Hypogonadism

M

ale hypogonadism is common and is not often diagnosed or treated. It causes small male sexual organs.The normal gonadal function guarantees the execution of the reproductive and sexual mission of man. The alterations to this level lead to dysfunction of various organs such as the brain, muscle, and sexual area.

The functioning of Hypothalamus-pituitary-gonadal axis depends on the secretion of several hormones: Gonadotropin-releasing hormone (GnRH), follicle stimulating hormone, (FSH) and luteinizing hormone (LH).

Hypogonadism or decreased gonadal function represents an alteration of the aforementioned hypothalamic-pituitary-gonadal axis.

Causes of male hypogonadism.

Male hypogonadism occurs when the testicles leave of producing sperm, testosterone or both.
There are three basic mechanisms:

1. An intrinsic testicular damage (primary hypogonadism).
2. An abnormality of the hypothalamic-pituitary axis (secondary hypogonadism).
3. A diminished or absent response from the target organs
(skin, hair, and prostate) to androgens (androgenic resistance).

In the first two cases, hormonal production is decreased but the hormonal response is normal; at the third case the production is normal but the answer is diminished.

If it occurs after puberty, the skeletal proportions and the size of the penis are normal. The testicles are not so small as in prepubertal failure but are soft and have a volume of less than 15 ml. The body hair disappears almost completely and the decrease in libido (sexual desire) is notorious. Over the years, osteoporosis occurs if the patient is not treated.

The management of men with hypogonadism has two objectives: achieve fertility and improve sexual characteristics. When there is testicular damage it is not possible to correct fertility. However, when the alteration resides in the hypothalamus, or in the pituitary it is possible to fulfill this objective.

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