What is hypogonadism?
Hypogonadism manifests itself in the form of a disorder of testosterone production and/or a disorder of sperm production.
The phenomenon of a drop in testosterone levels with age is a natural phenomenon in the course of a man’s longer life. In women, hormonal restructuring during the menopause is characterized by major fluctuations in emotional and physical state and is completed after several years. In contrast, the decline in testosterone levels in men is a process that begins around the age of 40 and progresses steadily. Various factors, some of which can be easily influenced by you as the person affected, accelerate this drop in the sex hormone. If the measured level of testosterone falls below a certain normal limit, this is referred to as a testosterone (sex hormone) deficiency. However, a disease is only present if the person concerned suffers from the low level.
In men, for example, a decrease in libido (desire) and potency can be the first sign of hypogonadism. However, testosterone also plays a central role in other processes, such as the production of red blood cells, the development of muscles and the maintenance of bone density.
Unlike in women, the process of decreasing sex hormones in men takes place slowly and continuously over several decades.
Hypogonadism: causes and risk factors
A distinction is made between primary hypogonadism, which is caused by a direct disorder of the testicles, and secondary hypogonadism. This occurs when the stimulation of the testicles by the pituitary gland does not function correctly (i.e. pituitary insufficiency with inadequate production of the control hormones – gonadotropins (FSH/LH)), or when higher-switched centers of the brain (hypothalamus) are affected (“tertiary” hypogonadism). The latter forms of hypogonadism can be caused, for example, by external influences such as stressful situations, food restriction or very low body weight (e.g. in anorexia nervosa) or very intensive physical training, severe general illnesses or certain medications (e.g. opiates).
Particularly common congenital forms of primary hypogonadism are based on disorders of the sex chromosomes, such as Klinefelter syndrome. Acquired forms are diseases or therapies that affect the testicles (injuries (torsions/individual testicles), operations, radiation, chemotherapy).
In many cases, the cause is acquired, secondary hypogonadism. The originally normal function of the pituitary gland is restricted by specific diseases, such as tumors of the pituitary gland (practically exclusively benign tumors, so-called adenomas, but also malignant tumors) as well as inflammatory processes or circulatory disorders. Other hormonal disorders can also affect the production of gonadotropins and sex hormones. In many diseases of the pituitary gland, failure of sex hormone control is usually one of the first hormonal disorders. In addition to diseases, interventions in the area of the pituitary gland, such as surgery or radiotherapy, can also result in dysfunction.
In addition to the normal decline in testosterone levels with increasing age, various other causes can promote the development of a decline in testosterone levels:
- Nutrition: overweight, excessive fasting, malnutrition, severe vitamin and mineral deficiencies
- Congenital diseases: Klinefelter syndrome (47 XXY), disorders of sexual development such as 46, XX males, gonadal dysgenesis with 46, XY/ X mosaic, XYY syndrome, disorders of testosterone biosynthesis
- Systemic diseases: Renal insufficiency (impaired renal function), hepatic insufficiency (impaired liver function), diabetes mellitus, chronic infections, HIV/AIDS, liver cirrhosis, severe lung diseases, atherosclerosis, thyroid dysfunction, inflammatory processes in the body
- Acquired diseases: Testicular tumors (especially after chemotherapy), testicles, radiation therapy of the testicles, mumps orchitis, age-related hypogonadism.
- Drugs: Alcohol, cannabis, amphetamines, heroin, cocaine, opiates
- Activity: lack of exercise, too little physical activity, excessive endurance sports
- Psychosocial factors: stress, excessive demands, exhaustion, burnout syndrome
- Injury or tumor in the brain
- Medication, for example the inadequate use of testosterone (bodybuilding), external testosterone substitution
- Radiotherapy of the brain
Hypogonadism: Frequency
The drop in testosterone levels in men begins around the age of 40. In addition to the decrease in production with advancing age, certain proteins in the blood also play a role. Whether a drop in testosterone levels develops into a pathological condition depends not only on the amount of testosterone measured in the blood, but also on the severity of the change, i.e. how quickly and how low the hormone level drops. This varies greatly from person to person. It is likely that many cases of a pathological drop are not recorded, as those affected do not feel any suffering themselves. Around two to five percent of all men between the ages of 40 and 79 are found to be genuinely deficient. Whether this also leads to treatment depends on the subjective condition of the person concerned. Drug therapy is only carried out if a patient has symptoms of testosterone deficiency, i.e. suffers physically, emotionally and psychologically.
In men who are overweight and have increased fatty tissue, fewer anabolic hormones (growth hormone or testosterone) are produced, which favors a further increase in fatty tissue and decrease in muscle mass.
Although the production of sperm and sperm cells decreases with increasing age, most men remain fertile even in old age.
Symptoms: Hypogonadism
The drop in testosterone levels is typically characterized by two main symptoms: A decrease in sexual desire (libido) and activity as well as erectile dysfunction. In addition, the lack of testosterone can also cause a variety of health problems and various complaints:
- Decrease in muscle mass and muscle strength
- Reduced physical performance
- Weight gain, more fat accumulation in the abdominal area
- Osteoporosis (decrease in bone density)
- Tendency to bone fractures
- Infertility
- Reduction of body hair
- Reduction of the testicular volume
- Gynecomastia (breast growth)
- Anaemia (anemia)
- Hot flashes
- Sleep disturbances
- Depression
- Concentration and memory disorders
- Tiredness, fatigue, loss of drive
The intensity, type and combination of symptoms of hypogonadism depend on the duration and intensity of the testosterone deficiency and the age of the person affected. Often, individual symptoms do not immediately suggest a pathologically low testosterone level, as various points such as reduced sexual desire, reduced cognitive function and mood swings can also have other causes – professional overload, possible private challenges or age-related depression. In any case, you should seek medical advice if you recognize the symptoms mentioned and suffer from them. You will be examined, a blood sample will be taken and, if necessary, therapeutic steps will be initiated.
Hypogonadism: Diagnosis at the USZ
If you suffer from sexual reluctance or erectile dysfunction over a longer period of time, this often causes considerable emotional and psychological stress. We will ask them many questions, including personal ones. Given the range of signs of abnormally low testosterone levels, we may also want to know things that seem unimportant to you. However, there are a number of diseases that can lead to a testosterone deficiency. Therefore, your entire medical history will play an important role.
During a physical examination, we focus on measuring the testosterone levels in the blood. It is preferable to test before 09:00 a.m., preferably on an empty stomach. If we detect a testosterone deficiency, we will confirm this in a second measurement and also check the control hormones of the brain on the testicles and other laboratory values with an effect on this cycle. In addition, further examinations of the brain, such as CT or MRI analyses, may be necessary.
Hypogonadism: prevention, early detection, prognosis
Testosterone deficiency in old age is a process that lasts for years and initially has no negative consequences for the person affected. However, due to the gradual change, the consequences can be increasingly restrictive. The resulting problems, especially in the private sphere, often lead to personal dissatisfaction and a perceived reduction in quality of life. Without medical treatment and lifestyle changes, other health problems can also develop.
Early detection and progression
The exact development of hormone levels in humans is difficult to predict. Nevertheless, you can prevent testosterone deficiency in old age by exercising regularly, maintaining a normal weight and eating a healthy and balanced diet. A conscious approach to any diabetes mellitus that may be present also supports a favorable development of testosterone levels. Early detection is difficult due to the dynamic development. You can influence the course of hypogonadism by seeking medical help in good time. An age-related testosterone deficiency that leads to symptoms can usually be treated well.