Therapeutic Areas

Men’s Health

Male hypogonadism

Androgens are male sex hormones that increase at puberty and are needed for a boy to develop into a sexually mature adult who can reproduce.

Androgens are produced by the testes and adrenal glands in men.

Male hypogonadsim (also referred to as androgen deficiency) affects 1 in every 200 men under 60 years of age.

Two hormones produced by the pituitary gland located in the brain – Lutenising (LH) and Follicle Stimulating (FSH) hormone act on the testes to stimulate the production of androgens and sperm.

Androgen deficiency can be caused by genetic disorders, medical problems, or damage to the testes or pituitary gland. This is classified into two main categories – primary and secondary testicular failure.

Primary Testicular Failure

Abnormalities of the testes characterised by low serum androgen levels, impairment of spermatogenesis (sperm production) and elevated gonadotropin levels. When severe, fertility may require assisted reproduction or donor sperm (or adoption).

Common Causes:

  • Klinefelter’s syndrome (1 in 550 men)
  • Testicular trauma, torsion, removal
  • Testicular infection
  • Testis atrophy (wasting) of any cause

Secondary Testicular Failure

Abnormalities of the hypothalamus or pituitary gland in the brain is characterised by low androgen levels, impaired spermatogenesis (sperm production), low or low-normal gonadotropin levels (FSH and LH).

Natural fertility can be restored with gonadotropin therapy. Evaluation may find pituitary tumour or systemic illness and other hormonal deficiencies.

Common causes:

  • Congenital: Kallmann syndrome, variants without anosmia (loss of ability to detect one or more smells)
  • Acquired: prolactinoma, pituitary tumour, surgery, radiotherapy
  • Delayed puberty

Primary and secondary testicular failure

Testicular failure due to abnormalities of both hypothalamus-pituitary gland and testes (uncommon)

Characterised by low serum androgen levels, impairment of spermatogenesis (sperm production) and variable gonadotropin levels, depending on whether primary testicular failure or secondary testicular failure (e.g. due to glucocorticoid (steroid) excess or alcoholism) predominates.

 

Reproduced with permission of Healthy Male*

Androgen deficiency is diagnosed by a medical practitioner after a thorough evaluation that includes the patient’s medical history, assessment of symptoms, and blood tests to measure hormone levels.

References:

  • Yeap BB et al. Endocrine Society of Australia Position Statement on male hypogonadism (part 1). MJA 2016;205(4):173-178.
  • Health Male – Andrology Australia fact sheets www.healthymale.org.au

* DISCLAIMER
This column is supplied by Healthy Male, a national organisation that provides easy access to the latest scientific and medical research on male reproductive and sexual health. Healthy Male is supported by funding from the Australian Government Department of Health. For more information, go to healthymale.org.au.
This information has been provided for education purposes only. It is not intended to take the place of a clinical diagnosis or proper medical advice from a fully qualified health professional. Healthy Male urges readers to seek the services of a qualified medical practitioner for any personal health concerns.

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