Primary hypogonadism in men treatment. What is hypogonadism in men and how to treat this disease. Consequences of hypogonadism in men

is an indicator of men's health. With a lack of sex hormones, hypogonadism develops in men. This disease most often occurs in adolescence and inhibits or completely stops the development of secondary sexual characteristics. The choice of treatment method depends on the type of manifestation of the pathology.

Hypogonadism (or hypogenitalism) is androgen deficiency in the body. However, testosterone levels are too low for a person to reach puberty. The disease manifests itself with a partial deficiency or complete absence of the sex hormone.

The causes of this pathology may be genetic diseases, testicular damage or acquired testosterone deficiency. Most of the androgens (95%) are produced in the testicles, the rest - in the adrenal glands.

For normal sexual development, men need:

• total testosterone in the blood: 30-1200 ng/ml;
• free testosterone: 52-280 ng/ml.

This developmental pathology also occurs in women, when the body stops developing due to a lack of estrogen. The cause is often functional ovarian failure. Male or female hypogonadism can be congenital or acquired.

Classification of the disease by cause

The disease affects the growth of male genital organs and is often accompanied by obesity. Children may develop a “eunuch” appearance. Treatment is very complex and does not always help patients cope with the disease. Therapy is selected depending on the type of pathology.

Primary

Primary is called hypergonadotropic hypogonadism. This is a classic manifestation of pathology when the genitals produce high amounts of testosterone. The congenital appearance is due to genetic predisposition. The most common cause is Klinefelter's syndrome, anorchism.

The symptoms of the congenital form of the disease are different:

• problems with spermatogenesis, lack of sperm activity;
• monorchidism, undescended or other pathologies of testicular development;
• congenital chromosomal abnormalities;
• male false hermaphroditism.

Due to the congenital form of the disease, the boy may have no testicles. Injuries, effects of radiation, or decreased fertility can trigger acquired hypogonadism. A man with the primary congenital form has no secondary sexual characteristics: growth stops and there is no facial hair.

Secondary

The secondary type is called hypogonadotropic hypogonadism. The production of sex hormones, namely testosterone in the male type, is suspended due to impaired functionality of the pituitary gland. A congenital developmental stimulator may be Kallmann syndrome.

There is a secondary type and acquired type; the development of the deviation is provoked by the presence of tumor processes in the hypothalamus or pituitary gland. Androgen deficiency occurs during a course of chemotherapy due to circulatory problems.

The development of pathology negatively affects reproductive function.

Age-related hypogonadism

Normogonadotropic hypogonadism in men is a disease in which testosterone levels are slightly reduced. The disease is more often observed in men over 35 years of age. The pathology is accompanied by impaired erectile function and reduced fertility.

Not all doctors recognize this form of deviation, since clinical signs are not observed based on the results of laboratory tests. The disease manifests itself in a man in the form of external symptoms: obesity, character changes, lack of erection.

Age-related hypogonadism in men develops due to an increased level of the hormone prolactin. Stress, taking certain medications and the presence of metabolic diseases (diabetes mellitus) affect hormonal levels.

Which doctor should I contact?

If you notice symptoms, you should seek help from a specialist. An endocrinologist deals with hormonal problems. It is also recommended to undergo examination by a sexologist and andrologist.

If sexual function or fertility is impaired, you can consult a fertility specialist. The doctor will help restore male fertility. In some cases, hypogonadism is a symptom of a cancerous tumor and will require examination by an oncologist.

Symptoms

The congenital form has distinctive features from the acquired one. The primary manifestation may be asymptomatic due to genetic predisposition. Signs of the disease can be divided into two groups: before and after puberty.

Symptoms of testicular failure before puberty:

• tall or short;
• violation of body proportionality;
• narrow chest, shoulders;
• skeletal underdevelopment;
• formation of a figure in a woman’s likeness;
• gynecomastia;
• high timbre of voice;
• anatomical structural features (testicular hypoplasia, lack of folds in the scrotum, micropenis;
• hair growth like women;
• dysfunction of the prostate gland;
• erectile disfunction;
• sexual passivity;
• fertility disorders.

Only a few of the listed symptoms may be present in a young patient. Outwardly, the boy will be similar to the girl in terms of figure development and voice pitch. In childhood, it is especially important to start treatment on time.

Age-related symptoms of hypogonadism:

• dysfunction of the testicles;
• female pattern hair growth;
• decreased skin elasticity;
• excess weight, development of obesity;
• sexual passivity;
• infertility.

The signs of the disease are practically the same. Low testosterone levels in old age are sometimes not considered a pathology. After 35 years, if a man wants to maintain the ability to conceive, he must immediately contact an endocrinologist.

Diagnostics

Already at the first examination, the doctor will make a preliminary diagnosis. To clarify suspicions, you will have to undergo laboratory or other additional research.

Diagnostic methods:

1. Medical examination. The endocrinologist will analyze the development of primary and secondary sexual characteristics, the presence of hair on the chest and face. The patient’s complaints and anamnesis also play an important role in determining the diagnosis.
2. Lab tests. You will need to undergo a complete hormonal blood test. The level of testosterone, FSH, LH, prolactin is determined. In some cases, especially in childhood, a genetic examination is prescribed (suspicion of chromosomal changes).
3. X-ray examination. It will be necessary to determine bone age using densitometry (usually prescribed to patients under 18 years of age); a comparison is made with the passport value. An x-ray using a sella turcica is also prescribed. The study will reveal the functionality of the pituitary gland.

If infertility or reduced fertility is suspected, the doctor will prescribe a spermogram. Typically, as an additional diagnostic test, a test for the presence of cancerous tumors is performed. In some cases, a testicular biopsy is indicated.

Treatment

The patient has a chance to regain the ability to conceive and develop the functionality of the reproductive system. It is necessary to consult a doctor in time. Diagnosis is often difficult if a boy at a young age is embarrassed to report underdevelopment of the genital organs.

There are three main treatment options: medication, conservative and surgical. The operation is indicated as a last resort when other therapeutic methods have not brought the desired results.

Hormonal

Drug treatment is prescribed based on the results of laboratory tests. The patient must regularly visit an endocrinologist to monitor the effectiveness of therapy. Men can undergo a hormonal course under the supervision of an andrologist.

Hormone therapy is used to increase testosterone levels. Drugs can be prescribed in various forms: ointments, gels, injections and tablets. Permanent subcutaneous testosterone implants are sometimes used.

Steroids are not prescribed in children. Fertility enhancing drugs are indicated only in cases of threatened infertility. Hormone therapy is highly effective, but has many side effects.

Negative consequences:

• increased red blood cell levels;
• blood thickening;
• gynecomastia;
• neoplasms on the prostate gland.

In old age, therapy is also prescribed with caution. Hormonal treatment is contraindicated for cardiovascular diseases and varicose veins. When undergoing treatment, it is recommended to undergo diagnostics and PSA analysis to monitor changes in the body.

Symptomatic

Another alternative to hormonal methods is conservative treatment. These are general strengthening activities that help strengthen men's health. Symptomatic therapy involves complete correction of diet and lifestyle.

You can do without medications, but the recovery process in this way is only possible in the acquired form of the disease. It is recommended that young people (especially teenagers) consult a psychologist. Communication with peers and a stable psychological state are the keys to successful recovery.

Innovative ways

In advanced cases, when drug and conservative treatment does not help cope with the pathology, surgery may be prescribed. The type of surgery depends on the type of hypogonadism and the cause.

Operational methods to solve the problem:

• relegation of the testicle to the scrotum area (with cryptorchidism);
• ligation of the vein and restoration of blood circulation (for testicular varicocele);
• surgery to eliminate dropsy;
• removal of tumors of the genitourinary system;
• elimination of gynecomastia;
• increasing the size of the penis or implantation;
• donor testicle or artificial organ replacement.

Plastic surgery is also performed if a man is embarrassed about the structure of his body. Liposuction, liposculpture or body contouring can be used. This surgical intervention is of an aesthetic nature.

Features of the course of the disease at different ages

Children with hypogonadism may develop complexes. It is very important for parents to notice the development of pathology in time and begin appropriate treatment. Psychological help will prevent the development of mental disorders.

It is important to undergo laboratory diagnostics and identify the cause of the pathology. Hormonal treatment is prescribed to children if other methods do not help. So that the boy can become a father in the future, it is recommended to treat him with Ami and other safe drugs.

The goal is to normalize androgen levels so that the boy develops secondary sexual characteristics. Puberty may not occur if action is not taken. When the patient reaches adulthood, it is allowed to use hormonal drugs to increase testosterone levels.

Prognosis for recovery

The disease cannot be completely cured. Hormonal therapy will help reduce androgen deficiency, the patient’s appearance will change, a mustache, beard and other signs characteristic of a man’s age will appear.

With hypogonadism, you can live a full life; the disease is not dangerous and does not threaten death. However, the most serious consequence is the development of infertility.

Complications of hypogonadism:

• osteoporosis,
• obesity,
• anemia,
• erectile disfunction,
• weakened muscles
• general weakness.

Timely treatment will help avoid unpleasant consequences. An important addition is compliance with preventive measures. First of all, you should change your lifestyle, play sports and balance your diet.

Prevention

In the congenital form of hypogonadism, when the parents are aware of the problem, the disease can be stopped. You can prevent the dramatic development of symptoms of androgen deficiency by changing your lifestyle.

It is also recommended to take more walks in the fresh air and protect the child from genital injuries and viral diseases. It is recommended for an adult man to have a regular sex life so that sex increases testosterone levels. Following simple rules will help stop the disease.

Video

Find out more about hypogonadism and its manifestations from the video.

So let's see what is hypogonadism?

From a medical point of view, hypogonadism (ICD-10 code: E23.0) is testicular failure caused by various factors and defects in their development.

Against the backdrop of all this the process of testosterone production is disrupted– the main male sex hormone. At the same time, the concentration of female sex hormones in the body increases (more precisely, their ratio with male ones), since in the stronger sex they are produced by the adrenal glands. There are significantly fewer of them than among women, but they still exist.

But a drop in testosterone levels provokes obesity, delayed sexual development, and the absence (or later appearance) of secondary sexual characteristics.

All this leaves its mark on the appearance of a patient with hypogonadism syndrome (photo below):

In addition, male hypogonadism syndrome is one of the most common causes of male infertility. Until the mid-90s, it was generally believed that hypogonadism (primary and secondary) was a 100% guarantee that a man would never be able to have children.

Today, there are therapies that can help him become active in reproductive terms. IVF is also used, that is, artificial insemination by extracting active sperm and forcing them into an egg.

The best thing about hypogonadism is that it is treatable. Accordingly, all unpleasant symptoms can be avoided, but only with timely seeking medical help. The longer you postpone such a visit, the higher the likelihood of complete atrophy of the testes, in which the production of testosterone (and sperm) completely stops.

Unfortunately, in the Russian Federation there is currently no practice for the early detection of hypogonadism, although the Ministry of Health has such plans.

Classification of hypogonadism

According to etiology (clinical signs), hypogonadism is divided into:

• or testicular hypogonadism (develops against the background of testicular dysfunction);
• or gonadotropic hypogonadism (implies problems with the pituitary gland, which regulates the production of androgens, which provokes the synthesis of testosterone).

With secondary hypogonadism, the functionality of the testes is not conditionally impaired, so the man retains reproductive function, but only if there is no testicular atrophy (and it develops over time).

With tertiary (hyperprolactinemic) hypogonadism, a pathology of the central nervous system is detected, due to which the production of gonadotropin-releasing hormone (abbreviated as GnRH) is disrupted. It is he who is responsible for the development of the testicles. Due to a lack of the hormone, the testes begin to work defectively, which in the future leads to a sharp decrease in testosterone concentration. And even later, testicular atrophy and infertility develop.

Age-related hypogonadism in men is a natural process for men. Over time, testosterone production slows down, or even stops altogether, due to the natural wear and tear of the gonads. The disease is especially active in those patients who live in environmentally unfavorable regions.

According to experts, signs of age-related hypogonadism can become apparent from 25 to 75 years of age. To one degree or another, it occurs in 30% of men, mostly of retirement age.

Unfortunately, it is impossible to counteract this process - this is the natural aging of the body. It can be compared to female menopause and the onset of menopause, when the body simply loses its ability to reproduce.

They are also conventionally divided congenital and acquired hypogonadism. The latter occurs against the background of physiological damage to the ovaries, or their damage by infection, radiation (after radiation therapy). Congenital is more common.

The share of acquired disease in all cases is only 25-35% (WHO has not conducted more accurate studies).

Male hypogonadism is testicular failure

How does hypogonadism occur in an adult male? If its course is subtle, the disease can be diagnosed, for example, after multiple unsuccessful attempts to conceive a child.

The culprit here is precisely testicular failure and subsequent poor sperm quality(low sperm concentration). Against this background, a man can be found to be overweight, general lethargy, low libido (sexual attraction to girls), and a penis that is too small.

Pay attention to the typical external manifestations of hypogonadism in men (photo):

Testosterone takes part in many physiological processes in the male body. It is partially responsible for the breakdown of fats, tone, immunity, external beauty, and so on. And all this is disrupted or damaged in hypogonadism to one degree or another.

This is less noticeable in adolescents, since puberty occurs on average after 12 years of age. Until this point, their testosterone levels are relatively low. But in an adult man, the concentration of the hormone is always at a relatively high level (in the range of 12-33 nmol/l for total testosterone).

Treatment of male hypogonadism

The basis is hormonal replacement and attempts to determine the primary factor in the manifestation of the disease.

Hypogonadism is a disease that you should never try to cure on your own. Self-medication is unacceptable, and the main therapy and the name of the drugs that a man should take are indicated exclusively by the attending physician.

So-called “traditional” methods of treatment should also be further discussed with him.

As during treatment, the patient is prescribed a synthetic analogue of testosterone. Typically this is:

• Sustanon;
• Omnadren;
• Testosterone Propionate;
• Andriol (for oral use);
• We are testing.

For the most part, it is prescribed in the form of injections for intramuscular and intravenous administration (at the discretion of the attending physician). The final choice depends only on the type of hypogonadism and the primary concentration of testosterone in the man’s blood.

Among traditional methods of treatment it is worth highlighting inclusion of natural aphrodisiacs in the diet. These include, for example, ginger, ginseng root (taken in the form of tea), carrots, lemon, gooseberries, and currants. But on this matter it is better to consult a nutritionist.

Surgery for hypogonadism used either for phalloplasty and correction of other "feminine" features in development (for example, correction of breast enlargement), or for transplantation of healthy testicular cells.

Operations are also performed during IVF, that is, artificial insemination. In this case, sperm are extracted using a specialized endoscope. But such therapy is prescribed only in cases where the functionality of the testicles is not impaired.

Hypogonadism and bodybuilding

In addition, this sport uses diets designed to stimulate testosterone production. And some athletes even inject themselves with hormones indicated for hypogonadism. This accelerates the growth of muscle mass, stimulates metabolic processes and, as a result, reduces fat mass.

We should not forget that excess weight can become the main provoking factor of hypogonadism.

Regarding bodybuilding and hormonal injections, you should also consult with your doctor.

Hypogonadism is one of the most severe diseases of the male reproductive system. But it is treatable. Therefore, at the slightest suspicion of pathology, you should seek medical help.

In some cases, short-term replacement therapy will be sufficient, while in others, lifelong monitoring of testosterone in the blood and surgery will be required. The development of the disease for each man in this regard is purely individual.

Hypogonadism in men is a disease caused by a deficiency of androgen hormones in the body. Depending on the etiology of the disease, it is customary to distinguish between primary hypogonadism and the secondary form of the disease (also known as hypogonadotropic hypogonadism). The primary form of the disease, characterized by increased levels of gonadotropic hormones in the body, is often called hypergonadotropic hypogonadism.

Pathology occupies a leading place in prevalence among male diseases caused by functional insufficiency of the gonads.

Primary hypogonadism in men

Primary hypogonadism can be congenital. The disease is manifested by testicular failure of the testicles or their complete absence (anorchism). Pathology manifests itself during the prenatal period. A boy is born with a penis whose size is significantly smaller than normal, as well as with an underdeveloped scrotum.

Further symptoms of primary congenital hypogonadism appear in adolescence. Young men with primary hypogonadism have the so-called “eunuchoid” type of skeleton, excess body weight, signs of gynecomastia (breast enlargement), and a low degree of hair growth.

Congenital primary hypogonadism is a common occurrence in the genetic syndromes of Klinefelter, Reifenstein, Shereshevsky-Turner, Noonan and Del Castillo.

Primary hypogonadism in men can also be acquired. It is this form of the disease that is the most common and occurs on average in every fifth man with diagnosed infertility.

Acquired primary hypogonadism develops as a result of inflammation of the seminal glands with:

• orchitis (inflammation of the testicles),
• vesiculitis (inflammation of the seminal vesicles),
• differentiation (inflammation of the spermatic cords),
• epididymitis (inflammation of the epididymis),
• infectious mumps (mumps),
• chicken pox.

Cryptorchidism (undescended testicles into the scrotum) is also considered a possible provoking factor for acquired primary hypogonadism. Injury or radiation damage to the testicles can provoke functional failure of the male gonads.

An idiopathic form of primary hypogonadism in men with an unknown etiology of the disease is also possible.

With acquired primary hypogonadism in adolescence, the formation of secondary sexual characteristics does not occur. In adult men, the disease leads to an increase in body weight, decreased libido, erectile dysfunction and spermatogenesis, a decrease in the severity of male sexual characteristics and the development of infertility.

Secondary hypogonadism in men

Secondary or hypogonadotropic hypogonadism can also be congenital. It develops when the secretion of hormones by the pituitary gland and hypothalamus is impaired. Secondary hypogonadism accompanies the following genetic diseases:

• Pasqualini syndrome,
• maddock syndrome,
• Prader-Willi syndrome.

The development of hypogonadotropic hypogonadism is also not uncommon in craniopharyngiomas (tumors of the brain epithelium).

Acquired secondary hypogonadism develops as a result of complications of inflammatory processes in the brain. They can be provoked by meningitis, arachnoiditis, meningoencephalitis, encephalitis, etc.

With them, not only the function of the sex glands suffers, but also other pathologies of the hypothalamic-pituitary system arise: disorders of thyroid secretion, thermoregulation, weight and linear growth.

Diagnosis of hypogonadism in men

Congenital primary hypogonadism is diagnosed if a newborn boy's testicles cannot be felt upon palpation. To confirm the diagnosis, pelvic ultrasound and hormonal blood tests are used.

Characteristic signs of the disease are testosterone levels below normal, high levels of luteinizing and follicle-stimulating hormones in primary hypogonadism and a deficiency of the above hormones in hypogonadotropic hypogonadism.

In the diagnosis of secondary hypogonadism in men, CT, MRI, and electroencephalography of the brain are used.

To determine the causes of hypogonadism of the primary or secondary form, a genetic differential diagnosis of the pathology is carried out.

Treatment of hypogonadism in men

In the treatment of hypogonadism, replacement therapy with male sex hormones is used. With lifelong continuous administration of drugs, starting from adolescence, the boy develops secondary sexual characteristics. In most cases, it is also possible to preserve sexual function.

Treatment of hypogonadism caused by cryptorchidism is predominantly surgical. The recommended age for surgical intervention is 1-1.5 years. The higher the position of the undescended testicle in the abdominal space, the earlier irreversible processes occur in the tissues of the seminal glands. They lead to acquired primary hypogonadism and infertility.

Treatment of hypogonadism of the hypogonadotropic form consists of treating the underlying disease. Surgery or radiation treatment of hypogonadism is carried out for brain tumors.

The replacement strategy for the treatment of secondary hypogonadism depends on the degree of disturbance in the production of hormones by the hypothalamic-pituitary system and the age of the patient.

If there is no need to preserve the patient’s sperm-forming function, treatment of hypogonadism of the hypogonadotropic form is carried out with the help of testosterone.

In young men and adolescent boys, a short course of testosterone therapy is used, and gonadotropic hormone preparations are used to normalize spermatogenesis in hypogonadotropic hypogonadism.

Video from YouTube on the topic of the article:

The cause of the development of both primary and secondary hypogonadism can be many factors:

There is a form of the disease that is based on the lack of sensitivity of androgen receptors to testosterone. It is called testicular feminization syndrome. There are 2 varieties of it:

1. 1. Full. It is characterized by absolute underdevelopment of the male genital organs, as a result of which the patient is assigned female gender at birth, but according to his genotype he has male characteristics. Attempts to masculinize such a person with hormonal drugs or operations are considered a gross mistake, since despite the normal content of androgens, the cells will still not perceive them.
2. 2. Incomplete. In such patients, against the background of symptoms of hypogonadism, there is the presence of a micropenis or small penis, hypospadias, which requires surgical intervention. In addition, therapy with high doses of hormones is carried out.

Hypogonadism in men is not an independent disease, but a pathological syndrome (complex of symptoms) that arises from many causes and is a manifestation of various diseases. The term comes from the Latin hypo - lower, lack, gonadis - sex glands that produce hormones and determine gender.

Most often, hypogonadism occurs in boys, which is also called insufficiency of sexual development, but it can also develop in adult men as a result of certain factors. This is a great tragedy for the stronger sex, accompanied by the loss of external sexual characteristics, a decrease in sexual abilities, and serious health disorders. A big problem is also the social disadaptation of patients, when they become outcasts in groups, in society, and often in families.

The pathology has a code according to ICD-10 (international classification of diseases) E29 - testicular dysfunction, subparagraph E29.1 - testicular hypofunction.

To understand the mechanism of development of hypogenitalism, you need to know how the male hormonal system normally works. It consists of 2 parts: the gonads (testes), which produce androgens (testosterone, dihydrotestosterone) and the pituitary gland, located at the base of the brain. It produces gonadotropic hormones: follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin. Androgens also affect the function of the pituitary gland: the less there are, the more gonadotropins are produced, and vice versa.

The classification of pathology is based on the causal factors underlying it. All types of hypogonadism are divided into 2 large groups:

1. Primary
2. Secondary.

Primary hypogenitalism (hypogonadism)

This is testicular hypogenitalism (from the Latin testiculos - testicles), it is based on decreased function gonads directly. Due to these disorders, there are 2 types of hypogenitalism:

1. Congenital, arising as a result of various anomalies and gene pathologies: anorchism (absence of testicles), hypoplasia (underdevelopment), male hermaphroditism, chromosomal developmental abnormalities (Klinefelter, Noonan, Sherishevsky-Turner syndrome).
2. Acquired when the child was born normal, but the development of the gonads was influenced by various factors: trauma, tumors, infections, autoimmune processes, harmful environmental factors (radiation, chemicals). In these cases, hypergonadotropic hypogonadism develops in men, when the pituitary gland increases stimulation of the testicles, increasing the production of hormones.
3. Age-related, developing against the background of a decrease in the hormonal function of the testicles in andropause, it is normotropic, without disruption of the pituitary function.

Secondary hypogonadism

This is hypogonadotropic hypogonadism, not associated with testicular pathology, develops as a result of insufficient stimulation of their pituitary gland due to a deficiency of gonadotropic hormones. It also comes in 2 types:

1. Congenital, caused by hereditary diseases:

• pituitary dwarfism – general underdevelopment due to decreased pituitary gland function;
• insufficient production of follicle-stimulating hormone (FSH);
• insufficiency of luteinizing hormone (LH) production – Pasqualini syndrome;
• pituitary-adrenal insufficiency - Meddock syndrome;
• congenital tumor of the base of the brain - craniopharyngeoma, compressing the pituitary gland;
• brain anomaly with underdevelopment of the pituitary gland, impaired vision and smell - Kallmann syndrome;
• idiopathic, occurring when the embryo’s production of human chorionic gonadotropin (hCG) decreases as a result of various unfavorable factors, complicated pregnancy.

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1. Acquired:

• as a result of damage to the pituitary gland by infection, trauma, with pituitary adenoma, after surgery;
• hyperprolactinemic – with increased production of prolactin during stress, taking certain medications;
• due to endocrine diseases - thyroid gland, diabetes;
• in case of severe diseases of internal organs, when the function of the pituitary gland is inhibited;
• with long-term use of anabolic steroids;
• with cryptorchidism due to testicular atrophy.

There are also hypogenitalism depending on age:

1. Embryonic, when disorders arose in the prenatal period.
2. Prepubertal, when hormonal imbalances develop in a child under 12 years of age.
3. Postpubertal, appearing in adolescence and 12 years of age and later.

Manifestations of various types of pathology

Clinical manifestations of hypogonadism vary depending on age. Before the onset of puberty in a boy or in the prepubertal period, the following symptoms are observed:

• eunuchoid appearance;
• dwarfism;
• overweight with fat distribution on the hips, chest, abdomen;
• looseness of the body, poor muscle development;
• small penis and testicles;
• presence of gynecomastia;
• high thin voice;
• pale skin.

In young children, when the pathology is congenital, other disorders are associated: mental retardation, speech disorders, strabismus, mental disorders, and there may be other organ abnormalities.

With the onset of puberty, the manifestations of this pathology are as follows:

• reduction of hair growth in the armpits, pubic area, face;
• decreased sexual function, up to the complete disappearance of erection;
• decreased libido;
• weak or absent orgasm;
• small size and laxity of the testicles;
• pale skin;
• lethargy, apathy.

Common symptoms for any type of hypogenitalism, at any age, are:

• change in body configuration – narrow shoulders and chest, wide hips;
• female-pattern pubic hair growth (horizontal hairline);
• decreased muscle tone;
• reduction in the size of the prostate gland;
• small penis size;
• emotional and vegetative-vascular disorders, development of neuroses and depression;
• poor sleep, increased fatigue, lethargy, general weakness.

Adult men look effeminate: both body shape and behavior, to one degree or another, resemble a woman.

Sometimes so-called subclinical hypogonadism occurs, when symptoms are not expressed for a long time: body configuration, genital size, and sexual activity may be normal. This pathology is more often detected when spouses come to see us about their inability to have children.

When examined, men are found to have low testosterone levels. As a result, the disease will manifest itself later if it is not treated.

Diagnostics

Already when examining a patient, the doctor decides which set of tests to prescribe. For example, if a varicocele or cryptorchidism, hydrocele or testicular tumor is detected, a general examination is carried out, and the patient is sent for surgical treatment. After eliminating these causes, androgenic function often returns to normal.

If there are external signs of hypogenitalism without visible genital pathology, a special examination is prescribed, which includes laboratory and instrumental methods.

Lab tests

The laboratory research package includes:

• blood test for testosterone levels;
• determination of gonadotropins in the blood (luteinizing hormone, follicle-stimulating hormone, prolactin);
• determination of GnRH, a releasing hormone of the hypothalamus that stimulates the pituitary gland;
• determination of anti-Mullerian estrogen-like hormone (AMH), in men its concentration is very low;
• determination of 17-ketosteroids in urine - decayed androgens excreted by the kidneys in the urine;
• chromosomal, genetic research to identify hereditary pathologies.

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The principle for assessing the test results is as follows: all patients have reduced testosterone levels in the blood serum, as well as reduced 17-ketosteroids in the urine.

With the primary nature of the disease, the content of gonadotropic hormones of the pituitary gland will be increased, as a compensatory reaction of the body, and with secondary hypogonadism, their level will be reduced, along with a decrease in testosterone.

Among the additional instrumental methods prescribe:

• Ultrasound of testicles, prostate gland;
• computer or magnetic resonance imaging of the brain, examination of the condition of the pituitary gland;
• X-ray of bones;
• densitometry (determination of bone density).

Ultrasound and tomography can reveal the presence of pituitary cysts, testicles and other tumors and developmental anomalies. A study of the state of the skeletal system makes it possible to determine at what stage puberty is located - by the size of the areas of ossification zones. Usually judged by the sesamoid bone on the wrist, which completely completes the ossification process by the beginning of puberty, normally this corresponds to 12-14 years. In this case, ethnic origin is taken into account: for southerners this process can begin at 10-11 years old, for residents of the northern regions it can be delayed up to 16 years.

Treatment methods

Treatment of hypogonadism is complex and comprehensive, it includes drug therapy, normalization of physical condition, metabolism and all body functions, sexual and psychological rehabilitation, surgical interventions, if necessary. The treatment protocol is drawn up for each patient individually, depending on his age, the cause of hormonal deficiency, and the severity of the syndrome.

Medicines for hormonal correction

Hormonal drugs are prescribed by an endocrinologist, and the patient is regularly monitored with the participation of a urologist (andrologist), with periodic laboratory monitoring of testosterone levels.

In case of primary hypogenitalism, testosterone production is stimulated using tablets or injections of LH, FSH, clomiphene, aromatase inhibitors (letrozole, exemestane, anastrozole), human chorionic gonadotropin (pregnyl, choragon, ovitrel, prophase) is also prescribed. Adult men are prescribed the drug prostatilen, which stimulates hormonal function and spermatogenesis, improves sperm quality.

If hormonal function is low, steroid replacement therapy is prescribed: testosterone depot, Delasteril, Omandren injection, or oral Striant, Andriol. In recent years, a method has been developed for external use in the form of ointments, gels, patches (Andractim, Androgel, Testomax), as well as subcutaneous testosterone implants.

Hormone therapy very effective, but has a number of side effects: increased red blood cell levels, blood thickening, development of gynecomastia, prostate tumors. It is prescribed with caution to men after 40 years of age, with ultrasound and PSA (prostate specific antigen) testing performed twice a year.

Surgical operations

Surgical treatment is aimed at eliminating the anatomical cause of the disease, correcting defects, and restoring the normal configuration of the body and genitals. The following types of operations are performed:

• elimination of cryptorchidism (reduction of the testicle into the scrotum);
• elimination of varicocele (vein ligation or microsurgical restoration of blood flow);
• removal of hydrocele of the testicular membranes;
• removal of a tumor in the scrotal cavity;
• plastic surgery of the mammary glands (removal of gynecomastia);
• phalloplasty – increasing the size of the penis and penile prosthesis – implantation of an artificial phallus;
• testicular prosthesis;
• implantation of functioning donor testicular tissue into the scrotum.