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Hypogonadism Booklet

Hypogonadism booklet

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Male

Hypogonadism Primary and Secondary

Low or no testosterone production in males due to testicular failure or hypothalamic/pituitary disruption resulting in abnormal development, physical growth and reproductive development.

Also known as Male Menopause, Hypogonadism Late Onset

About the Condition

Derives from the hypothalamic-pituitary-testicular axis and include congenital, genetic, immunological and structural abnormalities, all of which are manifested in the deficient secretion or attenuated action of testosterone itself.

The pituitary gland in the brain controls gonadal hormones, which determine the sex of a fetus, when a child matures into an adult, and reproductive function. Primary hypogonadism is a problem with the ovaries or testes. Secondary hypogonadism is a result of a problem with the pituitary gland.

Hypogonadism occurs more often in males than in females.

Occurrance:

  • 5 per 1000 males.
  • 5 per 100 diagnosed pre-puberty.
  • Many never diagnosed.

Can progress onwards to Oestoporosis, infertility, chronic fatigue, psychosocial factors.

Next page: Symptoms of Primary and Secondary Hypogonadism

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Symptoms of Primary and Secondary Hypogonadism

  • High pitched voice
  • Absent facial hair
  • Decreased or absent body hair
  • Eunuchoidal body proportions
  • Female escutcheon
  • Testicular volume < 4 mL
  • Testicular length < 2.5 cm
  • Penile length < 5 cm
  • Smooth scrotum with no rugae, small prostate

Genetic disorders such as chromosomal variants 47,XYY and XXY (Klinefelter Syndrome) are the most common form of genetic based hypogonadism. Hypogonadism does not present significant symptoms in most boys until puberty. Suspect XXY or Klinefelter syndrome if your son is taller than 75% of his male classmates, has thin arms and shoulders, severe acne, and is clumsy and uncoordinated. He will not have any physical abnormalities.

If your son does not develop a beard, but does develop enlarged breasts, and you are concerned about his lack of growth, then see your doctor.

Adult males with Klinefelter Syndrome are infertile, tend to be taller than average, have little body hair, have female-like fat distribution and small underdeveloped testes. In XXY boys and men testosterone supplementation is the gold standard treatment.

Extreme hypogonadism in boys is Frolich’s syndrome, eunuchism, or euchnuchoidism. Affected boys are small, obese, and have tiny genitals because of a tumor in the hypothalamus portion of the brain.

Most adult men with XYY syndrome are fertile and have normal sexual function. Some are infertile because of inadequate sperm production. Males with XYY have 40% fewer spontaneous erections, as compared to normal XY males. XYY men have fewer sexual fantasies, decreased sexual desire, and perform fewer sexual acts.

Testosterone supplementation can help to remedy the sexual dysfunction. 47,XYY syndrome is associated with an increased risk of learning disabilities and delayed development of speech and language skills.

Delayed development of motor skills (such as sitting and walking), weak muscle tone (hypotonia), hand tremors or other involuntary movements (motor tics), and behavioral and emotional difficulties are also possible. These characteristics vary widely among affected boys and men.

Androgen Deficient Ageing Males (ADAM), or late-onset hypogonadal males, are lethargic from disturbed sleep, depressed, irritable, have muscle weakness, increased fat at the hips and thighs, low energy, unexplainable fatigue, sexual dysfunction, confusion and anxiousness.

Next page: Causes of Primary and Secondary Hypogonadism

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For men

AndroForte® 2% Testosterone Cream is specially formulated for men with low blood testosterone levels.

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Causes of Primary and Secondary Hypogonadism

Hypogonadism is caused by:

  • Alstrom syndrome
  • Anorexia nervosa (excessive dieting)
  • Cancer of the gonads or prostate gland
  • Cirrhosis of the liver
  • Chemotherapy
  • Cushing syndrome
  • Diabetes mellitus
  • Environmental toxins (2,4-D; atrazine; borax; butylate; and methoxychlor)
  • Gaucher disease
  • Genetic disorders
  • Hemochromatosis
  • Histiocytosis
  • HIV (the virus that causes AIDS)
  • Hyperprolactinemia (too much prolactin, the milk-producing hormone) from a pituitary tumor or medicine like metoclopramide
  • Idiopathic Hypogonadotropic Hypogonadism
  • Kallmann syndrome
  • Klinefelter syndrome (XXY syndrome)
  • Laurence-Moon Biedl syndrome
  • Liver and kidney diseasev
  • Malnutrition
  • Polycystic ovarian syndrome
  • Prader-Willi syndrome
  • Prescription drugs, like methadone, spironolactone, and ketokonazole
  • Radiation
  • Removal of the pituitary gland to treat a pituitary or breast tumor
  • Sarcoidosis
  • Sickle cell anemia
  • Street drugs, like heroin and marijuana
  • Stress
  • Trauma to the gonads or head
  • Tuberculosis
  • Turner’s syndrome
  • Viral orchitis if a male gets mumps after puberty
  • XYY syndrome

This list does not include all causes.

Diagnosis

Tests: Testosterone (total and free), sex hormone binding globulin (SHBG), FSH and LH. Also plasma cortisol (early morning and late evening) together with urinary free cortisol, thyroid indices including free thyroxine (FT4) and thyroid peroxidase (TPO), prolactin, growth hormone, and insulin like growth factor (IGF-1). Full blood count, liver function tests, urea, electrolytes and calcium phosphate levels.

  • Clinical: Overall habitus, skin texture and affect. Skeletal proportions (increased span over height indicates delayed epiphyseal closure).
  • Secondary sexual characteristics and genital status, including testicular size by Prader orchidometer or axial length.
  • Prostate size small in adults. Fewer than 0.5% of normal males lack pubic hair at 15 years of age. Biochemical: as per Tests Radiological: Routine views of the skull should be taken to detect gross abnormalities including the pituitary fossa. A normal study does not exclude small pituitary lesions which are reasonably reliably detected by computerised tomography (CT) scan (50%), but better discerned by magnetic resonance imaging (MRI) (80%).Use tables to relate nondominant hand epiphyses for bone age and to project mature height. Bone density assessment for diagnosis of staging of osteoporosis in adults.

Secondary Consideration: Osteoporosis

Next page: Treatment and Management of Primary and Secondary Hypogonadism Symptoms

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For men

AndroForte® 5% Testosterone Cream is specially formulated for men with low blood testosterone levels.

Downloadable Resources

AndroForte® 2

AndroForte 2 testosterone cream packaging

For men

AndroForte® 2% Testosterone Cream is specially formulated for men with low blood testosterone levels.

Downloadable Resources

Treatment and Management of Primary and Secondary Hypogonadism Symptoms

If your son developed hypogonadism in the womb, he may have:

  • Undescended testicles (cryptorchidism)
  • Small penis (micropenis)
  • Feminized or ambiguous genitals (hermaphroditism)
  • Urethral opening on the bottom of the penis, instead of at the end of the glans (hypospadias)

Adult men with XYY, XXY and many other hypogonadal conditions can improve their sexual function with testosterone cream, patches, or injections. Oral testosterone is synthetic, not as effective and is dangerous to the liver. In recent years treatment for hypogonadal males has shifted from injectable forms of testosterone to topical application to the body (for testosterone patches and gels) or directly to the scrotum for testosterone creams.

The use of natural testosterone combats their:

  • Changes in mood (fatigue, depression, anger)
  • Decreased body hair (feminization)
  • Decreased bone mineral density and possible resulting osteoporosis
  • Decreased lean body mass and muscle strength
  • Decreased libido and erectile quality
  • Increased abdominal fat
  • Rudimentary breast development (man boobs or gynecomastia
  • Low or zero sperm in the semen (azoospermia)

You may inadvertently lower your testosterone level by consuming foods containing too much protein and too few carbohydrates. If you go on a fad diet with too many carbohydrates and too little fat, it can deplete testosterone. You can marginally increase your testosterone level with exercise.

To produce enough testosterone, your body requires the:

  • Minerals boron and zinc
  • Vitamins A, B6, and C
  • Branched Chain Amino-acids (BCAA) valine, isoleucine, and leucine

Other factors that may lower testosterone levels include:

  • Acute critical illness, burns, major trauma or surgery
  • Drug use (e.g., opiates, glucocorticoids, anabolic steroids, some anticonvulsants)
  • Chronic disease and its treatment
  • Alcohol abuse
  • Smoking
  • Ageing

Most of the above cause an increase in Sex Hormone Binding Globulin (SHBG). SHBG is a transporter protein found in the blood. It acts as a carrier to move hormones around the body. Up to 99% of testosterone produced is bound to SHBG. Once bound to SHBG, the testosterone is inactive. Testosterone to which SHBG does not attach is the biologically available testosterone that is free to act on cells throughout the body.

Eat a well-balanced diet, consider taking a dietary supplement containing the above ingredients, and exercise at least three times a week for 20 minutes.

Next page: Further Information about Primary and Secondary Hypogonadism

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AndroForte 5 testosterone cream packaging

For men

AndroForte® 5% Testosterone Cream is specially formulated for men with low blood testosterone levels.

Downloadable Resources

AndroForte® 2

AndroForte 2 testosterone cream packaging

For men

AndroForte® 2% Testosterone Cream is specially formulated for men with low blood testosterone levels.

Downloadable Resources

Download our Booklet

Downloading our booklets is FREE.

Topics discussed in the Understanding Hypogonadism booklet include:

  • What is hypogonadism?
  • When does hypogonadism occur?
  • How many people have hypogonadism?
  • What causes hypogonadism?
  • What are the symptoms of hypogonadism?
  • When should I be concerned?
  • Who is most likely to have hypogonadism?
  • How can I decrease my symptoms?
  • What are my treatment options?
  • What are the pros and cons of natural hormone creams versus synthetic treatments?
  • What is the role of progesterone in humans?
  • What is the role of testosterone in humans?

Testosterone for Men FAQ's

AndroForte® 5

AndroForte 5 testosterone cream packaging

For men

AndroForte® 5% Testosterone Cream is specially formulated for men with low blood testosterone levels.

Downloadable Resources

AndroForte® 2

AndroForte 2 testosterone cream packaging

For men

AndroForte® 2% Testosterone Cream is specially formulated for men with low blood testosterone levels.

Downloadable Resources

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