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Hypogonadism is a condition when the sex glands don't produce enough hormones. This condition can cause various disorders, such as impotence in men and menstrual disorders in women.

The sexual glands in men are the testes, while the sex glands in women are the ovaries. The gland is responsible for producing hormones that regulate sexual characteristics, such as the development of the testicles in men and the growth of breasts in women.

This hormone also regulates male sperm production as well as egg production and the female menstrual cycle . Not only that, sex hormones also play a role in many functions of other body organs, including the heart and brain.

Hypogonadism can occur due to damage to the sexual glands or due to certain diseases. This condition can not only cause disturbances in sexual function, but can also affect the overall physical condition.

Causes and Types of Hypogonadism

Based on the cause, hypogonadism is divided into primary and secondary. Primary hypogonadism is a condition when the sexual glands are damaged so they are unable to produce enough sex hormones.

Some things that can cause primary hypogonadism are:

  • Autoimmune diseases , eg Addison's disease
  • Genetic disorders, eg Klinefelter syndrome, Turner syndrome, or Kallman syndrome
  • Kidney disorders
  • Heart trouble
  • Severe infection
  • Injury to the testes
  • Hemochromatosis or high blood iron levels
  • Cryptorchidism or undescended testicle position
  • Side effects of radiotherapy or chemotherapy in cancer treatment
  • Operations on the sexual organs

Meanwhile, secondary hypogonadism occurs due to damage to the glands in the brain, namely the pituitary gland (pituitary) and hypothalamus, which are responsible for sending signals to the sex glands to produce hormones. Conditions that can cause secondary hypogonadism include:

  • Injury or tumor to the pituitary gland or hypothalamus
  • Genetic disorders, such as Kallmann's Syndrome
  • Infection, including HIV/AIDS infection
  • Radiation exposure to the head
  • Obesity
  • Brain surgery
  • Nutritional deficiencies, for example due to anorexia nervosa
  • Drastic weight loss
  • Long-term use of corticosteroids or opioids
  • Diseases that cause inflammation, such as tuberculosis, sarcoidosis , or histiocytosis

Symptoms of Hypogonadism

Symptoms of hypogonadism can vary, depending on the sex and age of the sufferer. Here is the explanation:

Male before puberty

If hypogonadism occurs since childhood, for example due to genetic disorders, the symptoms that can appear are:

  • Slow or abnormal growth of the penis and testicles ( ambiguous genitalia )
  • Enlarged breasts ( gynecomastia )
  • Hands and legs look longer than the body
  • Slim and small body
  • The voice gets heavy late at puberty or doesn't even get heavy at all

Men after puberty

If hypogonadism occurs after puberty, symptoms that can appear include:

  • The body gets tired easily
  • Concentration difficulties
  • Loss of muscle mass
  • Loss of sexual desire
  • Impotence
  • Reduced hair on face and body

Women before puberty

Hypogonadism in prepubertal women can cause the following symptoms:

  • Breasts grow slowly or don't grow at all
  • Little hair growing on the pubic
  • Primary amenorrhea or delayed first menstruation (> 14 years)

Woman after puberty

If hypogonadism occurs in women who have reached puberty, symptoms that can appear include:

  • Menstruation becomes infrequent ( oligomenorrhea ) or even does not occur at all for more than 3 months
  • Decreased passion and mood to undergo activities
  • Body feels hot
  • Heart pounding
  • Dry vagina
  • Decreased sexual desire
  • Thick white discharge from the breast

When to see a doctor

It is recommended that you check with your doctor if you have symptoms of hypogonadism as mentioned above. The sooner hypogynadism is detected and treated, the more likely it is to be cured.

Hypogonadism can be passed from parent to child. Therefore, if there are family members who have a history of hypogonadism or other conditions that can cause hypogonadism, it is best to consult this problem with a pediatrician so that the condition of the child's sexual hormones can be monitored early on.

Diagnosis of Hypogonadism

Diagnosis of hypogonadism begins with asking questions about symptoms, medical history, and medications that are being used. The doctor will also carry out a physical examination by examining the condition of the genital organs, hair growth patterns, and muscle mass.

For an accurate diagnosis, the doctor will also perform hormone tests , such as:

  • Examination of follicle stimulating hormone (FSH) and luteinizing hormone (LH) produced by the pituitary gland
  • Examination of testosterone levels in male patients
  • Examination of estrogen levels in female patients

Hormone checks are generally carried out in the morning before 10 o'clock, when testosterone and estrogen levels are increasing.

In addition to hormone examinations, doctors can also perform the following tests to diagnose hypogonadism:

  • Examination of sperm in male patients
  • Examination of iron and platelet levels
  • Examination of prolactin levels
  • Thyroid hormone check
  • Genetic test

The doctor can also do an ultrasound to find out if there are disorders of the ovaries (ovaries), such as ovarian cysts and polycystic ovary syndrome ( PCOS ). A CT scan or MRI can also be done to check for a possible tumor in the pituitary gland.

Hypogonadism Treatment

Hypogonadism treatment will be adjusted to the sex of the patient and the underlying cause.

Hypogonadism can be cured if the cause is a curable condition, such as obesity. However, if the cause is an incurable condition, such as a genetic disorder, then hypogonadism can become a chronic disease requiring lifelong treatment.

Based on the patient's gender, the following are treatments that can be used to treat hypogonadism:

Treatment of hypogonadism in men

In male patients, hypogonadism is generally treated to cover up testosterone deficiency, through testosterone replacement therapy ( TRT). TRT is done by administering artificial testosterone which can be given in the form of:

  • Gel
    Gel can be applied to the upper arms, shoulders, thighs or underarms. Make sure the gel has been absorbed if the patient wants to take a shower.
  • Testosterone injections
    can be done alone at home or by a doctor, depending on the preparation. Typically, injections are given every 2–3 weeks.

  • TRT tablets, for example mesterolone , will allow testosterone to be absorbed by the lymph system.
  • Patch
    Patches can be affixed every night to the thighs, stomach or back.
  • Gum
    patches Gum patches are shaped like tablets, but should not be bitten or swallowed. Patches are used on the upper gums, to be precise between the gums and lips, and need to be replaced every 12 hours.
  • Nasal gel
    Different from the previous gel, this gel is inserted into the nostrils. The gel is applied 2 times to each nostril, 3 times a day.
  • Testosterone
    implants Testosterone implants are surgically inserted into the skin every 3–6 months.

Keep in mind, patients undergoing TRT must check themselves regularly to the doctor. The reason is, this therapy can trigger various risks, such as sleep apnea , breast enlargement, prostate enlargement, reduced sperm production, blood clot formation, and heart attacks.

Treatment of hypogonadism in women

Hypogonadism in female patients is generally treated with estrogen replacement therapy in the form of pills or patches. Doctors can also provide low-dose testosterone therapy accompanied by the administration of the hormone dehydroepiandrosterone (DHEA) to treat decreased sex drive in women.

In women who experience menstrual cycle disorders or have difficulty getting pregnant, the doctor will give an injection of the hormone choriogonadotropin (hCG) or pills containing the hormone FSH to trigger ovulation .

Hypogonadism complications

Hypogonadism that is not handled properly can cause a number of complications, such as:

  • Early menopause
  • Barren
  • Osteoporosis
  • Anxiety disorders or depression
  • Heart disease
  • Interrupted relationship with partner

Prevention of Hypogonadism

Hypogonadism caused by genetic disorders cannot be prevented. However, several causes of hypogonadism, such as malnutrition, infection, and obesity, can be prevented by diligently exercising, adopting a healthy lifestyle and diet, and maintaining an ideal body weight.

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