Okay, you have been to the doctor’s clinic, multiple investigations have been ordered and your doctor tells you all the preliminary tests are normal. Your testicles are producing enough testosterone. But you still feel tired, decreased sex drive, feeling depressed. You may be suffering from Secondary Hypogonadism. Secondary Hypogonadism is a type of hypogonadism that indicates a problem in the hypothalamus or the pituitary gland — parts of the brain that signals the testicles to produce testosterone. The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then signals the testes to produce testosterone.
In other words, the testicles are normal but don’t function properly due to a problem with the pituitary or hypothalamus. A number of conditions can cause secondary hypogonadism.
Causes
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Kallmann’s syndrome. This is an abnormal development of the area of the brain that controls the secretion of pituitary hormones (hypothalamus). This abnormality can also affect the ability to smell (anosmia) and cause red-green color blindness.
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Pituitary disorders. An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production. A pituitary tumor or other type of brain tumor located near the pituitary gland may cause testosterone or other hormone deficiencies.
Also, treatment for a brain tumor, such as surgery or radiation therapy, can affect the pituitary gland and cause hypogonadism.
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Inflammatory disease. Certain inflammatory diseases, such as sarcoidosis, histiocytosis and tuberculosis, involve the hypothalamus and pituitary gland and can affect testosterone production.
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HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
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Medications. The use of certain drugs, such as opiate pain medications and some hormones, can affect testosterone production.
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Obesity. Being significantly overweight at any age might be linked to hypogonadism.
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Normal aging. As men age, there’s a slow, progressive decrease in testosterone production. The rate varies greatly.
Risk factors
Risk factors for hypogonadism include:
- HIV/AIDS
- Previous chemotherapy or radiation therapy
- Aging
- Obesity
- Malnutrition
Complications might include:
- Abnormal genitalia
- Enlarged male breasts (gynecomastia)
- Infertility
- Erectile dysfunction
- Osteoporosis
- Poor self-image
Diagnosis
Other than all the preliminary investigations ordered before (for primary Hypogonadism) including HIV, confirming that you have low testosterone, additional investigations that may be ordered include:
- Semen analysis
- Pituitary imaging
- Genetic studies
- Testicular biopsy
Management
If there were any pituitary tumor, an assessment and removal will be needed by a Neurosurgeon. Otherwise after adequate exercise, change in diet, not taking medicines unnecessarily, ruling out all the infections & inflammatory conditions, the staple of therapy will be Hormonal replacement therapy.
Types of testosterone replacement therapy
- Gel. There are several gels and solutions available, with different ways of applying them. Depending on the brand, you rub the testosterone into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo) or apply it to the front and inner thigh (Fortesta).
Your body absorbs testosterone through your skin. Do not shower or bathe for several hours after a gel application, to be sure it gets absorbed.
Side effects include skin irritation and the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry, or cover the area after an application.
- Injection. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate are given in a muscle or under the skin. Your symptoms might waver between doses depending on the frequency of injections.
Testosterone undecanoate (Aveed) is given by deep intramuscular injection, typically every 10 weeks. It must be given at your doctor’s office and can have serious side effects.
- Patch. A patch containing testosterone (Androderm) is applied each night to your thighs or torso. A possible side effect is severe skin reaction.
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