Hypogonadism in men is a serious condition in which the testicles do not produce enough of the hormone testosterone. Without timely specialized intervention, the quality of life will significantly decrease, and the risk of severe complications is high. Therapy begins with the establishment of the cause that led to the failure. Read more about the treatment of hypogonadism in men in our article.

The correct appointment of therapy is possible only after determining the form of hypogonadism.

Patient Interview Data

Late appearance of signs of puberty, the presence of operations, injuries, infections in the past, low level of sexual desire, poor maintenance of erection, reduced duration of sexual intercourse, infertility;

Inspection

Signs of fat deposition in the chest, thighs, poor development of the muscular system, thin hair on the body, face, reduction in the size of the penis and testicles;

Blood tests

Additional examination methods

In order to determine the cause of a lack of testosterone, prescribe:

• radiography of the bones in the area of ​​the wrist joint to assess the correspondence between the real age and the bone. It is needed to determine the time of puberty in adolescents;
• Ultrasound of the scrotum - in diseases of the testicles, hypogonadism is considered primary;
• CT or, - pathologies in this area are the cause of a secondary decrease in testosterone levels.

An increased level of gonadotropins also indicates damage to the testicles, and in diseases of the brain, their content in the blood is reduced. Additional methods for clarifying the origin of the disease include:

• gonadoliberin of the hypothalamus in the blood (its lack leads to a decrease);
• estradiol (female sex hormone) is higher than normal with tumors of the testicles, adrenal glands, in the second case, urine ketosteroids also increase;
• genetic analysis for suspected chromosomal diseases;
• testicular biopsy.

Treatment of hypogonadism in men

The goal of treatment in young men is to stimulate sexual function, potency and sexual desire, as well as to restore the ability to conceive.

For older patients, the following are considered relevant: increasing the endurance of the body, preventing progression, diseases of the heart and blood vessels.

Anti-aging drugs

If androgen deficiency is detected, testosterone-based medications are recommended.

They are presented in several dosage forms with different properties:

Dosage form	Name of the drug	Mode of application
Injections	Sustanon, Delasteril, Omnadren, Nebido	They are administered every 2-3 weeks, and Nebido can be injected only 4 times a year. High efficiency. Treatment is accompanied by fluctuations in the level of the hormone, which affects the overall well-being.
Tablets		Does not impair liver function. You need to drink daily, it is recommended only with a slight lack of testosterone.
Patch	Androderm, Testoderm	Easy to use, allergic reactions are limitations.
Gels	Androgel, Testogel	They are effective, there is no skin irritation, but if they come into contact with the skin of women, they may experience reactions of excess male hormones (acne, hair growth on the body, face). This is especially dangerous during pregnancy and lactation.

The negative properties of testosterone include:

• inhibition of sperm formation (especially characteristic of long-acting drugs);
• change in body weight (there is an increase due to swelling);
• an increase in the volume of the mammary glands (occurs mainly in obesity);
• acne;
• swelling in the legs;
• depression, insomnia;
• violation of bile secretion, nausea, pain in the right hypochondrium;
• painful erection.

Enlargement of the mammary glands

Treatment should take place under constant monitoring of hormone levels, blood tests for hemoglobin, red blood cells, cholesterol. They need to be determined at least once every 3 months. Also, in old age, the risk of prostate diseases increases against the background of hormonal therapy.

The use of testosterone is contraindicated in:

• hypertrophy (growth) of the prostate, adenoma;
• tumor processes;
• open growth zones in children;
• stopping breathing during sleep (sleep apnea);
• heart failure;
• increased hematocrit (thickening of the blood);
• severe course of diabetes;
• diseases of the liver and kidneys with a pronounced violation of their function;
• excess calcium in the blood;
• recent myocardial infarction.

Blood clotting, one of the contraindications to the use of testosterone

Most often, long-acting medications, especially Nebido, are not prescribed to correct the age-related decrease in the hormone, since even if it is canceled, the residual effect remains for a long time.

Hypergonadotropic (primary)

In congenital and acquired forms of primary hormone deficiency, it is first necessary to determine whether there is a reserve of tissue that can be stimulated by hormones. This is possible with the introduction of chorionic gonadotropin and a blood test for testosterone.

With preserved activity in boys aged 13-15 years, long-acting testosterone preparations are used in courses, and in case of irreversible damage to the ovaries, life-long replacement therapy is indicated.

Patients of the childbearing period may also be recommended drugs that block aromatase - an enzyme that converts testosterone into estrogens (Arimidex), drugs that suppress estrogen activity (Klostilbegit, Tamoxifen).

Hypogonadotropic (secondary)

If a tumor lesion of the pituitary gland, hypothalamus is detected, it must be removed. The lack of gonadotropins is compensated by the introduction of their analogues of placental origin - Horagon, Pregnil. These drugs are used in both adolescents and adults. They stimulate puberty and the production of testosterone by the testicles. For mature patients, human chorionic gonadotropin can be combined with testosterone.

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For the correct treatment of hypogonadism, it is necessary to establish its cause. Treatment is primarily aimed at eliminating the underlying disease. With age-related and primary violation of the formation of testosterone by the testicles, replacement therapy is indicated. Both long-acting injections and dermal dosage forms are used.

In the secondary form of a lack of male hormones, chorionic gonadotropin is recommended to stimulate the testicles. In obesity, weight normalization is a prerequisite for correcting hormonal deficiency.

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Men suffer from various diseases of an infectious and non-infectious nature. Often in men you can find a condition in which the function of the male gonads (testes) is impaired. This reduces the production of sex hormones (androgens). This condition is called hypogonadism.

Separately, it is necessary to highlight hypogonadotropic hypogonadism. Its difference is that in this condition, the production of gonadotropic hormones, which regulate the synthesis of androgens, in particular, testosterone, decreases. Gonadotropic hormones are produced in the brain. This condition is called secondary hypogonadism.

It should be noted that the violation of the male hormonal background negatively affects health. In this condition, metabolism is disturbed, various organs and systems can be affected. Of great importance is the fact that the development of secondary sexual characteristics in men is disturbed. All this has a certain mental effect on men, disrupts their sexual development. Let us consider in more detail what is hypogonadotropic hypogonadism, what is the etiology, clinic and treatment of this disease.

Definition and classification of hypogonadism

The gonads in men not only contribute to the synthesis of germ cells (spermatozoa), but also synthesize a very important hormone - testosterone. The latter is involved in potency, the formation of the genital organs and their function. An interesting fact is that the synthesis of testosterone in men is under the direct influence of the so-called gonadotropic hormones. These include follicle-stimulating, luteotropic hormones and prolactin.

If there is a decrease in the production of the first two and an increase in the latter, then this is the cause of a violation of testosterone synthesis. Hypogonadism is a pathological condition caused by insufficient production of testosterone and a decrease in the work of the testes.

In men, there are primary and secondary hypogonadism. The secondary is caused precisely by a violation of the function of the central nervous system, as a result of which the production of gonadotropic hormones suffers. Any hypogonadism can be congenital or acquired. In the latter case, the causes lie in both endocrine and non-endocrine diseases. Secondary hypogonadotropic hypogonadism occurs at any age. The list of clinical manifestations in men largely depends on this. The most important in the etiology of secondary hypogonadism is the pathology of the hypothalamic-pituitary system.

Congenital hypogonadotropic hypogonadism

This pathology in men occurs with various diseases and conditions. It may be due to a congenital tumor. The latter is the cause of panhypopituitarism. In such a situation, with a significant size of the tumor, compression of the pituitary gland tissues occurs, which serves as a trigger for disrupting the production of gonadotropic hormones. Pathology is observed immediately after the birth of the child.

At the same time, he begins to lag significantly behind in physical development. The reproductive organs do not develop properly. Secondary hypogonadism in men occurs with Maddock's syndrome. This is a very rare pathology characterized by impaired production of gonadotropic hormones and ACTH.

With this syndrome, hypocorticism develops. In adolescence, hypogonadism begins to manifest itself. During this period, boys have insufficient development of male sexual characteristics. They have a eunuchoid physique, reduced sexual desire. Often all this becomes the cause of infertility. Secondary hypogonadism is characteristic of pituitary dwarfism. This disease has a second name - dwarfism. Its difference is that the production of ACTH, TSH, STH, FSH, LH is reduced.

All this leads to dysfunction of various organs. The thyroid gland, kidneys, adrenal glands suffer. Males have infertility, short stature (about 130 cm). Hypogonadotropic hypogonadism in men may be associated with dysfunction of the hypothalamus only. In this case, there is a sharp decrease in the production of gonadotropic hormones. Secondary hypogonadism is an integral part of the Cullman syndrome.

Acquired hypogonadotropic hypogonadism

Hypogonadism syndrome in men can be acquired. If in childhood or adolescence there is such a pathology as hyperprolactinemia, then hypogonadism may develop. In this situation, it is combined with a delay in sexual development.

Hypogonadism in men is one of the manifestations of adiposogenital dystrophy. It is manifested not only by a violation of the production of androgens, but also by obesity. This pathology most often occurs in males aged 10-12 years. It is important that with dystrophy, the hypothalamus and pituitary gland are not involved in the process. Dystrophy in men is manifested by eunuchoidism, sexual dysfunction and infertility.

Of great importance is the fact that dystrophy disrupts the work of other important organs. In some cases, myocardial dystrophy is observed. You need to know that hypogonadism in men is one of the manifestations of various syndromes. The latter include Laurence-Moon-Barde-Biedl, Prader-Willi syndrome. The first is characterized by such symptoms as mental retardation, obesity, polydactyly.

The most striking manifestations of this syndrome are an increase in the mammary glands, hypoplasia of the testicles, an abnormal location of the testicles (cryptorchism). In addition, erectile function suffers, male-type hair growth is underdeveloped.

Common manifestations of hypogonadism in men

The clinical symptoms of secondary male hypogonadism largely depend on the age at which it occurs. If changes in the production of male sex hormones occur even before the birth of a male child, then at birth the presence of bisexual organs may be observed. If hypogonadism developed in childhood before puberty, then sexual development changes.

If, under normal conditions, adolescents gradually develop secondary male characteristics (male type of hair, rough voice, changes in the skeleton), then in this situation this process is disrupted. There is eunuchoidism, large growth, a change in the formation of the skeleton.

Adolescents have weak muscle development, true gynecomastia. The function of the scrotum is also impaired. Characterized by hypogenitalism. In some cases, adolescents develop obesity. Its peculiarity is that it happens according to the female type, that is, fat is deposited in parts of the body that are atypical for a man. Very often, the secondary form of pathology is manifested by a violation of the function of the thyroid gland. The most serious manifestation of this condition is infertility. As for the gonads themselves, they are almost always smaller in size than in a healthy man.

Diagnostics and therapeutic measures

In order to prescribe the appropriate treatment for men, it is necessary to correctly diagnose. It is based on the patient's complaints, the history of life and the history of the disease. The period of bearing a child is of some importance. External examination is of great importance. In addition, laboratory and instrumental studies are carried out. The first include the study of the level of testosterone and gonadotropic hormones.

With secondary hypogonadism, they are reduced. Determination of bone age is of no small importance. This allows you to identify a violation of the ossification process. To determine the possible cause of the pathology, an x-ray of the brain is performed. MRK or CT can be used. These methods allow to identify the pathology of the pituitary gland and hypothalamus. With their help, you can determine the presence of a tumor.

Treatment of hypogonadism involves addressing the underlying cause. Hypogonadism is not the main disease, but only a manifestation. If hypogonadism is congenital, then treatment is more aimed at eliminating the symptoms of the disease and normalizing the hormonal background.

If there is infertility that developed in adolescence, then this process is not amenable to therapy.

Treatment of children includes the use of hormonal drugs, in particular gonadotropins. They give the best result in combination with sex hormones. Treatment must be comprehensive. It involves physiotherapy, exercise therapy.

In severe cases, when there is cryptorchidism or underdevelopment of the penis, surgery is performed. It includes phalloplasty, testicular transplantation. Thus, hypogonadotropic hypogonadism is a manifestation of various pathologies. It is most dangerous at a young age, when sexual function is being formed.

- a syndrome accompanied by insufficiency of the functions of the sex glands and a violation of the synthesis of sex hormones. Hypogonadism, as a rule, is accompanied by underdevelopment of the external or internal genital organs, secondary sexual characteristics, a disorder of fat and protein metabolism (obesity or cachexia, changes in the skeletal system, cardiovascular disorders). Diagnosis and therapy of hypogonadism is carried out by the joint work of endocrinologists, gynecologists and gynecologists-endocrinologists (in women), andrologists (in men). Hormone replacement therapy is the mainstay of treatment for hypogonadism. If necessary, surgical correction, plastic surgery and prosthetics of the genital organs are performed.

General information

- a syndrome accompanied by insufficiency of the functions of the sex glands and a violation of the synthesis of sex hormones. Hypogonadism, as a rule, is accompanied by underdevelopment of the external or internal genital organs, secondary sexual characteristics, a disorder of fat and protein metabolism (obesity or cachexia, changes in the skeletal system, cardiovascular disorders). There are male and female hypogonadism.

Hypogonadism in men

Classification of hypogonadism in men

Hypogonadism is divided into primary and secondary. Primary hypogonadism is caused by dysfunction of the testicular tissue due to a defect in the testicles themselves. Chromosomal disorders can lead to aplasia or hypoplasia of the testicular tissue, which is manifested by the absence of androgen secretion or their insufficiency for the normal formation of the genital organs and secondary sexual characteristics.

The occurrence of secondary hypogonadism is due to a violation of the structure of the pituitary gland, a decrease in its gonadotropic function or damage to the hypothalamic centers that regulate the activity of the pituitary gland. Primary hypogonadism, which develops in early childhood, is accompanied by mental infantilism, secondary - mental disorders.

There are also hypogonadotropic, hypergonadotropic and normogonadotropic hypogonadism. Hypergonadotropic hypogonadism is manifested by a primary lesion of the testicular tissue of the testicles in combination with an increased level of pituitary gonadotropic hormones. Hypogonadotropic and normogonadotropic hypogonadism occur when the hypothalamic-pituitary system is affected. Hypogonadotropic hypogonadism is associated with a decrease in the secretion of gonadotropins, resulting in a decrease in androgen production by the testicular tissue of the testicles. Normogonadotropic hypogonadism is caused by hyperprolactinemia, manifested by normal levels of gonadotropins and decreased testicular function of the testicles.

Both primary and secondary hypogonadism can be congenital or acquired. Some forms of male infertility (from 40 to 60% of all cases of male infertility) can serve as a manifestation of hypogonadism. Depending on the age of development of insufficiency of sex hormones, embryonic, pre-pubertal (from 0 to 12 years) and post-pubertal forms of hypogonadism are distinguished.

Congenital primary (hypergonadotropic) hypogonadism occurs:

• with anorchism (aplasia) of the testicles;
• in violation of the omission (cryptorchism and ectopia) of the testicles;
• with true chromatin-positive Klinefelter syndrome (combines testicular hypoplasia, hyalinosis of the walls and dysgenesis of the seminiferous tubules, gynecomastia, often accompanied by azoospermia (absence of spermatozoa). Testosterone production is reduced by about 50%.
• with (chromosomal disease with characteristic disorders of physical development: short stature and lack of sexual development, rudimentary testes);
• with sertoli cell syndrome or del Castillo syndrome (underdevelopment of the testicles with a normal or increased amount of gonadotropins). With this syndrome, spermatozoa are not formed, patients are infertile. Physical development occurs according to the male pattern;
• with the syndrome of incomplete masculinization - false male hermaphroditism. The reason is a decrease in tissue susceptibility to androgens.

Acquired primary hypogonadism develops as a result of exposure to the testicles of internal or external factors after birth.

• with injuries, tumors of the testicles and early castration - manifested by a picture of a typical eunuchism - total hypogonadism;
• with insufficiency of the germinal epithelium (false Klinefelter's syndrome). Characterized by high growth, eunuchoid physique, gynecomastia, underdeveloped secondary sexual characteristics, small size of the genitals. By puberty, patients develop eunuchoid features, and subsequently reduced fertility.

Congenital secondary (hypogonadotropic) hypogonadism develops under the following conditions:

• associated with damage to the hypothalamus - an isolated form with damage only to the reproductive system. It is characterized by a total deficiency of gonadotropic hormones, while there may be a deficiency of lutropin or folitropin;
• with Cullman's syndrome - characterized by a deficiency of gonadotropins, underdevelopment of the genitals and secondary sexual characteristics, a decrease or absence of smell (hyposmia or anosmia). Eunuchoidism is noted (often in combination with cryptorchidism), various malformations: splitting of the upper lip and hard palate, shortening of the frenulum of the tongue, facial asymmetry, six-fingeredness, gynecomastia, cardiovascular disorders.
• with pituitary dwarfism (pituitary dwarfism). There is a sharp decrease in somatotropic, luteinizing, follicle-stimulating, thyroid-stimulating and adrenocorticotropic hormones, which is manifested by impaired function of the testicles, adrenal glands and thyroid gland. It is characterized by insufficiency of sexual characteristics, dwarf growth of less than 130 cm, infertility.
• with congenital panhypopituitarism (craniopharyngioma) caused by a congenital brain tumor. Growing, it compresses the tissues of the pituitary gland, disrupting its functions. The production of gonadotropins, as well as hormones that regulate the functions of the adrenal cortex and the thyroid gland, decreases. It leads to a lag in the physical and sexual development of the child.
• with Maddock's syndrome - an extremely rare form of hypogonadism that occurs when the gonadotropic and adrenocorticotropic functions of the pituitary gland are insufficient. It is characterized by a gradual increase in hypocorticism. After the passage of the puberty period, there is a lack of function of the gonads - eunuchoidism, hypogenitalism (underdevelopment of the genital organs and secondary sexual characteristics), decreased libido, infertility.

Acquired secondary hypogonadism develops when:

• adiposogenital dystrophy - manifested by obesity and hypogenitalism. There is a lack of gonadotropic function of the pituitary gland. Appears at 10-12 years of age. Hypothalamo-pituitary pathology with pronounced clinical symptoms is not observed. Characterized by eunuchoid proportions of the skeleton, usually sexual dysfunction and infertility. Due to dystrophic changes in the heart and vascular hypotension, shortness of breath, biliary dyskinesia, and flatulence may develop.
• Laurence-Moon-Barde-Biedl syndrome (LMBB), Prader-Willi syndrome. LMBB syndrome is manifested by obesity, low intelligence, retinitis pigmentosa, and polydactyly. There is cryptorchidism, testicular hypoplasia, gynecomastia, erectile dysfunction, poor facial hair, armpits, pubis, and kidney development defects are possible. The Prader-Willi syndrome, in contrast to the LMBB syndrome, has multiple anomalies (“Gothic” palate, epicanthus, etc.), pronounced muscle weakness against the background of a decrease in the amount of androgens and gonadotropins in the blood. Both syndromes are classified as functional disorders of the pituitary and hypothalamus.
• hypothalamic syndrome due to damage to the hypothalamic-pituitary region as a result of an infectious-inflammatory, tumor process, traumatic brain injury.
• hyperprolactinemic syndrome - accompanies infertility and disorders of sexual function, and arising in childhood and adolescence, causes delayed sexual development and hypogonadism.

Causes and mechanisms of development of hypogonadism in men

Androgen deficiency can be caused by a decrease in the amount of hormones produced or a violation of their biosynthesis as a result of the pathology of the testicles themselves or a violation of the hypothalamic-pituitary regulation.

The etiological factors of primary hypogonadism are often:

• congenital underdevelopment of the gonads that occurs with genetic defects - for example, dysgenesis (violation of the tissue structure) of the seminiferous tubules; testicular dysgenesis or aplasia (anorchism, monorchism). In the occurrence of congenital pathology, a negative role is played by harmful effects on the body of a pregnant woman. A hypogonadal state can be caused by impaired testicular descent.
• toxic effects (chemotherapy of malignant tumors, organic solvents, nitrofurans, pesticides, alcohol, tetracyclines, hormonal drugs in large doses, etc.)
• infectious diseases (mumps, measles orchitis, epididymitis, deferentitis, vesiculitis)
• radiation injury (in contact with x-rays, radiation therapy)
• acquired damage to the testicles - trauma, torsion of the spermatic cord, varicocele, testicular volvulus; atrophy and hypoplasia of the testicles after operations of orchidopexy, hernia repair, surgical interventions on the organs of the scrotum.

Some cases of primary hypogonadism are idiopathic. Modern endocrinology does not have sufficient data on the etiology of idiopathic hypogonadism.

With primary hypogonadism, there is a decrease in the level of androgens in the blood, the development of a compensatory reaction of the adrenal glands to hypoandrogenization, and an increase in the production of gonadotropins.

Violations of the hypothalamic-pituitary regulation (inflammatory processes, tumors, vascular disorders, pathology of embryonic development) lead to secondary hypogonadism. The development of hypogonadism can be caused by pituitary adenomas that produce growth hormone (with acromegaly) or adrenocorticotropic hormone (with Cushing's disease), prolactinoma, postoperative or post-traumatic hypothalamic-pituitary dysfunction, hemochromatosis, aging processes, accompanied by an age-related decrease in blood testosterone levels.

With secondary hypogonadism, there is a low level of gonadotropins, leading to a decrease in the secretion of androgens by the testicles.

One form of male hypogonadism is a decrease in sperm production with normal testosterone levels, as well as extremely rare cases of a decrease in testosterone levels without a decrease in sperm production.

Symptoms of hypogonadism in men

Clinical manifestations of hypogonadism are due to the age of onset of the disease and the degree of androgen deficiency. Violation of androgen production in the prenatal period can lead to the development of bisexual external genitalia.

If testicular damage occurs in boys in the prepubertal period, there is a delay in sexual development, typical eunuchoidism is formed: disproportionately high growth associated with delayed ossification of the epiphyseal (growth) zones, undeveloped chest and shoulder girdle, long limbs, underdeveloped skeletal muscles. There may be a development of female-type obesity, true gynecomastia, hypogenitalism, which manifests itself in a small size of the penis, lack of pigmentation and folding of the scrotum, testicular hypoplasia, underdevelopment of the prostate gland, lack of facial and pubic hair, underdevelopment of the larynx, high voice.

In cases of secondary hypogonadism, obesity often occurs, symptoms of hypofunction of the adrenal cortex, thyroid gland, manifestations of panhypopituitarism, lack of sexual desire and potency are possible.

If a decrease in testicular function develops after puberty is completed, then the symptoms of hypogonadism are less pronounced. There is a decrease in the size of the testicles, slight facial and body hair, female-type fat deposits, loss of elasticity and thinning of the skin, infertility, decreased sexual function, vegetative-vascular disorders.

Reduction of the testicles is observed in almost all cases of male hypogonadism (exception - if the disease has begun recently). Reducing the size of the testicles is usually closely associated with a decrease in sperm production. With the loss of the sperm-producing function of the testicles, infertility develops with the cessation of testosterone production, libido decreases, regression of secondary sexual characteristics occurs, erectile dysfunction, generalized symptoms are noted (decrease in muscle strength, fatigue, general weakness).

Diagnosis of hypogonadism in men

It is based on the patient's complaints, anamnesis data, a general status study using anthropometry, examination and palpation of the genitals, an assessment of the clinical symptoms of hypogonadism, and the degree of puberty.

According to the X-ray examination, bone age is estimated. To determine the mineral saturation of the bones, densitometry is performed. When radiography of the Turkish saddle is determined by its size and the presence of a tumor. Evaluation of bone age makes it possible to accurately determine the onset of puberty by the timing of ossification of the wrist joint and hand. The onset of puberty is associated with the formation of a sesamoid bone in the I metacarpophalangeal joint (approximately at 13.5 - 14 years). Full puberty is evidenced by the appearance of anatomical synostoses. This feature makes it possible to distinguish between prepubertal and pubertal age. When evaluating bone age, it is necessary to take into account the possibility of earlier (for patients from the southern regions) and late (for patients from the northern regions) ossification, as well as the fact that osteogenesis impairment may be due to other factors. With pre-pubertal hypogonadism, there is a lag of several years of "bone" age from the passport one.

A laboratory study of sperm analysis (spermogram) in hypogonadism is characterized by azo- or oligospermia; sometimes ejaculate can not be obtained. The level of sex and gonadotropins is measured: serum testosterone (total and free), luteinizing, follicle-stimulating hormone and gonadoliberin, as well as serum anti-Müllerian hormone, prolactin, estradiol. The content of testosterone in the blood is reduced.

With primary hypogonadism, the level of gonadotropins in the blood is increased, with secondary hypogonadism it is lowered, sometimes their content is within the normal range. Determination of the level of serum estradiol is necessary for clinically pronounced feminization and secondary hypogonadism, in the case of estrogen-producing tumors of the testicles or adrenal glands. The level of 17-KS (ketosteroids) in the urine with hypogonadism may be normal or reduced. If Klinefelter's syndrome is suspected, a chromosomal analysis is indicated. Testicular biopsy rarely provides information for diagnosis, prognosis, or treatment.

Treatment of hypogonadism in men

Therapy of hypogonadism is carried out strictly individually, and is aimed at eliminating the cause of the disease. The purpose of the treatment is to prevent the retardation of sexual development, in the future - malignancy of the testicular tissue of the testicles and infertility. Treatment of hypogonadism should be carried out under the supervision of a urologist and an endocrinologist.

Treatment of hypogonadism depends on its clinical form, the severity of disorders in the hypothalamic-pituitary and reproductive systems, comorbidities, the time of onset of the disease and the age of diagnosis. Therapy of hypogonadism begins with the treatment of the underlying disease. Treatment of adult patients consists in correcting androgen deficiency and sexual dysfunction. Infertility that occurs against the background of congenital and prepubertal hypogonadism is incurable, especially in the case of aspermia.

In the case of primary congenital and acquired hypogonadism (with preserved reserves of endocrinocytes in the testicles), stimulating therapy is used: in boys - with non-hormonal drugs, and in adult patients - with hormonal agents (small doses of gonadotropins, androgens). In the absence of the reserve capacity of the testicles, the replacement intake of androgens (testosterone) is shown constantly, throughout life. In secondary hypogonadism, both in children and adults, it is necessary to use stimulating hormonal therapy with gonadotropins (if necessary, combining them with sex hormones). It is also shown to conduct general strengthening therapy, physiotherapy exercises.

Surgical treatment of hypogoandism consists in testicular transplantation, bringing down the testicle in case of cryptorchidism, and in case of underdevelopment of the penis - phalloplasty. For cosmetic purposes, a synthetic testicle is implanted (in the absence of an undescended testicle in the abdominal cavity). Operations are performed using microsurgical techniques with control of the immunological and hormonal status of the patient and the transplanted organ. In the process of systematic treatment of hypogonadism, androgen deficiency decreases: the development of secondary sexual characteristics resumes, potency is partially restored, the severity of concomitant manifestations decreases (osteoporosis, lagging "bone age", etc.).

Hypogonadism in women

Female hypogonadism is characterized by underdevelopment and hypofunction of the gonads - the ovaries. Primary hypogonadism is caused either by congenital underdevelopment of the ovaries, or by damage to them during the neonatal period. In the body, there is a deficiency of female sex hormones, which causes an increase in the production of gonadotropins that stimulate the ovaries in the pituitary gland. In the blood serum, there is a high level of follicle-stimulating and luteinizing hormones (hypergonadotropic hypogonadism) and a low concentration of estrogens.

Estrogen deficiency causes underdevelopment and atrophic changes in the female genital organs, mammary glands, primary amenorrhea. If the violation in the ovaries occurred in the prepubertal period, then there are no secondary sexual characteristics.

The causes of primary hypergonadotropic hypogonadism are a congenital genetic disorder (Shereshevsky-Turner syndrome), congenital ovarian hypoplasia, infectious processes (syphilis, tuberculosis, mumps), ionizing radiation (radiation, X-ray), surgical removal of the ovaries, autoimmune ovarian damage (autoimmune oophoritis), testicular feminization syndrome (a congenital condition in which the appearance of a person corresponds to a woman with a male genotype), polycystic ovary syndrome.

Secondary female hypogonadism (hypogonadotropic) occurs with hypothalamic-pituitary pathology, characterized by a deficiency or complete cessation of the synthesis and secretion of gonadotropins that regulate ovarian function. It develops as a result of inflammatory processes in the brain (encephalitis, meningitis, arachnoiditis), the damaging effect of brain tumors and is accompanied by a decrease in the stimulating effect of gonadotropins on ovarian function.

Symptoms of hypogonadism in women

One of the main symptoms of hypogonadism in the childbearing period is menstrual irregularity and amenorrhea. The lack of female sex hormones leads to underdevelopment of sexual characteristics: genitals, mammary glands, violation of the deposition of fatty tissue according to the female type, poor hair growth. If the disease is congenital, or it arose in early childhood, then there are no secondary sexual characteristics. Characterized by a narrow pelvis and flat buttocks. If hypogonadism has developed in the puberty period, the sexual characteristics that have already developed persist, but menstruation stops, the tissues of the female genitalia undergo atrophy.

Diagnosis of hypogonadism in women

With hypogonadism, there is a noticeable decrease in the content of estrogens in the blood, an increase in the level of gonadotropins (follicle-stimulating and luteinizing hormones). Ultrasound examination reveals a uterus, reduced in size (hypoplasia of the uterus), reduced ovaries. X-rays reveal osteoporosis, or delayed skeletal development.

Treatment of hypogonadism in women

With primary hypogonadism in women, drug replacement therapy with female sex hormones (ethinyl estradiol) is prescribed. In the event of a menstrual-like reaction, combined oral contraceptives are prescribed containing two types of hormones - estrogens and gestagens. Women over 40 are prescribed estradiol + cyproterone, estradiol + norethisterone. Hormone replacement therapy is contraindicated in malignant tumors of the mammary glands and genital organs, cardiovascular diseases, diseases of the kidneys, liver, thrombophlebitis, etc.

The prognosis for life with hypogonadism is favorable. Prevention of hypogonadism consists in the health education of the population, the observation of pregnant women and the protection of their health.

The entire vital activity of the body is controlled by special chemical compounds - hormones. Metabolism, bone and muscle growth are completely dependent on a small amount of these compounds. The sexual sphere is one of the main points of influence of hormones. For the normal transformation of a boy into a man in adolescence and the further ability to have offspring, the friendly activity of two endocrine glands - the testicles and the pituitary gland - is necessary. With a lack of pituitary hormones, male secondary, or hypogonadal, hypogonadism is observed.

The role of pituitary hormones in normal and secondary hypogonadism

The hormonal background of the male body is very different from the female. The reason is the presence in men of the sex glands - testicles. They are formed during the period of being in the womb of the fetus, which inherited the X and Y chromosomes. There are two types of cells in the testes. Sertoli cells are the source of spermatozoa. Leydig cells produce the male sex hormone, testosterone. In a small amount, the hormone is produced by the adrenal glands - about 5%.

The testicles produce not only sex cells, but also hormones.

Testosterone is the main cause of the formation of external male sexual characteristics in the fetus. In childhood, the production of this hormone decreases significantly. The high point of testosterone is puberty. It is the high content of the hormone in the blood that leads to natural changes in the body of a teenager:

However, testosterone itself is extremely susceptible to the influence of the central conductor of all endocrine glands - the pituitary gland. This small organ is located in the cranial cavity in close proximity to the brain. The pituitary gland controls the endocrine glands with the help of a special tool - tropic hormones. These substances obey, in addition to the testicles, also the thyroid gland, adrenal glands, mammary glands, kidneys. For each of these organs, the pituitary gland secretes its own type of tropic hormones into the blood.

Gonadotropic hormones directly affect the activity of the testicles in the production of spermatozoa and testosterone. These include two types of chemical compounds - luteinizing (LH) and follicle-stimulating hormone (FSH). Without their influence, puberty, the formation of secondary sexual characteristics and full-fledged spermatozoa in the testicles is impossible. It is the change in their quantity in the blood that ultimately triggers the process of puberty. During the life of an adult male, LH and FSH allow for offspring and retain the appearance that was acquired by a teenager.

LH and FSH are produced in the cells of the adenohypophysis

The pituitary gland directs the production of testosterone, but such LH and FSH, in turn, depends on the hypothalamus. This part of the brain is located next door and produces special substances of a protein nature - releasing factors. Luliberin leads to an increase in the production of LH and FSH, lustatin, respectively, reduces their number.

All endocrine glands in the body are controlled by the hypothalamus.

Hypogonadotropic hypogonadism - changes in the male body regarding secondary sexual characteristics, muscle and skeletal structure, the ability to have offspring, the cause of which is a deficiency of pituitary gonadotropic hormones. The lack of LH and FSH can be combined with that of other pituitary hormones.

Synonym of the disease: secondary hypogonadism.

Classification

Hypogonadotropic hypogonadism has several varieties:

Causes of deficiency of gonadotropic hormones of the pituitary gland

There are two large groups of causes of deficiency of the pituitary hormones LH and FSH. The first is congenital diseases, which most often have a hereditary nature. With these pathologies, genes with an incorrect structure are transmitted from parents. For this reason, the hormones FSH and LH either do not form at all, or have a defective structure, which is why they cannot affect the Leydig cells in the testicles and other target organs.

Cullman's syndrome is one of the representatives of this group. In this case, there is an interesting combination of hypogonadism due to lack of LH and FSH and impaired sense of smell. The ability to distinguish smells can be greatly reduced (hyposmia) or absent (anosmia). Gonadotropin deficiency occurs due to a congenital defect in the structure of the hypothalamus, which is unable to produce the appropriate releasing factors.

Smell discrimination is impaired in some forms of hypogonadism

Congenital deficiency can affect only one of the tropic hormones - luteinizing. LH deficiency leads to low testosterone levels in the blood. In the presence of FSH in the testicles, this disease still produces spermatozoa, but most of them have structural defects and low mobility. These two circumstances directly depend on the lack of testosterone.

A deficiency of gonadotropins occurs when the cells of the pituitary gland are affected by a tumor. The most common benign neoplasm called craniopharynginoma. The tumor in most cases disrupts the production of all tropic hormones of the pituitary gland. Rarely, changes concern only LH and FSH.

Pituitary adenoma - video

Extremely rare combined deficiency of gonadotropins and adrenocorticotropic hormone (ACTH) - Maddock's syndrome. In this case, not only the testicles are affected, but also the adrenal glands. The work of the thyroid gland in this pathology is not disturbed. The onset of the disease occurs in adulthood. The exact reason for these changes is not fully understood.

Hypogonadism can occur during life due to an injury or tumor of the pituitary gland or circulatory problems in this area. In addition, the production of tropic hormones can suffer from the effects of an infection that has penetrated the brain and its membranes (meningitis, meningoencephalitis). In this case, LH and FSH deficiency is often accompanied by obesity with a characteristic distribution of adipose tissue according to the female type (stomach, trunk, face). The disease in this case is called adipose-genital dystrophy.

With hypogonadism, there is a change in body proportions and poor hair growth.

Whatever the nature of LH and FSH deficiency, it will inevitably affect three significant circumstances: secondary sexual characteristics, body structure and the ability to have offspring. Hypogonadism is only a consequence of low levels of the sex hormone testosterone. Normally arranged Leydig cells can increase the production of testosterone, but do not receive the appropriate command to do so. The most pronounced signs of the disease are manifested in the case when the deficiency of the sex hormone occurs long before birth. There is a problem with the formation of the genital organs themselves and the determination, ultimately, of belonging to the male or female sex.

Hypogonadism - video

Signs of hapogonadism

Symptoms of hypogonadotropic hypogonadism differ somewhat depending on the nature of the disease and the deficiency of a particular hormone - LH or FSH.

Signs of secondary hypogonadism - table

Disease	The debut of the disease	signs
		secondary sexual characteristics	Type of structure of the figure and skeleton	Sexual sphere	Other changes
Cullman's syndrome	Neonatal period	lack of pilosis of the pubis and armpits; breast enlargement (gynecomastia); high timbre of voice.	high growth; shortened body; long arms and legs; pale skin.	the absence of one of the testicles in the scrotum (cryptorchism); infertility; reduction in the size of the testicles and penis.	reduced ability to distinguish odors; inability to distinguish odors; splitting of the upper lip and palate; deafness.
Isolated LH deficiency	School and puberty		high growth; shortened body; long arms and legs.	infertility.	Breast enlargement (gynecomastia)
craniopharynginoma	Any	Scanty growth of hair on the pubic, face, in the armpits	high growth; shortened body; long arms and legs.	reduction in the size of the testicles and penis; infertility.	impaired visual acuity; loss of visual fields; inability to distinguish odors.
Maddock syndrome	adult age	Scanty growth of hair on the pubic, face, in the armpits	high growth; shortened body; long arms and legs.	reduction in the size of the testicles and penis; infertility.	Dark (bronze) skin coloration
Adiposo-genital dystrophy	10–12 years old	Scanty growth of hair on the pubic, face, in the armpits	high growth; shortened body; long arms and legs.	reduction in the size of the testicles and penis; infertility; cryptorchidism.	obesity; gynecomastia.

Symptoms of hypogonadism - scheme

Obesity often accompanies hypogonadism A pituitary tumor often damages the optic nerves Hypogonadism reduces the lumen of the seminiferous tubules Cryptorchidism can cause the testicle to be in different areas

Methods for diagnosing secondary hypogonadism

The problem of diagnosing hypogonadotropic hypogonadism and finding out the cause of hormonal disorders is dealt with by a specialist endocrinologist. To establish an accurate diagnosis, an in-depth examination of the body is required:

• an objective examination will reveal a change in body proportions, gynecomastia, underdevelopment of skeletal muscles, testicles and penis, as well as a meager expression of hair growth on the pubis, face and in the axillary areas;
• a neurological examination will reveal visual and olfactory disorders;
• ophthalmological examination allows us to conclude that there is reduced visual acuity and loss of visual fields;
• in the blood test, there is a low content of luteinizing, follicle-stimulating hormone and testosterone, which makes it possible to distinguish primary hypogonadism from secondary;
• ultrasound examination of the testicles reveals a decrease in their size, the presence of cryptorchidism;
  In hypogonadism, the testicle is reduced in size
• analysis of seminal fluid reveals a decrease in the total number of spermatozoa and their motility;
• analysis of cerebrospinal fluid obtained through a puncture (puncture) of the spinal canal at the lumbar level will reveal the presence of infection in the nervous system - a high content of protein and immune cells of leukocytes;
• x-ray of the skull allows you to suspect the presence of a tumor in the area of ​​​​the pituitary gland;
• analysis of the x-ray of the hand allows us to conclude that there is a lack of testosterone in the body. At a sufficient level, the small bones of the wrist and wrist joint are visible in the picture;
  The bones of the wrist - an indicator of sufficient testosterone levels
• computed or magnetic tomography allows you to study the structure of the brain and pituitary gland at the most subtle level, to identify tumors and other abnormalities.
  A pituitary tumor is one of the causes of hypogonadism

Hypogonadotropic hypogonadism must be differentiated from the following pathologies:

Treatment Methods

Treatment of patients of different ages with hypogonadotropic hypogonadism is carried out by a specialist endocrinologist. In some cases, a neurosurgeon is involved.

The appointment of hormonal drugs

The appointment of hormonal drugs is, of course, the basis of the treatment of hypogonadism, since all its symptoms are due to a lack of LH, FSH and testosterone. The introduction of their chemical analogues from the outside in the form of injections and tablets allows you to achieve the desired result: start the process of puberty in the right way in boys, form secondary sexual characteristics, change the proportions of the skeleton, increase muscle mass.

Hormonal drugs for the treatment of secondary hypogonadism - table

Name of the drug	Active substance	Release form	Indications	Contraindications	The cost of the drug in pharmacies
Profazi			infertility; cryptorchidism.	hypersensitivity;	From 366 rubles
		Lyophilisate for solution for injection	hypogonadotropic hypogonadism; infertility; cryptorchidism.	hypersensitivity; prostate tumor.	From 366 rubles
		Lyophilisate for solution for injection	hypogonadotropic hypogonadism; infertility; cryptorchidism.	hypersensitivity; prostate tumor.	From 187 rubles
		Lyophilisate for solution for injection	hypogonadotropic hypogonadism; infertility; cryptorchidism.	hypersensitivity; prostate tumor.	From 1750 rubles
Humegon	Menotropins	Lyophilisate for solution for injection	Infertility		From 1270 rubles
Pergonal	Menotropins	Lyophilisate for solution for injection	Infertility	Tumors of various localization	From 1300 rubles
	Testosterone	Injection	hypogonadism; testosterone deficiency.	prostate tumor	From 626 rubles
Omnadren-250	Testosterone	Injection	hypogonadism; testosterone deficiency.	prostate tumor	From 765 rubles
	Testosterone	Capsules	hypogonadism; testosterone deficiency.	prostate tumor	From 995 rubles

Preparations for the treatment of hypogonadism - photo gallery

Pregnyl contains human chorionic gonadotropin Choragon is used in secondary hypogonadism
Andriol is prescribed for testosterone deficiency Chorionic gonadotropin eliminates the deficiency of pituitary hormones Sustanon-250 - a chemical analogue of testosterone

Surgical treatment

In the presence of a tumor as a cause of hypogonadotropic hypogonadism, a neurosurgeon is involved in the treatment. Access to the pituitary gland can be done in two ways. The most beneficial is transsphenoidal - through the nasal cavity and the main (sphenoid) sinus. It is these two structures that are closest to the pituitary gland. In some cases, access through the frontal bone is used - transfrontal. The technique of the operation is selected by the doctor individually, depending on the size and location of the tumor.

Access to the pituitary gland is possible through the main sinus (sphenoid)

With cryptorchidism, the help of a pediatric urologist is required. An undescended testicle is forcibly placed in the scrotum and fixed (orchiopexy). Currently, such an operation is all performed laparoscopically through several small holes for the introduction of a video camera and miniature instruments.

Lifestyle change

Changing the nature of nutrition is a key factor in the treatment of hypogonadism, accompanied by obesity. These recommendations are relevant for both adults and children. In this case, it is recommended to switch to fractional nutrition - five to six meals a day in small portions. It is useful to use the following products:

• fresh vegetables;
• fresh fruits;
• berries;
• berry jellies and desserts;
• whole grain bread;
• wholemeal bread;
• muesli;
• milk and dairy products;
• pasta from durum wheat;
• lean meats - turkey, rabbit, skinless chicken;
• sea ​​fish - cod, perch, pollock, pink salmon, salmon, dorado.

Products recommended for use in hypogonadism and obesity - photo gallery

Vegetables and fruits are rich in vitamins Berry dessert contains a minimum of calories Muesli is an ideal breakfast Dairy products are a source of calcium to strengthen bones Dorado contains healthy fatty acids

• fast food
• sweet carbonated drinks;
• alcoholic drinks;
• chocolate, sweets;
• dough confectionery;
• cream confectionery products (cakes, pastries);
• canned food;
• marinades;
• fatty meats - pork, lamb;
• smoked products, including sausages;
• hot herbs and spices.

Foods to avoid - photo gallery

Fast food contributes to weight gain Chocolate contains a lot of sugar Cakes are a very high-calorie product Sausages contain dyes and flavor enhancers

To combat excess weight, it is vital for adults and children to increase their level of physical activity - walking, swimming in the pool, skiing and cycling. A useful tool is a pedometer - a calorie counter and distance traveled per day.

Complications and prognosis

The prognosis for the treatment of hypogonadotropic hypogonadism is extremely diverse, highly dependent on the specific cause of the disease. Hereditary diseases, as a rule, have an unfavorable prognosis. Restoring reproductive function in most cases fails. The appointment of drugs can affect the start of puberty and the formation of secondary sexual characteristics. The success of surgery for a pituitary tumor largely depends on its size and the experience of the neurosurgeon. In severe cases, the following complications are noted:

• low visual acuity up to complete blindness;
• paresis and paralysis of muscles;
• violation of skin sensitivity;
• irreversible loss of reproductive function;
• tendency to break bones.

Prevention

Prevention of the development of pituitary tumors has not yet been developed. The main measures to prevent hereditary diseases are pregnancy planning and medical genetic counseling. The main way to prevent infectious causes of hypogonadism is vaccination.

Hypogonadotropic hypogonadism is a complex hormonal disease that affects not only the sexual sphere and the ability to have offspring. Seeking help from a specialist will allow you to prescribe treatment in time and significantly improve social adaptation and quality of life.

Hypogonadism in men is a disease in which male sex hormones - androgens - are almost not produced due to impaired functioning of the testicles or malfunction of the hypothalamus or pituitary gland.

What is it and how does it manifest itself?

Depending on the cause of androgen deficiency, there are two forms of male hypogonadism:

• primary(hypergonadotropic) associated with congenital or acquired testicular pathologies;
• secondary(hypogonadotropic), caused by a decrease in the level of gonadotropins responsible for the synthesis of testosterone due to damage to the hypothalamus or pituitary gland.

Both forms of the disease lead to the fact that in the human body there is a lack of androgens responsible for the formation of the genital organs and reproductive functions.

The reasons

Causes of Primary Hypogonadism

The disease is associated with the following congenital causes:

• aplasia (absence) of the testicles;
• improper development of the seminiferous tubules;
• cryptorchidism (undescended) testicles;
• genetic anomalies (syndromes of Klinefelter, del Castillo, Shereshevsky-Turner);
• male hermaphroditism (Reifenstein's syndrome).

Sometimes primary hypogonadism is acquired.

The reasons:

• tumors or injuries of the testicles;
• infectious and inflammatory diseases (orchitis, vesiculitis, trim, epididymitis);
• toxic effects on the body (chemotherapy, hormonal drugs, alcohol), leading to a decrease in the performance of the testicles.

Most often, the disease occurs after injuries, operations on the scrotum, radiation damage to tissues, and also as a result of complications of infectious diseases (tuberculosis, syphilis, chickenpox, mumps).

Causes of secondary hypogonadism

The disease is caused by genetic abnormalities and congenital pathologies, including:

• Cullman's syndrome, accompanied by a defect in the hypothalamus;
• pituitary dwarfism;
• Pasqualini syndrome associated with a decrease in the production of luteinizing hormone in the absence of other disorders;
• congenital tumor that compresses the pituitary gland tissues;
• Maddock's syndrome;
• hemochromatosis.

Causes of acquired secondary hypogonadism:

• acquired pathologies of the hypothalamus and pituitary gland (Lawrence-Moon-Barde-Biedl, Prader-Wiley, Pehkrantz-Babinsky-Frelich syndromes);
• a tumor or infection of the hypothalamic-pituitary zone (a consequence of meningitis or encephalitis);
• hyperprolactinemia associated with an excess of the hormone prolactin, an androgen inhibitor (causes normogonadotropic hypogonadism);
• damage to the hypothalamus or pituitary gland as a result of surgery or trauma;
• age-related changes leading to a decrease in testosterone production.

Usually secondary hypogonadism leads not only to disorders in the genital area.

It is accompanied by improper functioning of the thyroid gland, growth retardation, and obesity.

Symptoms

Signs of illness in teenagers

If hypogonadism appeared in a boy before the age of 16–18, then the signs are as follows:

• delayed sexual development;
• underdeveloped testicles and scrotum, small penis;
• enlarged breasts (gynecomastia);
• tall, narrow shoulders, poorly developed chest, elongated arms and legs, weak muscles;
• obesity (accumulation of fat deposits on the buttocks and thighs, in the chest area);
• lack of hair on the pubis, in the armpits, on the face;
• high thin voice;
• lack of sexual desire.

Hypogonadism can be accompanied not only by external defects, but also by mental disorders (secondary) or mental infantilism (primary).

Signs of illness in men

Hypogonadism is less severe if it occurs when the male's sexual development has already been fully completed.

Its symptoms:

• decrease in the size of the testicles;
• a small amount of hair on the face and body;
• deterioration in the condition of the skin;
• female-type obesity, gynecomastia;
• decreased potency, sexual desire;
• diseases of the heart and blood vessels, anemia, dizziness, pressure fluctuations;
• a decrease in the amount of ejaculate and a deterioration in its quality;
• inability to conceive a child;
• osteoporosis, atrophy of muscle tissue, weakness of the muscular frame.

Such symptoms are accompanied by a deterioration in the general condition of the patient. He becomes lethargic, apathetic, hardly performs physical work.

If these symptoms are associated with age-related changes (occur after 55 years), there may be a deterioration in memory, absent-mindedness, and a decrease in mental abilities.

Effects

The most severe consequence of hypogonadism is infertility. Insufficient functioning of the genitals and a decrease in the quality of sperm leads to the fact that a man loses the opportunity to conceive a child.

If the disease manifests itself in adulthood, a man has an increased risk of developing cardiovascular diseases and pathologies of bone and muscle tissue.

Diagnostics

Despite the fact that outwardly hypogonadism manifests itself quite clearly, the patient will have to undergo a comprehensive examination. Only in this way can the cause of the disease be identified and eliminated.

To make an accurate diagnosis, a doctor (andrologist or endocrinologist) conducts a series of studies:

• visual examination of the patient;
• palpation and examination of the genitals;
• Ultrasound of the pelvic organs;
• radiography to assess the condition of the skeleton;
• laboratory study of ejaculate;
• study of hormonal status (testosterone, prolactin, estradiol, gonadotropins);
• urinalysis for ketosteroids;
• CT, MRI, electroencephalography of the brain.

If a genetic origin of the disease is suspected, a chromosomal study is performed.

Treatment

Treatment of hypogonadism is carried out only in specialized medical institutions and is always selected individually. Self-medication with folk remedies will not help here - delay will only aggravate the patient's condition and make it difficult to correct symptoms.

The goal of treating pubertal boys is to correct the lag in the development of the reproductive system. The goal of treatment for sexually mature men is to eliminate androgen deficiency and sexual dysfunction.

Treatment options:

• phalloplasty with abnormal development of the penis;
• bringing down the testicle when it is not descended;
• testicular transplantation or implantation;
• lifelong intake of gonadotropins or androgens;
• elimination of the factor that led to androgen deficiency.

Self-treatment at home is not recommended. Even taking medications should be carried out only under the strict supervision of a doctor.

If you start therapy on time, over time, you can reduce the lack of androgens, which will accelerate the development of the genital organs, restore potency and reduce the risk of developing cardiovascular diseases and osteoporosis.

Unfortunately, if the disease occurs at a young age, doctors can only correct its external manifestations. A man who survives hypogonadism before puberty will not be able to have children.