Male Hypogonadism : Causes-Symptoms-Diagnosis-Treatment
What is Male Hypogonadism?
Male hypogonadism is a condition in which the body does not produce enough of the hormone that plays a key role in masculine growth and development during puberty. There is a need to increase awareness of this condition among doctors and other medical professionals. Doctors who specialize in primary care are usually the first people a patient sees. Hypogonadism can have a significant impact on a person's quality of life, and has led to the loss of jobs and marriages. It is also important for doctors to be aware that testosterone is not the only hormone that matters. Testosterone is a sex hormone. This article is about how testosterone has several effects on metabolism, the vasculature, and brain function. It will be necessary to develop sensitive and reliable assays for sex hormones and for symptoms and treatment of hypogonadism.
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| Male Hypogonadism |
Male hypogonadism is a medical condition in which the gonads (male reproductive organs) produce less hormone. This can lead to problems such as decreased function of the testes or ovaries. Testosterone is a critical hormone that helps with sexual cognitive and body function and development. Clinically low testosterone levels can cause the absence of secondary sex characteristics, infertility, muscle wasting, and other abnormalities. Testosterone levels can be low due to a problem with the testicles. If an individual also has signs and symptoms of a hypothalamic or pituitary disorder, treatment with testosterone replacement therapy is generally recommended by clinical guidelines.
The male reproductive system is a complex and essential structure that carries out the essential function of producing offspring. This system includes the testes, which produce sperm; the epididymis, which stores sperm until they are injected into the vas deferens; and the prostate, which produces seminal fluid.
Internal reproductive organs
External reproductive organs
Medical terms
- Male hypogonadism is a condition in which the body doesn't produce sufficient of the hormone that plays a key function in masculine boom and development at some stage in puberty (testosterone) or sufficient sperm or each.
- You can be born with male hypogonadism, or it is able to increase later in lifestyles, frequently from damage or infection. The outcomes — and what you can do approximately with them — rely on the reason and at what factor in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone substitute remedy.
- is caused by abnormality in the hypothalamus and/or the pituitary gland Male hypogonadism is defined as a deficiency in the production of testosterone which leads to an imbalance between testosterone release and male sex hormone binding globulin (SHBG) The main causes of hypogonadism are abnormalities in the hypothalamus or pituitary gland These include: - Kallman syndrome – This is characterized by an absence of development during puberty and a result of a failure of sexual maturation It can be attributed either to an absent or improperly developed olfactory bulb or tract as well as to damage to the area around them .
is a condition that prevents the body from producing normal amounts of testosterone The term "male hypogonadism" refers to a group of disorders in which the testicles do not develop properly or are unable to function normally resulting in low production of testosterone and sperm The testicles are responsible for producing sperm and male sex hormones Testosterone is the hormone that stimulates muscle growth bone strength sex drive and sperm production It also keeps the skin healthy and helps build and maintain muscle mass A lack of testosterone can lead to several conditions associated with aging such as fatigue and weak bones ( osteoporosis ).
The pathophysiology of testosterone and hypogonadism is explained
The cerebral cortex – the layer of the brain that is often referred to as “the gray matter” – is the most highly developed portion of the human brain. This portion of the brain comprising about two-thirds of the brain mass is responsible for the processing of information in the brain. It is located within The hypothalamus is responsible for stimulating testosterone production in the brain. The cerebral cortex sends a signal to the hypothalamus which causes it to release the gonadotropin-releasing hormone in pulses. This then signals the pituitary gland to start producing testosterone. The hypothalamus is responsible for hormones that regulate growth, thyroid function, blood pressure, and other essential body functions. Once stimulated by gonadotropin-releasing hormone, the pituitary gland produces follicle-stimulating hormone and luteinizing hormone. Luteinizing hormone is released into the bloodstream when you are sexually aroused. This hormone triggers activity in the Leydig cells in your testes. The Leydig cells transform cholesterol into testosterone. When your testosterone levels are high, the pituitary gland slows the release of luteinizing hormone, via a negative feedback loop. The feedback mechanism slows testosterone production. With so many steps involved, there are many potential problems that could lead to low testosterone levels. Anything that changes in the testicles (the hypothalamus or the pituitary gland), whether it's congenital or acquired temporarily, can cause hypogonadism. Decoupage is permanent.
Studies have found that testosterone production gradually decreases as we age. However, the rate of decline varies from person to person. Unlike women who experience a rapid decline in hormone levels during menopause, men experience a slow continuous decline over time. The Baltimore Longitudinal Study of Aging found that testosterone levels decrease slowly over time for most men. A study reported that around 20% of men in their 60s and 50% of men in their 80s are hypogonadal. This is a condition in which the level of a man's natural hormone, testosterone, is low. This type of hypogonadism is sometimes called "late-onset hypogonadism." PADAM is a disorder that affects males as they age. It is likely to increase in prevalence in the next few decades as the elderly population grows.
Obesity is associated with reduced testosterone levels. Studies have found that for every 1-kg/m2 increase in body mass index, testosterone levels decrease by 10 ng/dL. Obesity can affect a person's testosterone level. The causes are unknown, but may include increased clearance or aromatization of testosterone in the fat cells and increased formation of inflammatory cytokines, which block the release of the hormone that stimulates the production of testosterone. Obesity is associated with an increased incidence of secondary hypogonadism. Diabetes, even without the other risk factors for obesity, still remains a significant risk factor for hypogonadism. Although the risk factors for obesity and age have been removed, diabetes still remains an independent risk factor for hypogonadism. Previously, it was thought that diabetes mellitus was associated with decreased testosterone levels. However, new study results show that one-third of diabetic men also have low levels of pituitary hormones. This means that the number of cases of diabetes mellitus is expected to increase in the future. In the next ten years, there will be an increase of 366 million people with hypogonadism. This will have a significant impact on the prevalence of low testosterone levels. Certain medications can reduce testosterone production. Some medications used to treat conditions like asthma, Crohn's disease, bipolar disorder, and schizophrenia are steroids, ketoconazole (an anticonvulsant), ethanol (a psychoactive drug), immunosuppressants, opiates (painkillers), and psychotropic medications and hormones.
CLASSIFICATION OF MALE HYPOGONADISM
There are two types of hypogonadism: One is called primary hypogonadism, and it's when the body doesn't produce enough testosterone. The other is called secondary hypogonadism, and it's when the body can't use testosterone normally.
Primary hypogonadism is caused by a problem with the testicles.
Secondary hypogonadism means there is a problem with the hypothalamus or pituitary gland - two parts of the brain that signal the testicles to produce testosterone. The hypothalamus produces the gonadotropin-releasing hormone which signals the pituitary gland to make testosterone. FSH and luteinizing hormone are hormones that stimulate the production of testosterone. If testosterone production is not normal, this may be due to an inherited trait or something that happens later in life, such as an injury or infection.
Primary Hypogonadism
Primary hypogonadism is caused by various things, some of which are common:
Klinefelter's Syndrome is a condition caused by a congenital abnormality of the sex chromosomes. In most cases, a male has one X and one Y chromosome. In Klinefelter's syndrome, two or more X chromosomes are present in addition to the normal Y chromosome. The Y chromosome contains the genetic information for a male. Klinefelter's syndrome is a condition that results in an extra X chromosome. This extra chromosome causes abnormal development of the testicles, which then causes a lack of testosterone production.
Undescended testicles
Before birth, the testicles develop in the abdomen. Normally, they will move down into the scrotum after birth. If this doesn't happen, it can usually be corrected within the first few years of life without any treatment. Early exposure to the chemical may lead to testicular malfunction and a decreased production of testosterone in children.
Mumps orchitis
If a mumps infection involves the testicles and the salivary glands, long-term testicular damage may occur. This could affect normal testicular function and testosterone production.
Hemochromatosis
Too much iron in the blood can lead to testicular failure or a dysfunction of the pituitary gland, which affects testosterone production.
Injury to the Testicles
Testicles are located outside of the abdomen, which means they are at a greater risk for injury. If testicle damage occurs, it can lead to a condition called hypogonadism. Damage to only one testicle does not always impair the production of testosterone.
Cancer treatment
Cancer treatment can interfere with testosterone production and sperm production. The effects of both treatments are often temporary, but some men may experience permanent infertility. Although fertility may return within a few months after treatment ends, preserving your fertility may require long-term care. Some men choose to have sperm preserved before beginning cancer therapy. Howell et al. found that 30% of the men with cancer had low testosterone levels and 90% of these men had germinal epithelial failure, a condition in which the cells that line the uterus do not work properly.
Normal aging
Older men generally have lower testosterone levels than younger men do. This is because testosterone production decreases slowly and steadily as men age. As many as 30% of men older than 75 have a testosterone level that is below normal. Doctors are still debating whether or not treatment is necessary for people with this condition.
Secondary Hypogonadism
In secondary hypogonadism, the testicles are normal but they function improperly because of a problem with the brain. There are many causes for secondary hypogonadism, including:
Kallmann syndrome
Abnormal development of the hypothalamus (an area of the brain that controls the secretion of pituitary hormones) can cause hypogonadism. This abnormality is also associated with the impaired development of the ability to smell (anosmia).
Pituitary disorders
An abnormality in the pituitary gland can interfere with the release of hormones from the pituitary gland to the testicles. This can be caused by a tumor or other kind of brain tumor located near the pituitary gland, which can result in a deficiency of testosterone or other hormones. Treatment for a brain tumor may impair the pituitary gland and cause low levels of testosterone.
Inflammatory disease
Inflammatory diseases such as sarcoidosis, histiocytosis, and tuberculosis can affect the hypothalamus and pituitary gland and lead to reduced testosterone production.
HIV/AIDS
The virus can reduce testosterone levels by affecting the hypothalamus, pituitary, and testes.
Medications
Certain drugs, such as pain medications and hormones, can affect testosterone production.
Obesity
Being significantly overweight may be linked to a lack of testosterone.
Stress-induced Hypogonadism
Excessive exercise and weight loss are all associated with hypogonadism. Some people believe that this is because of the stress-induced increase in cortisol, which would suppress the hypothalamus.
ROLE OF TESTOSTERONE
Testosterone plays a critical role in sexual development during the male lifespan. During fetal development, testosterone helps to determine one's sex. The most visible effects of increased testosterone levels begin during puberty. At this time, body odor may develop. Acne is more likely to occur when the skin and hair are oily. Acne growth spurts will happen more quickly, pubic and facial hair will grow earlier, and men's testosterone levels will increase. Testosterone increases the depth of a person's voice, heightens bone maturation, causes hair loss on the scalp and growth in other areas such as the chest, legs, and axillae. Even as adults, the effects of testosterone are visible in changes such as increased libido, penile erection, aggression, and energy.
Symptoms Male hypogonadism
If a person's serum testosterone level is below 300 ng/dL, along with at least one clinical sign or symptom, they have hypogonadism. Symptoms of hypogonadism may include the loss of secondary sex characteristics, anemia, muscle wasting, reduced bone mass or density, and oligospermia (low sperm count). Postpubescent boys may experience symptoms of hypogonadism, including sexual dysfunction (reduced libido diminished penile sensation difficulty attaining orgasm and reduced ejaculate), reduced energy and stamina, depressed mood, increased irritability, and difficulty concentrating. Cholesterol levels and other health problems can result from not receiving treatment in early adolescence. If the treatment is not started, signs and symptoms may include sparse hair on the body and delayed closure of the epiphyseal bone.
Hypogonadism can begin during fetal development, before puberty or during adulthood. Signs and symptoms depend on when the condition develops.
Fetal development
If the frame would not produce sufficient testosterone all through fetal improvement, the end result may be impaired boom of the outside intercourse organs. Depending on while hypogonadism develops and how much testosterone is gift, a child who is genetically male can be born with:
Female genitals
Genitals that are neither clearly male nor clearly female (ambiguous genitals)
Underdeveloped male genitals
Puberty
Male hypogonadism can put off puberty or motive incomplete or lack of regular development. It can hamper:
Development of muscle mass
Voice deepening
Growth of body and facial hair
Growth of the penis and testicles
And it can cause:
Excessive growth of the arms and legs in relation to the trunk of the body
Development of breast tissue (gynecomastia)
Adulthood
In grownup adult males, hypogonadism can alter sure masculine physical traits and impair ordinary reproductive characteristics. Early signs and symptoms may encompass:
Decreased sex drive
Decreased energy
Depression
Over time, men with hypogonadism can develop:
Erectile dysfunction
Infertility
Decrease in hair growth on the face and body
Decrease in muscle mass
Development of breast tissue (gynecomastia)
Loss of bone mass (osteoporosis)
Severe hypogonadism can also cause intellectual and emotional changes. As testosterone decreases, some men have symptoms similar to those of menopause in girls. These can consist of:
Difficulty concentrating
Hot flashes
When to seek help
See your healthcare provider if you have signs and symptoms of male hypogonadism. Finding the cause of hypogonadism is a crucial first step to getting suitable treatment.
Causes Male hypogonadism
Hypogonadism in a male refers to a decrease in both or both of the 2 principal capabilities of the testes: sperm production and testosterone production.
Male hypogonadism method the testicles don't produce enough of the male sex hormone testosterone. There are two primary sorts of hypogonadism:
Primary. This sort of hypogonadism — also known as number one testicular failure — originates from a hassle within the testicles.
Secondary. This sort of hypogonadism shows trouble in the hypothalamus or the pituitary gland — elements of the brain that signal the testicles to supply testosterone. The hypothalamus produces gonadotropin-freeing hormone, which alerts the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then alerts the testes to provide testosterone.
Either kind of hypogonadism may be due to an inherited (congenital) trait or something that happens later in existence (acquired), which includes an injury or an infection. At times, number one and secondary hypogonadism occur collectively.
Primary hypogonadism
Common causes of primary hypogonadism include:
- Klinefelter syndrome. This situation consequences from a congenital abnormality of the sex chromosomes, X and Y. A male commonly has one X and one Y chromosome. In Klinefelter syndrome, two or extra X chromosomes are present further to at least one Y chromosome.The Y chromosome includes the genetic material that determines the sex of a baby and related development. The extra X chromosome that takes place in Klinefelter syndrome causes atypical improvement of the testicles, which in turn results in underproduction of testosterone.
- Undescended testicles. Before starting, the testicles broaden within the stomach and normally circulate down into their permanent vicinity in the scrotum. Sometimes one or both of the testicles are not descended at birth.This condition frequently corrects itself in the first few years of existence without treatment. If not corrected in early formative years, it may lead to malfunction of the testicles and reduced production of testosterone.
Mumps orchitis. A mumps contamination concerning the testicles that occurs at some point of early life or adulthood can harm the testicles, affecting the characteristic of the testicles and testosterone production.
Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
Injury to the testicles. Because they're out of doors in the abdomen, the testicles are vulnerable to damage. Damage to each testicles can cause hypogonadism. Damage to 1 testicle might not impair overall testosterone manufacturing.
- Cancer treatment. Chemotherapy or radiation remedy for the remedy of most cancers can intervene with testosterone and sperm production. The effects of each remedy frequently are temporary, but everlasting infertility may also occur.Although many men regain their fertility inside a few months after treatment, maintaining sperm before starting cancer therapy is an option for men.
Secondary hypogonadism
In secondary hypogonadism, the testicles are regular but don't feature nicely because of a hassle with the pituitary or hypothalamus. A quantity of conditions can cause secondary hypogonadism, consisting of:
Kallmann's syndrome. This is an atypical improvement of the area of the brain that controls the secretion of pituitary hormones (hypothalamus). This abnormality also can affect the potential to smell (anosmia) and cause crimson-green coloration blindness.
- Pituitary disorders. An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting ordinary testosterone production. A pituitary tumor or different sort of mind tumor located close to the pituitary gland might also cause testosterone or other hormone deficiencies.Also, remedy for a mind tumor, such as surgical operation or radiation remedy, can have an effect on the pituitary gland and motivate hypogonadism.
Inflammatory disease. Certain inflammatory diseases, including sarcoidosis, histiocytosis and tuberculosis, contain the hypothalamus and pituitary gland and may affect testosterone production.
HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
Medications. The use of sure drugs, which include opiate ache medicines and some hormones, can have an effect on testosterone production.
Obesity. Being significantly overweight at any age might be linked to hypogonadism.
Aging. As guys age, there is a slow, revolutionary decrease in testosterone manufacturing. The rate varies substantially.
Risk factors Male hypogonadism
Risk factors for hypogonadism include:
Previous chemotherapy or radiation therapy
Aging
Obesity
Malnutrition
Hypogonadism can be inherited. If any of those chance elements are to your family fitness history, inform your medical doctor.
Is hypogonadism reversible?
Hypogonadism is a condition in which the testicles or testes do not produce enough testosterone Testosterone is the hormone responsible for male sex characteristics and normal sexual development It promotes muscle growth red blood cell production and sperm production in men Because testosterone levels decrease with age older men often experience hypogonadism as well as other health issues including weight gain and loss of strength and muscle mass Men who are diagnosed with hypogonadism are given testosterone replacement therapy to help correct the imbalance in their body's levels of this hormone The therapy can be administered through injection or a gel to be rubbed into the skin on the upper.
How long does it take to treat hypogonadism?
Hypogonadism also known as low testosterone is a condition in which the testicles fail to produce enough testosterone The good news is that hypogonadism can be treated It usually occurs during middle age due to a natural decline in testosterone production Treatment of hypogonadism includes medication and lifestyle changes such as exercise and weight loss.
How do you reverse hypogonadism naturally?
Natural remedies for low testosterone can be found in a number of different foods and herbs For example broccoli spinach strawberries and walnuts contain zinc. Zinc deficiency is linked to low testosterone levels Dark chocolate can help increase your testosterone levels naturally due to its high content of magnesium and folic acid.
Does exercise increase testosterone?
It's a common belief that exercise increases testosterone levels—but is it true? Recent research has revealed that at least for women this claim may not be accurate The study published in the American Journal of Physiology-Endocrinology and Metabolism in March 2014 found that while short-term exercise did increase testosterone levels in women over 50 years old long-term exercise had the opposite effect on younger women Because testosterone plays such an important role in how our bodies function and develop over time it is essential to know how physical activity impacts our hormone levels Read on to discover whether or not you need to add more exercise into your life—and if.
Which exercise is best for testosterone?
So we don’t know if you’ve noticed but it seems like every guy who takes a single step towards better health immediately becomes obsessed with testosterone And while we could debate whether or not this obsession is healthy (or even warranted) science has already confirmed that it is A study published in the Journal of Clinical Endocrinology & Metabolism found that when men over age 60 lowered their testosterone levels through medication they experienced significant health problems including memory deficits and muscle mass loss.
Complications Male Hypogonadism
The headaches of untreated hypogonadism differ relying on while it develops — during fetal development, puberty or maturity.
Complications might include:
Abnormal genitalia
Enlarged male breasts (gynecomastia)
Infertility
Erectile dysfunction
Osteoporosis
Poor self-image
Diagnosis Male hypogonadism
If hypogonadism is diagnosed early, it can be prevented from developing into more serious conditions. The diagnosis of hypogonadism is based on a man's symptoms and tests. The symptoms and blood work are particularly concerning for testosterone levels. The first step in diagnosis is the Androgen Deficiency in Aging Male (ADAM) test – a 10-item questionnaire that identifies men who may have low testosterone. Testosterone levels can vary throughout the day, and they can change significantly from one day to the next. Testosterone levels are generally highest in the morning. If low testosterone levels are confirmed, further testing may be done to identify the cause, such as testing for testosterone levels in the blood, semen analysis, pituitary imaging, or a combination of these. A testicular biopsy and genetic studies may be done to determine the best treatment plan. Once the treatment begins, the patient's testosterone levels may be monitored to see if the medication is helping to produce adequate levels.
Early detection in boys can help prevent issues from not on time puberty. Early diagnosis and remedy in guys provide higher protection in opposition to osteoporosis and different related conditions.
Your fitness care issuer will conduct a bodily exam and notice whether your sexual development, including your pubic hair, muscle tissue and length of your testes, is steady together with your age.
Your issuer will check your blood degree of testosterone when you have symptoms or signs and symptoms of hypogonadism. Because testosterone levels vary and are normally highest inside the morning, blood checking is normally accomplished early in the day, earlier than 10 a.M., possibly on a couple of days.
If tests confirm that you have low testosterone, further checking can determine if a testicular disease or a pituitary abnormality is the cause. These research may encompass:
Treatment Male hypogonadism
Adult men
Male hypogonadism commonly is handled with testosterone alternative to return testosterone degrees to everyday. Testosterone can help counter the signs and symptoms of male hypogonadism, inclusive of decreased sexual choice, decreased power, reduced facial and body hair, and lack of muscle groups and bone density.
For older guys who have low testosterone and symptoms and symptoms of hypogonadism because of growing older, the blessings of testosterone replacement are less clean.
While you take testosterone, the Endocrine Society recommends that your health care issuer monitor you for treatment effectiveness and aspect results numerous instances for the duration of your first 12 months of remedy and yearly after that.
Types of testosterone replacement therapy
Oral testosterone arrangements have now not been used for remedy of hypogonadism due to the fact they are able to cause critical liver issues. Also, they don't maintain testosterone levels regularly.
One Food and Drug Administration-authorized oral testosterone replacement preparation, testosterone undecanoate (Jatenzo), is absorbed by the lymph gadget. It would possibly keep away from the liver troubles visible with other oral forms of testosterone.
Other arrangements you may select, depending on convenience, fee and your coverage coverage, include:
- Gel. There are numerous gels and answers to be had, with extraordinary methods of applying them. Depending on the logo, you rub the testosterone into your pores and skin to your higher arm or shoulder (AndroGel, Testim, Vogelxo) or apply it to the front and inner thigh (Fortesta).Your frame absorbs testosterone through your skin. Don't bathe or bathe for numerous hours after a gel utility, to make sure it gets absorbed.Side outcomes consist of skin irritation and the opportunity of shifting the medicine to another character. Avoid skin-to-skin contact till the gel is absolutely dry, or cowl the place after an utility.
- Injection. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate are given in a muscle or below the skin. Your signs would possibly waver between doses depending on the frequency of injections.You or a member of the family can learn how to deliver testosterone injections at home. If you're uncomfortable giving yourself injections, members of your care team can provide the injections.Testosterone undecanoate (Aveed) is given by means of deep intramuscular injection, usually every 10 weeks. It must be accepted at your provider's office and might have extreme results.
Patch. A patch containing testosterone (Androderm) is implemented each night in your thighs or torso. A viable facet impact is severe pores and skin response.
- Gum and cheek (buccal cavity). A small putty-like substance, gum-and-cheek testosterone replacement supplies testosterone through the natural despair above your top tooth where your gum meets your top lip (buccal cavity).This product, taken three times a day, sticks for your gum line and lets in testosterone to be absorbed into your bloodstream. It can cause gum inflammation.
Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This choice reduces the hazard that medicinal drugs will be transferred to any other character through pores and skin touch. Nasal-delivered testosterone should be implemented twice in every nostril, three times day by day, which might be more inconvenient than different shipping methods.
Implantable pellets. Testosterone-containing pellets (Testopel) are surgically implanted below the pores and skin every three to 6 months. This calls for an incision.
Testosterone therapy carries various risks, including:
Increased production of red blood cells
Acne
Enlarged breasts
Sleep disturbances
Prostate enlargement
Limited sperm production
Treatment of infertility due to hypogonadism
If a pituitary problem is the purpose, pituitary hormones can be given to stimulate sperm manufacturing and repair fertility. A pituitary tumor may additionally require surgical removal, medicinal drug, radiation or the alternative of different hormones.
There's often no powerful treatment to repair fertility in men with primary hypogonadism, but assisted reproductive era can be helpful. This technology covers a spread of strategies designed to assist couples who have been unable to conceive.
Treatment for boys
Treatment of not on time puberty in boys relies upon the underlying cause. Three to 6 months of testosterone supplementation given as an injection can stimulate puberty and the improvement of secondary sex characteristics, which include elevated muscular tissues, beard and pubic hair increase, and boom of the penis.
TREATMENT OPTIONS
Treatment for hypogonadism typically involves replacement of testosterone levels that are in the range of 300 to 800 ng/dL. The guidelines from the American Association of Clinical Endocrinologists[12] state that this should provide physiological levels of testosterone. The goals of therapy are to help you feel better.
- (1)The decoupage will help restore sexual function and well-being.
- (2)Produce and maintain virilization
- (3)Bone density can be increased to prevent osteoporosis.
- (4)In elderly men, normal growth hormone levels may be normalized.
- (5)This might increase the risk of heart disease.
- (6)If someone has hypogonadotropic hypogonadism, they need to restore their fertility.
Currently, several testosterone delivery methods are available on the market for treating patients with symptoms of low testosterone levels. A 2006 guideline published by the Endocrine Society recommends not treating patients with just low levels of testosterone unless they have symptoms.
Transdermal Patch
Transdermal testosterone patches are available in India under the brand name Androderm. These patches deliver continuous levels of testosterone over a 24-hour period. The most common adverse effects associated with these patches are at the application site, where reactions (such as redness, swelling, and pain) occur. Patches are particularly prone to skin irritation. These reactions include pruritus (a itchiness), blistering, erythema (redness), vesicles (small fluid-filled bumps), and allergic contact dermatitis (a type of skin reaction that occurs when the person's immune system reacts to a substance they come in contact with). Approximately 10% of patients stop using the patch due to skin reactions. In one study, 60% of subjects discontinued using the patch because of The patch between weeks 4 and 8 was discontinued because some patients experienced skin irritation. A small percentage of patients may also experience headache, depression, and gastrointestinal (GI) bleeding. Some patients find it difficult to remove the patch from the package without help. Injections are more expensive than transdermal patches, but they are more convenient due to their continuous use and the maintenance of normal testosterone levels. Some patients find that the patch is noisy, but overall it is advantageous.
Topical Gel
There are currently two topical testosterone therapies - Androgel and Testim. These therapies are best applied in the morning, following a normal circadian pattern. Topical testosterone treatments also provide longer-lasting elevations in serum testosterone levels than injections. Transdermal patches are similar to patches that deliver testosterone. These patches do not go through the first stage of metabolism, which can lead to adverse effects such as a headache, hot flushes, insomnia, increased blood pressure, acne, emotional lability and nervousness. The application site may also react negatively. Gels are less likely to cause skin irritation than patches. Some advantages of topical gels include maintaining normal diurnal testosterone levels and documented increases in bone density. Potential problems with gels include the potential for increased skin irritation. There's a potential for the gel to be transferred from person to person, and the cost of that is unknown.
Buccal Tablets
Some testosterone tablets marketed as Striant release testosterone in a pulsatile manner. With this route, the peak testosterone levels are rapidly achieved and a steady state is reached after two doses per day. This method is similar to gel and liquid forms of testosterone. Drugs that are applied topically (through the skin) bypass the body's first-pass metabolism, which means the drug is absorbed more quickly. The food we eat and drinks have no effect on drug absorption via this route. The chief adverse effects of transdermal administration are transient gum irritation and a bitter taste. Gum irritation usually resolves within the first few days, while the taste can be mildly unpleasant at first but usually goes away after a while. The side effects of buccal tablet therapy can last for a week. Other adverse effects include dry mouth, toothache, and stomatitis. Some patients find the tablet uncomfortable when it is in their mouth, and they may be concerned about the tablet shifting around while they are talking.
Implantable Pellet
Testosterone has also been formulated into a pellet that is implanted under the skin. This pellet slowly releases testosterone over many months (up to six months), although peak levels are achieved within 30 minutes. Some people complain about this type of treatment. There are potential side effects associated with this drug formulation, including minor bleeding and fibrosis at the site.
Intramuscular Injections
Intramuscular testosterone injections are also available in a form called Depo-Testosterone (testosterone cypionate) and Delatestryl (testosterone enanthate). The testosterone is suspended in oil to increase absorption. Levels peak within 72 hours of injection, but intramuscular administration is associated with less pain and a faster onset of action. Supraphysiological testosterone levels are achieved early on in treatment, followed by lower levels near the end of the treatment period. Such fluctuations are often associated with wide variations in mood. Testosterone therapy can be challenging for some patients. To reduce fluctuations, lower doses and shorter dosing intervals are often used. Injection site reactions are also common, but they are rarely the reason for discontinuation of therapy. Despite these fluctuations, testosterone therapy can still be helpful for many patients. Intramuscular injections provide a cost-effective option and the convenience of two to four week dosing intervals. Disadvantages associated with injections include visits to the doctor's office for dose administration and a lack of physiological testosterone patterns.
Oral Tablets
Although Andriol, an oral testosterone product, is not currently available in India, there are other countries where Android and Testroid - both methyl testosterone products - are FDA approved oral formulations. Andriol is relatively inexpensive, but Oral testosterone products are not always affordable. Oral products require a lot of the body's energy, and as a result, they require multiple daily doses. Patients who take oral testosterone treatments may experience elevated liver enzymes, gastrointestinal intolerance, acne and male breast enlargement. Regardless of the treatment option, patients should be aware of the risks associated with testosterone therapy, including:
Worsening of the prostatic hypertrophy
Increased risk of prostate cancer
Lower sperm count with large doses
If you experience swelling in your ankles, feet, or body, this might be a sign of heart failure.
Gynecomastia
Sleep apnea
Blood clots
Patients should be aware of the signs and symptoms of these adverse effects and should tell their doctor if they occur.
Coping and support
Having male hypogonadism can have an effect on your self-image and, probably, your relationships. Talk together with your health care issuer approximately how you could reduce the anxiety and stress that regularly accompany these conditions. Many men gain from mental or own family counseling.
Find out if there are help businesses in your region or online. Support corporations placed you in contact with other people with similar demanding situations.
Preparing for your appointment
Although you are probably to begin by way of seeing your own family medical doctor or different care company, you might be referred to someone who specializes within the hormone-producing glands (endocrinologist).
Here's some statistics to help you get ready for your appointment.
What you can do
Make a list of:
Your symptoms, Along with any which can appear unrelated to the reason for that you scheduled the appointment, and after they started out
Key personal information, including any major stresses, recent life changes, and history of childhood illnesses or surgeries
All medications, vitamins or other supplements you take, including doses
Questions to ask your provider
For male hypogonadism, some questions to ask your provider include:
What's the most likely cause of my symptoms?
Are there other possible causes for my symptoms?
What tests do I need?
Is my condition likely temporary or chronic?
What treatments are available?
I have other health conditions. How can I best manage them together?
Are there restrictions I need to follow?
Are there brochures or other printed material I can have? What websites do you recommend?
Don't hesitate to ask other questions.
Preparing for an appointment
Be prepared to answer questions about your condition, such as:
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
When did you begin puberty? Did it seem to be earlier or later than your peers?
Did you have any growth problems as a child or adolescent?
Have you injured your testicles?
Did you have the mumps as a child or teen? Do you recall if you felt pain in your testicles while you had the mumps?
Did you have undescended testicles as a baby?
Did you have surgery for a groin hernia or genital surgery as a child?
General summary
- Low testosterone levels can affect men of all ages. For patients who have symptoms associated with their low testosterone levels, treatment is essential for the prevention of sexual cognitive and physical changes. A variety of treatment options are available. There is a need for increased awareness of hypogonadism among doctors, as different dosage formulations and providing patients with choices that match their needs are necessary. This is because there is a clear need for primary care physicians to be the first point of contact for hypogonadism patients. Be patient.
- Doctors need to be aware of hypogonadism as a common clinical condition. Some key triggers for investigating a person for hypogonadism are decreased libido, fatigue, osteoporosis, and fractures. And also erectile dysfunction may be a sign.
- The most common cause of male hypogonadism is Klinefelter syndrome a genetic disorder in which a male has an extra X chromosome It affects about one in every 1,000 men Male hypogonadism can also be caused by health problems including infections such as mumps and prostate cancer treatment Aging is associated with low testosterone levels as well even for men without medical conditions related to low testosterone levels The condition often goes undiagnosed because the symptoms are subtle and commonly mistaken for signs of aging or stress.
