Hypogonadism is a condition where the gonads—testes in men and ovaries in women—produce insufficient sex hormones. This can interfere with the development of secondary sexual characteristics, maintenance of muscle and bone mass, and reproductive capability. Available treatments are tailored to address the underlying cause and the individual’s specific symptoms.
The Diagnostic Process
A diagnosis is established by a healthcare provider through a physical examination and a review of the patient’s symptoms. In men, symptoms can include reduced libido, fatigue, and loss of muscle mass. Women may experience irregular periods, hot flashes, or vaginal dryness.
Blood tests are used to confirm the diagnosis by measuring hormone concentrations. For men, a test measures early morning total testosterone, as levels are highest at this time. For women, tests for estrogen are common. To determine the origin of the problem, physicians also measure levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are produced by the pituitary gland to regulate the gonads.
These results help distinguish between two main types of the condition. High levels of LH and FSH alongside low sex hormone levels point to primary hypogonadism, indicating a problem with the gonads themselves. Low or inappropriately normal levels of LH and FSH suggest secondary hypogonadism, where the issue originates in the brain’s pituitary gland or hypothalamus.
Hormone Replacement Therapy for Men
For men with hypogonadism, Testosterone Replacement Therapy (TRT) is a common treatment used to restore hormone levels to a normal range. The primary goal is to alleviate symptoms and maintain functions like bone density and red blood cell production. Target testosterone concentrations are often in the mid-normal range but can be adjusted based on individual response.
Testosterone can be delivered through several methods, each with a different application schedule.
- Intramuscular injections of testosterone cypionate or enanthate are administered every one to two weeks.
- Long-acting injections, such as testosterone undecanoate, are given less frequently, often every 10 weeks, by a healthcare professional.
- Transdermal gels are applied daily to the skin on the shoulders, upper arms, or thighs, absorbing directly into the bloodstream.
- Transdermal patches are another daily option, applied nightly to the torso or arm.
- Subcutaneous pellets are surgically implanted under the skin, where they slowly release testosterone over three to six months.
- Newer oral capsules are absorbed through the lymphatic system, avoiding potential liver issues associated with older forms.
Throughout treatment, regular monitoring is necessary. Blood tests are performed periodically to check testosterone levels, hematocrit, and cholesterol to ensure the dosage is appropriate and to manage potential side effects. This oversight allows for adjustments to the treatment plan to ensure it remains effective.
Hormone Replacement Therapy for Women
For women with hypogonadism, Hormone Replacement Therapy (HRT) replenishes estrogen. The goal is to manage symptoms of its deficiency and prevent long-term bone loss that can lead to osteoporosis.
Estrogen can be administered through oral pills, which are a convenient option. Transdermal patches and gels deliver estrogen through the skin, which can provide more consistent hormone levels. Creams and vaginal rings are also available for localized symptom relief, such as addressing vaginal dryness.
For women who have not undergone a hysterectomy, HRT includes a progestin along with estrogen. Progestin is prescribed to protect the uterine lining, or endometrium. Unopposed estrogen can stimulate the growth of the endometrium, which increases the risk of endometrial cancer.
Transdermal estrogen may be recommended for women with certain risk factors, as it is associated with a lower risk of blood clots compared to oral estrogen. Regular follow-up with a healthcare provider ensures the treatment remains effective and appropriate.
Treatments to Address Fertility
Standard hormone replacement therapy manages symptoms but does not restore fertility. For individuals who wish to conceive, different treatments are used to activate the gonads to produce gametes—sperm in men and eggs in women.
One of the primary treatments for inducing fertility is gonadotropin therapy. This involves injections of hormones that mimic the body’s own signals. Human chorionic gonadotropin (hCG) is often used because it acts similarly to LH, stimulating testosterone production in men and promoting ovulation in women.
In more significant cases of secondary hypogonadism, a combination of hCG and follicle-stimulating hormone (FSH) may be required. FSH is needed to support the maturation of sperm cells in men and the development of ovarian follicles in women. The process can take several months, with semen analysis or ovulation tracking used to monitor progress.
Another option, primarily for secondary hypogonadism caused by hypothalamic issues, is gonadotropin-releasing hormone (GnRH) therapy. This treatment uses a small pump to deliver pulsatile doses of GnRH, mimicking the natural rhythmic release from the hypothalamus. This stimulation prompts the pituitary gland to produce its own LH and FSH, restoring a more natural hormonal cycle.
Lifestyle and Supportive Approaches
Lifestyle strategies can support medical treatments by improving well-being and helping to manage symptoms. A balanced diet with adequate lean protein, healthy fats, and a variety of fruits and vegetables provides nutrients for hormone synthesis and general health.
Regular physical activity is also beneficial. A combination of resistance training and cardiovascular exercise can help maintain muscle mass, bone density, and cardiovascular health. These exercise routines also contribute to stress reduction and improved energy levels.
Managing stress and ensuring adequate sleep are additional supportive measures. Chronic stress can negatively affect hormone balance, so incorporating relaxation techniques can be helpful. Aiming for seven to nine hours of quality sleep per night supports the body’s natural restorative processes, which includes hormone production.