Hypogonadismen

Hypogonadism is a medical condition in which the gonads produce insufficient sex hormones, resulting in impaired gamete production and often delayed or incomplete sexual development. It can affect males and females at any age.

There are two main forms: primary (hypergonadotropic) hypogonadism, due to intrinsic gonadal failure, and secondary (hypogonadotropic) hypogonadism, due to impaired signaling from the hypothalamus or pituitary. In primary disease, gonadotropins (LH and FSH) are elevated; in secondary, they are low or inappropriately normal.

Causes include congenital conditions such as Klinefelter syndrome and Kallmann syndrome, and acquired factors such as infections, autoimmune damage, testicular injury or radiation, chemotherapy, obesity, malnutrition, and drugs that suppress the hypothalamic-pituitary-gonadal axis.

Symptoms vary by sex and development stage. In males: delayed puberty, reduced libido, erectile dysfunction, smaller testes, decreased muscle mass, and a higher risk of low bone density. In females: amenorrhea or oligomenorrhea, reduced fertility, vasomotor symptoms, vaginal atrophy, and reduced bone density.

Diagnosis relies on hormone testing and clinical assessment. Morning testosterone with LH and FSH helps distinguish primary from secondary disease; in women, estradiol with gonadotropins is assessed. Additional tests may include stimulation tests, pituitary imaging, and genetic studies as indicated.

Treatment is individualized. Hormone replacement therapy aims to restore balance and improve symptoms, bone health, and quality of life, while fertility goals and underlying causes are also addressed. Regular monitoring for effectiveness and adverse effects is important.