Definition

Hypogonadism is a medical disorder characterized by insufficient production of sex hormones in the male testes or female ovaries. Hypogonadotropic hypogonadism (HH) is a type of hypogonadism caused by dysfunction in the pituitary gland or hypothalamus.

In addition, hypogonadism occurring prior to puberty has a substantial impact on both sexual and physical development. Hypogonadism can either be congenital or acquired, with the latter typically resulting from injury or infection.

In adult women, insufficient secretion of estrogen by the ovaries could result in symptoms such as hot flashes, alterations in mood and energy levels, and irregular menstruation. Low levels of testosterone produced in the testicles can lead to reduced libido, decreased muscle tone, and, in rare instances, gynecomastia or enlarged breasts tissues in males.

Individuals with hypogonadism, regardless of gender, could experience infertility and have a higher susceptibility to osteoporosis. There is no elevated risk of mortality associated with this condition.

Causes

Hypogonadotropic hypogonadism or HH is a condition resulting from insufficient production of hormones that typically stimulate the ovaries or testes. The hormones in question include  GnRH (Gonadotropin-releasing hormone), FSH (Follicle stimulating hormone), and LH (Luteinizing hormone).

Typically, GnRH is secreted in the brain, which then prompts the pituitary gland to secrete FSH and LH. These hormones stimulate the female ovaries or male testes to secrete hormones that facilitate typical sexual maturation during puberty, regular menstrual cycles, appropriate levels of estrogen and fertility in adult women.

These hormones also play a part in normal testosterone and sperm synthesis in adult men. Any alteration in this cascade could result in sex hormone deficiency. This would hinder the normal development of sexual maturity and impairs the normal functioning of the testicles or ovaries.

HH has multiple underlying factors, such as:

• Pituitary gland or hypothalamus damage in the brain can occur due to surgical procedures, injuries, tumors, infections, or exposure to radiation.
• Genetic abnormalities
• Prolonged or high doses administration of opioid or glucocorticoid medications
• Other hormones secreted by the pituitary gland (prolactin) could elevate 
• Intense stress
• Nutrition issues (either excessive weight gain or weight loss)
• Chronic inflammation or infections
• Substance abuse, specifically heroin or prescription opioids
• Certain health issues such as excessive accumulation of iron

Risk Factors

Some factors that could increase the risk of developing hypogonadism are:

• HIV/AIDS
• History of chemotherapy or radiation therapy
• Advanced age
• Excessive weight gain or obesity
• Malnutrition

This disease can be inherited from their parents. If any of these risk factors are present in your family, it is important to inform your doctor about it. 

Symptoms

Hypogonadism is characterized by insufficient or reduced levels of sex hormones, resulting in a range of symptoms that differ depending on the sex. This condition could also significantly delay puberty. Girls might experience irregular menstrual cycles or no periods at all. Meanwhile, testes in boys with hypogonadism could not develop well during puberty.

Hypogonadism could also be found among adult women. Typically, it occurs as a consequence of menopause, which signifies the end of menstrual cycles.

The fluctuations in estrogen levels could result in:

• Irregular menstruation
• Hot flashes, episodes of sudden and intense heat sensations in the upper body
• Fatigue
• Mood fluctuations 
• Lack of ability to focus
• Premature menopause
• Nipple secretions characterized by a milky appearance
• Sleep issues

In adult males, symptoms occur as a result of insufficient levels of testosterone, which can be caused by either aging or other medical disorders. Typical signs that could occur include:

• Low sexual desire
• Fatigue
• Gynecomastia, refers to the abnormal growth of breast tissue in males
• Erectile dysfunction
• Issues with concentration and focus
• Muscle atrophy
• Loss of body and pubic hair, often evident by a reduced need for shaving
• Hot flashes, episodes of sudden and intense heat sensations in the upper body

Diagnosis

Doctors will conduct medical interviews by inquiring about the symptoms and medical history of the patients. A physical examination would also be conducted to assess the condition of the testes or genitalia, as well as other secondary sexual traits that should have developed during puberty.

Other possible diagnostic tests that could be conducted include:

• Blood tests to assess hormone levels, namely FSH, LH, TSH, etc.
• LH response to GnRH
• Brain MRI scan could help in identifying any presence of tumors or abnormal growths in the hypothalamus or pituitary gland 
• Genetic analysis
• Iron saturation level

Management

The most effective and basic treatment for individuals with hypogonadotropic hypogonadism is by giving replacements of sex hormones. The course of treatment is reliant upon the cause of the issue, but could include the following:

• Testosterone injections, skin patch or gels for men
• Estrogen and progesterone skin patches or pills for women
• Hormone injections, such as GnRH or HCG injections

However, it is important to note that for men who want to improve their fertility, one possible treatment option is the use of pulsatile LHRH or injections of HCG and FSH.

Complications

If the condition is left untreated and keep developing, hypogonadism can result in further health complications that have the potential to be disabling. The most prevalent complications of hypogonadism include:

• Osteoporosis: Lack of sex hormones in the body can result in decreased bone strength, elevating fractures risk 
• Infertility: Lack of estrogen or testosterone hormone, coupled with reduced sperm counts in men, could result in infertility and hinder the ability to conceive
• Mood disorders: Experiencing the symptoms of hypogonadism can have a substantial impact on mental well-being, potentially leading to depression, anxiety, and other related problems 
• Weight gain: Hypogonadism is occasionally associated with being overweight or obesity. Consequently, this can majorly affect cardiovascular health

Prevention

There is still no known method to prevent lack of sex hormones caused by genetic conditions or the aging process. If you have a family history of hypogonadism, you are advised to get tested early on to monitor your health or receive early treatment.

When to See a Doctor?

Due to its nature as a hormonal disorder, hypogonadism could manifest in distinct ways in children and adults. The most apparent indication of hormonal disorder in children or teenagers is delayed puberty. For adults, consult a doctor if you experience these symptoms and signs below: 

• Diminished libido
• Hair loss in armpits
• Cessation of menstrual cycle in women under 40 of age
• Sudden and intense heat sensations or hot flashes
• Erectile dysfunction
• Secretion of milky fluid from nipples

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