Secondary Hypogonadotrophic hypogonadism

Secondary Hypogonadotrophic Hypogonadism

Secondary hypogonadotrophic (SH) hypogonadism is a type of male hypogonadism in which the pituitary gland does not produce the hormones necessary to stimulate the testes, resulting in low testosterone levels, infertility, and a decrease in secondary sex characteristics. The condition can be either congenital or acquired and is typically diagnosed during adolescence or adulthood.

SH can cause decreased libido, erectile dysfunction, impaired fertility, and reduced muscle mass, fat-free mass and bone mineral density. Men who have SH not only experience physical symptoms, but may also experience depression, anxiety, body-image issues, anger, and other psychosocial problems. SH is treated by supplementing the body with testosterone, either through injections, patches, gels or other methods.

The primary cause of secondary hypogonadotrophic hypogonadism is a disruption of the hormones responsible for stimulating the gonads to produce testosterone. These hormones include follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In SH, LH and FSH production is suppressed, which reduces testosterone production. This can be caused by either a pituitary or hypothalamic abnormality.

The following conditions may lead to SH:

  • Pituitary tumor
  • Congenital or acquired hypothalamic injury
  • Kallman’s syndrome
  • Chromosomal abnormality
  • Injury to the testes
  • Hormonal Therapy
  • Testicular Torsion

The diagnosis of SH is made by measuring FSH and LH on multiple occasions, as well as serum testosterone, and ruling out any other underlying causes of low testosterone. Other tests may include MRI of the pituitary gland, depending on the history and physical examination. Once the diagnosis is confirmed, treatment typically includes some form of testosterone supplementation depending on the patient’s tolerance and desired results. Complications can occur from too much testosterone, so the patient should be monitored closely.