hypogonadism

Hypogonadism is a condition characterized by inadequate gonadal function, resulting in reduced sex steroid production and impaired gametogenesis. It can affect men and women and is categorized as primary (gonadal failure) or secondary (hypothalamic-pituitary dysfunction). Primary hypogonadism means the gonads themselves fail; secondary means insufficient gonadotropin signaling.

Symptoms vary by sex. Men: low libido, erectile dysfunction, reduced body/facial hair, decreased muscle mass, small testes, infertility. Women: irregular or absent menses, infertility, hot flashes, vaginal atrophy, reduced breast tissue. General symptoms include fatigue, mood changes, and decreased bone density.

Causes. Primary causes include genetic conditions such as Klinefelter syndrome (males) or Turner syndrome (females), congenital gonadal abnormalities, infections, trauma, chemotherapy or radiation, autoimmune oophoritis. Secondary causes include hypothalamic or pituitary disorders such as Kallmann syndrome, pituitary tumors, hyperprolactinemia, chronic illness, obesity, and aging.

Diagnosis. Evaluation combines symptoms with laboratory testing. In men, measure morning total testosterone and gonadotropins (LH/FSH) to distinguish primary vs secondary. In women, assess FSH, LH, and estradiol; prolactin as indicated; imaging or dynamic tests if indicated. Bone density assessment may be useful in those with long-standing deficiency.

Management. Treatment is cause- and sex-specific. Testosterone replacement therapy is used in men with confirmed deficiency (with monitoring for adverse effects). In women, estrogen-progestin therapy or other hormonal regimens may be used. Address fertility concerns with appropriate options; manage bone health and comorbidities; treat underlying illness. Regular follow-up is essential.