropins.
With the help of ultrasound, a decrease in the size of the uterus and ovaries is detected.
X-rays are necessary to detect osteoporosis and delayed skeletal development.

Primary hypogonadism in women is treated with female hormone replacement therapy (ethinyl estradiol). After a menstrual-like reaction occurs, they begin taking contraceptives containing estrogens and gestagens:
- Silesta;
- triquilar;
- trisiston.
But this type of therapy is contraindicated in breast cancer, heart and vascular diseases, thrombophlebitis, liver and kidney diseases.
In this case, as in the treatment of hypogonadism in men, Transfer factor preparations are very effective as part of complex therapy.

Very few people think about the huge role hormones play in our body. The endocrine system is second only to the nervous system in importance, it is responsible for the normal functioning of the whole body, including procreation. With its pathology, diseases such as diabetes mellitus, gigantism, hypothyroidism and even hypogonadism are observed.

Hypogonadism - what is it in men?

Hypogonadism syndrome refers to the underdevelopment of the gonads or a decrease in their function. Basically, its pathogenesis is characterized by a decrease in the production of male steroids, signs of infantilism appear, that is, there is a reverse development from a man to a boy, in connection with.

IMPORTANT: the concentration of androgens depends not only on the normal state of the organs directly producing it - but also on the endocrine system located in the brain. According to the international classification of diseases of the 10th revision (ICD 10), hypogonadism can be assigned the code E29 if it is associated with testicular dysfunction and E23 if it is a consequence of the pathology of the pituitary gland.

Kinds

There are many disorders that lead to the described symptom complex, however, for convenience, it is classified into 3 main types.

Hypergonadotropic hypogonadism

Caused by damage to the hypothalamic-pituitary system, which dominates the rest of the endocrine glands. That is, in fact, it is responsible for the production of absolutely all hormones in our body, and human viability depends on its work.

The hypothalamus controls the pituitary gland, and the second synthesizes gonadotropins: follicle-stimulating hormone (FSH) and luteinizing (LH) hormone, which regulate all the activity of the reproductive system. With this hypogonadism, there is an excessive or incorrect production of these hormones.

Normogonadotropic hypogonadism

This type differs from the previous one in that the pituitary gland is working normally, but the problem occurs directly in the sex glands. The formation of testosterone in the Leydig cells of the testicles is disrupted, usually this is caused by inflammatory or cicatricial changes.

Hypogonadotropic hypogonadism

It is characterized by a decrease in the secretory function of the dominant endocrine system - the synthesis of gonadotropins in the structures of the brain decreases, which leads to underdevelopment of the testicles and, as a result, a decrease in the production of steroids.

Causes

Many researchers divide the causes of hypogonadism into two large groups.

Congenital (primary):

• complete absence of testicles;
• not lowering them into the scrotum;
• Klinefelter's syndrome (additional X chromosome in males, formula 47, XXY);
• Heller-Nelson syndrome (improper development of Leydig cells in the testes, which leads to a decrease in testosterone production);
• de la Chapelle disease (violation of the divergence of sex chromosomes, as a result of which a person looks like a man, but has a female set of chromosomes 46, XX);
• Morris symptom complex (complete insensitivity of receptors in the body to androgens) and Reifenstein's syndrome (partial insensitivity);
• Jacobs syndrome (47, XYY);
• myotonic dystrophy (a genetic disease characterized by weakness of the muscles of the face and hands, as well as changes in the thyroid, pancreas and gonads);
• Del Castillo disease (during development in the womb, the primary cells of the gonads are not laid);
• underdevelopment of Leydig cells and, as a result, insufficient production of the main male hormone;
• Kallman's syndrome (hereditarily determined decrease in the production of FSH and LH);
• adrenogenital symptom complex (genetic deficiency of the enzyme that forms steroids).

Acquired (secondary):

• castration;
• bilateral atrophy, that is, a decrease in volume and loss of function;
• excess estrogens inhibit the synthesis of FSH due to the "feedback" mechanism;
• orchitis;
• exposure to radiation;
• in the area of ​​the pituitary gland;
• tumors of the hypothalamus, pituitary gland or testicles;
• trauma;
• slowing down the breakdown of estrogens;
• uncontrolled use of drugs (cytostatics);
• hyperprolactinemic symptom complex (which inhibits testosterone secretion);
• with chronic renal failure;
• with cirrhosis of the liver;
• with anorexia nervosa;
• with other endocrinological diseases (, thyrotoxicosis, etc.);
• with injuries of the lumbar spine with spinal cord injury;
• age-related androgen deficiency in men.

Symptoms and signs

Testosterone and gonadotropins affect not only the reproductive system, but also the musculoskeletal system. Accordingly, if pituitary hypogonadism is congenital or acquired during sexual maturation, then changes in the normal proportions are observed.

A eunuchoid skeleton is formed: tall and long limbs. The bones become thin and brittle. Skeletal muscles are poorly expressed, fat is deposited on the hips and buttocks (according to the female type). There are no changes in the larynx, the voice remains high, like that of a child. Beard, mustache, pubic hair and in the armpits are weakly expressed. The genitals are reduced, the penis is small, there are no folds on the scrotum, and there is no erection. Often observed and gynecomastia (benign breast enlargement in men).

If hypogonadism began to progress in adulthood, then changes are observed mainly in the reproductive system:

• increasing impotence;
• the disappearance of adequate and spontaneous erections;
• reduction of testicles.

Stop growing hair on the face, in the armpits and groin. Weakens, however, does not disappear completely. Very often, such men suffer from depression, neurosis, there is a frequent change of mood. Gynecomastia may also develop.

Diagnosis of hypogonadism in men

The lack of sex hormones is called hypogonadism. In men, this disease is associated with insufficient secretion of androgens, and in women - estrogens. With hypogonadism, the manifestations of the disease primarily relate to the sexual sphere and reproductive abilities. Also, the lack of sex hormones provokes changes in metabolism and functional disorders of various organs and systems.

sex hormones

Sex steroids in adults are formed mainly in the gonads. In women, the source of estrogens is the ovaries, in men, the source of androgens is the testicles.

The activity of sex steroid synthesis is regulated by the central regions of the endocrine system. The pituitary gland secretes stimulatory gonadotropins.

These include:

• FSH - follicle stimulating hormone;
• LH is a luteinizing hormone.

Both hormones support the normal functioning of the reproductive system in adults and contribute to its proper development in children.

Follicle-stimulating gonadotropin causes:

• accelerates the maturation of eggs in women;
• triggers spermatogenesis in men.

Luteinizing gonadotropin:

• stimulates the synthesis of estrogens in the ovaries;
• responsible for ovulation (release of a mature egg);
• activates the production of testosterone in the testicles.

The activity of the pituitary gland is subject to the regulation of the hypothalamus. In this department of the endocrine system, releasing hormones are produced for LH and FSH. These substances increase the synthesis of gonadotropins.

The hypothalamus secretes:

• luliberin;
• folliberin.

The first of them stimulates mainly the synthesis of LH, the second - FSH.

Classification of hypogonadism

The lack of sex steroids in the body may be due to damage to the hypothalamus, pituitary gland, ovaries or testicles.

Depending on the level of damage, 3 forms of the disease are distinguished:

• primary hypogonadism;
• secondary hypogonadism;
• tertiary hypogonadism.

The tertiary form of the disease is associated with damage to the hypothalamus. With such a pathology, releasing hormones (luliberin and folliberin) cease to be produced in sufficient quantities.

Secondary hypogonadism is associated with dysfunction of the pituitary gland. At the same time, gonadotropins (LH and FSH) cease to be synthesized.

Primary hypogonadism is a disease associated with the pathology of the gonads. In this form, the testicles (ovaries) cannot respond to the stimulating effects of LH and FSH.

Another classification of androgen and estrogen deficiency:

• hypogonadotropic hypogonadism;
• hypergonadotropic hypogonadism;
• normogonadotropic hypogonadism.

Normogonadotropic hypogonadism is observed in obesity, metabolic syndrome, hyperprolactinemia. According to laboratory diagnostics, in this form of the disease, normal levels of LH and FSH, a decrease in estrogens or androgens are observed.

Hypergonadotropic hypogonadism develops when the testicles (ovaries) are affected. In this case, the pituitary and hypothalamus secrete an increased amount of hormones, trying to activate the synthesis of sex steroids. As a result, an increased concentration of gonadotropins and a low level of androgens (estrogens) are recorded in the analyzes.

Hypogonadotropic hypogonadism is manifested by a simultaneous drop in blood tests of the levels of gonadotropins and sex steroids. This form of the disease is observed when the central parts of the endocrine system (pituitary and / or hypothalamus) are affected.

Thus, primary hypogonadism is hypergonadotropic, while secondary and tertiary hypogonadism is hypergonadotropic.

Primary and secondary hypogonadism can be congenital or acquired.

Etiology of hypogonadotropic hypogonadism

Secondary hypogonadism can develop for a variety of reasons.

Congenital forms are associated with:

• Cullman's syndrome (hypogonadism and impaired sense of smell);
• Prader-Willi syndrome (a genetic pathology that combines obesity, hypogonadism and low intelligence);
• Laurence-Moon-Barde-Biedl syndrome (a genetic pathology that combines obesity, hypogonadism, pigmentary retinal degeneration and low intelligence);
• Maddock's syndrome (loss of gonadotropic and adrenocorticotropic functions of the pituitary gland);
• adiposogenital dystrophy (a combination of obesity and hypogonadism);
• idiopathic hypogonadism (cause unknown).

Isolated idiopathic hypogonadism may be associated with adverse effects on the fetus at the time of intrauterine development. An excess of chorionic gonadotropin in the mother's blood, dysfunction of the placenta, intoxication, and exposure to drugs can adversely affect the emerging pituitary and hypothalamus. Subsequently, this can lead to hypogonadotropic hypogonadism. Sometimes there is a sharp decrease in the synthesis of only one of the hormones (LH or FSH).

Acquired secondary hypogonadism can be caused by:

• severe stress;
• lack of nutrition;
• a tumor (malignant or benign);
• encephalitis;
• trauma;
• surgery (for example, removal of a pituitary adenoma);
• irradiation of the head and neck;
• systemic connective tissue diseases;
• vascular diseases of the brain.

Manifestations of the disease

Congenital hypogonadism provokes violations of the formation of the genital organs and the absence of puberty. In boys and girls, the disease manifests itself in different ways.

Congenital hypogonadotropic hypogonadism in men leads to:

• underdevelopment of the genital organs;
• lack of spermatogenesis;
• eunuchoidism;
• gynecomastia;
• deposition of adipose tissue according to the female type;
• lack of secondary sexual characteristics.

For girls:

• the external genital organs are developed correctly;
• secondary sexual characteristics do not develop;
• observed primary amenorrhea and infertility.

In adults, the loss of secretion of LH and FSH can lead to a partial regression of secondary sexual characteristics and the formation of infertility.

Diagnosis of the disease

Secondary hypogonadism may be suspected in children and adults with characteristic reproductive disorders.

To confirm the diagnosis is carried out:

• external examination;
• Ultrasound of the testicles in men;
• Ultrasound of the small pelvis in women;
• blood test for LH and FSH;
• analysis for releasing hormones (luliberin);
• blood test for androgens or estrogens.

In men, sperm can be examined (with an assessment of the number and morphology of gametes). In women, egg maturation is monitored (for example, with ovulation tests).

Secondary hypogonadism is put if a low level of FSH, LH, androgens (estrogens) is detected.

Treatment of hypogonadism

Treatment is carried out by doctors of different specialties: pediatricians, endocrinologists, urologists, gynecologists, reproductologists.

In boys, treatment should begin as soon as the disease is diagnosed. In girls, hypogonadism is corrected from the age of 13–14 (after reaching a bone age of 11–11.5 years).

Hypogonadism in men is corrected with drugs with gonadotropic activity. Therapy with exogenous testosterone does not restore its own spermatogenesis and the synthesis of sex steroids.

The choice of a specific medication to protect against a form of deficiency. The most commonly used preparations of chorionic gonadotropin. This substance is effective in the treatment of LH deficiency or a combined decrease in two gonadotropins. Chorionic gonadotropin is used for idiopathic secondary hypogonadism, Maddock and Cullman syndromes, adiposogenital dystrophy.

If the patient is dominated by FSH deficiency, then he is shown treatment with other drugs - menopausal gonadotropin, serum gonadotropin, pergonal, etc.

In women, treatment is carried out:

• chorionic gonadotropin;
• clomiphene;
• menopausal gonadotropin;
• pergonal;
• estrogen and progesterone.

Clomiphene stimulates the synthesis of gonadotropins in the pituitary gland. Chorionic hormone, menopausal gonadotropin and pergonal replace LH and FSH. Estrogens and progesterone are used with caution. These hormones suppress the pituitary gland. But they successfully replace the natural hormones of the ovaries.