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HYPOGONADISM

Male hypogonadism is a syndrome characterized by a deficiency in the production of male hormones – especially testosterone and in the production of sperm.

Testosterone is the fuel for male health and is produced by the testicles and critical for normal sperm production. The drop in blood levels of testosterone negatively affects the quality of life, sexual and reproductive health of men.

 

Male hypogonadism can have different causes and, therefore, it is classified into different types:

  • Hypergonadotrophic hypogonadism (primary):  deficiency in testosterone production due to testicular dysfunction. These dysfunctions can be congenital or acquired.

  • Hypogonadotrophic hypogonadism (secondary):  deficiency in the production of pituitary hormones, FSH and LH, responsible for stimulating the testicle to produce testosterone. Pituitary disorders can also be congenital or acquired.

  • Late-onset or functional hypogonadism:  when the drop in testosterone levels is related to age associated with metabolic changes, especially obesity, pre-diabetes and diabetes.

  • Hypogonadism due to insensitivity of androgen receptors:  it is a rare form characterized by dysfunction of cellular testosterone receptors, compromising the normal functions of organs that depend on the action of testosterone.

 
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WHAT ARE THE CAUSES OF HYPOGONADISM IN MAN?

The main causes of  hypogonadism  according to the types described above are:

Primary hypogonadism:

  • Klinefelter Syndrome:  genetic syndrome resulting from alterations in the sex chromosomes leading to incomplete development of the testis and, consequently, decreasing production of testosterone (hypogonadism) and sperm (azoospermia).

  • Cryptorchidism or congenital anorchia:  Cryptorchidism is the condition in which the testicles do not migrate into the scrotum and become trapped in the intra-abdominal or inguinal spaces (groin region). Congenital Anorchia is the absence of testicles.

  • Use of chemotherapy:  these drugs are toxic to the testicle impairing its function.

  • Testicular malignant neoplasm:  better known as testicular cancer, it can lead to  hypogonadism  and azospermia.

  • Testicular infections (orchitis):  infections  caused by sexually transmitted microorganisms, or even mumps, can result in testicular changes and impaired production of testosterone and sperm.

Secondary hypogonadism:

  • Pituitary tumor:  tumors  in the pituitary gland that impair the gland's ability to secrete the hormones FSH and LH, which stimulate testosterone production by the testes.

  • Hemochromatosis:  a disease in which there is an accumulation of iron in the body, which ends up being deposited in tissues, including the pituitary.

  • Abuse of anabolic steroids:  Testosterone-derived substances used to increase muscle mass. They affect the hypothalamus-pituitary-testis hormone production axis.

  • Obesity:  one of the most frequent causes of  hypogonadism  male, as 64% of obese men have low levels of testosterone. Obesity is a low-grade inflammatory state with production of inflammatory cytokines that impair the function of the pituitary and testicles, causing a  hypogonadism  mixed.

  • Radiotherapy:  when this procedure is performed near the testes or pituitary region, the function of these organs may be affected.

  • Untreated hormonal disorders:  too much or too little production of other hormones can affect testicular function, such as thyroid hormones, adrenal hormones, growth hormone, and prolactin.

It is important to emphasize that aging is one of the factors that increase the chances of men having low concentrations of testosterone in the body, giving rise to  hypogonadism  of late start. It affects about 20% of the senile population, according to information from the Brazilian Society of Endocrinology and Metabolism, and it is estimated that from the age of 40 onwards, the decrease in testosterone production is around 10% every decade.

 

WHAT ARE THE SIGNS AND SYMPTOMS?

The most common symptoms of  hypogonadism  male are:

  • Unclosed epiphyses (ends of bones);

  • Sarcopenia (loss of muscle mass);

  • High-pitched voice;

  • Small testicles;

  • Infertility;

  • Reduced sexual activity/desire;

  • Gynecomastia (growth of breasts in men);

  • Sparse facial and body hair.

And in the  hypogonadism  of late start?

  • Loss of libido;

  • Sarcopenia (loss of muscle mass);

  • Insulin resistance;

  • Hot flashes (sudden feeling of heat);

  • Sleep disorders;

  • Mood changes, fatigue and irritability;

  • Erectile dysfunction;

  • Increased fat in the abdomen region;

  • Depression.

 

HOW IS DIAGNOSIS DONE?

The diagnosis of  hypogonadism  is based on clinical signs and symptoms associated with laboratory and imaging tests.

The main methodology used to confirm the diagnosis is the measurement of testosterone levels in the blood. It is recommended that the analysis be performed on 3 different days in the morning.

According to the signs and symptoms of each patient, other tests may be requested by the doctor, in order to complement the diagnosis, such as:

  • Seminal analysis (spermogram);

  • Dosage of other hormones, such as FSH, LH, among others;

  • Pituitary resonance or tomography;

  • Testicle ultrasound.

 

HOW IS THE TREATMENT PERFORMED?

The treatment of  hypogonadism  male enhancement will be performed by a specialist physician, who will individually assess each patient in order to improve their quality of life and restore testosterone levels.

In most cases, the treatment of choice is hormone replacement. There are several drugs available on the market and only the doctor is able to assess which is the best for each type of  hypogonadism. It is essential that the individual strictly follow the dosage and period recommended by the professional so that the treatment offers the expected result.

It is important to note that men of reproductive age (17 to 40 years) or who wish to have children cannot indiscriminately replenish testosterone, as they run the serious risk of activating the negative feedback mechanism of the hypothalamic-pituitary-testicles axis and inhibiting the production of testosterone and sperm by the testicles, which can lead to atrophy (important reduction in volume) of the testicles.

Some lifestyle habits can reduce the chances of developing the  hypogonadism, such as maintaining a regular sleep routine and exercising. If you have any doubts about the subject, especially when aimed at the male audience, get in touch and schedule your appointment.

 

When looking for a specialist doctor to treat varicocele, it is extremely important to choose a professional with expertise in the area, recognized by renowned institutions in the sector. Dr. Jorge Hallak, for example, is a pioneer in men's health in Brazil and a member of the main national and international associations, such as the Brazilian Society of Urology (SBU),  American Society of Andrology,  International Society of Andrology, among others.

Given the effects of varicocele on men's reproductive health, it is essential that men go to an andrologist annually to take care of their reproductive health. If you have any questions, please contact us and schedule an appointment.