Hypogonadism (literally, gonad deficiency) is a state of low or no production of sex hormones. In men, that will mean low testosterone. Testosterone is responsible for masculine traits in men, including the testes, penis, sperm, libido, body hair, muscle mass, and bone growth. It also enhances many other physiological processes, such as red blood cell production, body fat regulation, brain function, stress control, and mood.
Two types of causes of hypogonadism
Testosterone is critical for a good quality of life, but deficiency is, unfortunately, very common in modern times. Hypogonadism in men is accompanied by low libido, weak erections, muscle loss, bone fragility, excess weight, reduced physical/mental energy, weak concentration, and low self-confidence. If left unchecked and untreated for a longer period, it can raise the risk of heart disease, stroke, diabetes, and depression.
Understanding the causes of hypogonadism is vital to finding the most suitable solution to the problem. Hypogonadism causes fall into two broad categories – primary causes and secondary causes. The two causes are not mutually exclusive – you may have both at the same time.
Primary causes of hypogonadism are also referred to as primary testicular failure. They are testicular disorders that may occur at birth or be acquired later in life. The testicles do not function as they should and are thus unable to produce testosterone at normal levels.
A condition referred to as cryptorchidism, it occurs when a male baby’s testicles do not descend into the scrotum before birth or within the first few months. For testicles to discharge their function optimally, including producing testosterone, they need to be at a temperature that is two or three degrees less than the body’s core.
Orchitis is an inflammation of the testicles that causes one or both of them to be painful and swell. This is sometimes caused by bacterial sexually transmitted diseases or urinary tract infections. Orchitis is, however, more often caused by viral illnesses such as mumps, a type of orchitis referred to as mumps orchitis. It may eventually cause testicles to shrink and hamper testosterone production.
A male is usually born with one X and one Y chromosome. However, Klinefelter syndrome is a genetic condition where male children are born with an additional X chromosome. That is, XXY as opposed to XY. The condition causes the testes not to produce enough testosterone.
Hemochromatosis is a condition where the body absorbs and retains much more iron than is needed. Often genetic, it may cause significant damage by storing the iron in body organs including the pancreas, liver and heart. Hemochromatosis could affect the testes, impair testosterone production and cause erectile dysfunction.
Cancer treatment on the testicles, such as radiation therapy and chemotherapy, can inhibit the healthy production of testosterone and sperm. Effects are usually temporary and should go away in a few months. Sometimes though, permanent infertility may occur.
Injury to the testicles
A kick to the groin is a famously painful experience for a man. The testes have a large number of densely packed nerve endings which makes them unusually sensitive. It is part of the body’s evolved defense mechanism for protecting the testes. Physical injury to the testicles can have the same impact as missing or stunted testicles. The resulting testicular rupture, torsion, or epididymitis could temporarily or permanently inhibit testosterone production.
Secondary causes of hypogonadism originate from problems with the pituitary gland or hypothalamus function. The hypothalamus makes the gonadotropin-releasing hormone that triggers the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The dysfunctions may occur at birth or be acquired later in life.
Pituitary disorders may be caused by a tumor, injury, infection, radiotherapy, or surgery that inhibits the normal function of the pituitary gland. This impairs pituitary hormone release, which in turn interferes with normal testosterone production.
Kallmann syndrome is a genetic condition that leads to the loss of nerve cells’ development in the hypothalamus, responsible for gonadotropin-releasing hormone production. It is characterized by delayed or absent puberty as well as a lack of sense of smell.
HIV/AIDS may affect the pituitary gland, hypothalamus, and testes resulting in low testosterone levels. One study found that about 30 percent of HIV-infected men on antiretroviral treatment had testosterone deficiency. Among men that have progressed to AIDS, the prevalence is even higher at more than 50 percent.
Some inflammatory illnesses, including tuberculosis, histiocytosis, and sarcoidosis, impact the pituitary gland and hypothalamus. This could interfere with the production of hormones that signal testosterone production.
Overweight and obese individuals, irrespective of age, are more likely to have low testosterone. This is also the case in persons diagnosed with obesity-linked conditions such as diabetes and high blood pressure. A study found obese teens had 50 percent less testosterone than their peers. The relationship between obesity and low testosterone is bidirectional.
With aging comes a steady decline in Leydig cells and hypothalamic-pituitary function. For virtually every man, this leads to a drop in free testosterone and sperm production. This decline varies greatly from person to person with a fraction of individuals experiencing a more rapid drop than the average man.
Some types of Medication
Certain prescription and over-the-counter (OTC) drugs can curtail testosterone production. Medications used for conditions such as diabetes, heart disease, high blood pressure, prostate cancer, pain management, depression, and anxiety may inadvertently reduce free testosterone levels. The longer the medication is used, the higher and potentially more damaging the risk. This is why it’s important you get your doctor’s clearance before using OTC medication in the medium- to long-term.
When should I consult a doctor?
Low testosterone can be problematic since it will not always show symptoms. Some people only realize that they have it after routine blood work and physical examination. Still, the earlier you can identify the problem, the better.
So, schedule a conversation with your doctor if you suspect you have at least one symptom of low testosterone. They will review the symptoms and may have you undergo tests to check for low testosterone levels or the symptoms. If your son is not exhibiting puberty signs by the time he has turned 14 years of age, consult their pediatrician.
In case you have already been placed on testosterone replacement therapy, make regular appointments with your doctor.
According to the American Urological Association, low testosterone is present in roughly 1 in 50 men, including 2 in 5 among those aged 45 and older. The risk grows with age, weight, sedentary lifestyle, and unhealthy diets. Most cases can be treated. Recognizing the early signs is vital to quick diagnosis and timely treatment.