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Consequences of a lack of hormones: is it possible to cure hypogonadism?

Hypogonadism is a syndrome that occurs due to a deficiency of sex hormones in the body, associated with functional deficiency of sexual glands - gonads. This pathology can develop both in men and in women. In some cases, the manifestations of the syndrome are found in childhood and adolescence. Pathology is accompanied not only by underdevelopment of the organs of the sexual sphere, but also has a very negative effect on the state of vital systems and organs, the skeleton, protein-fat metabolism, etc.

Content

What is the disease and what are its types

Decrease in the production of sex hormones in the body due to various circumstances can occur both in women and men, but the manifestations of the disease will be significantly different.

Endocrinologists distinguish between primary and secondary hypogonadism. The first variant of the disease is provoked by pathologies associated directly with the state of the tissue of sexual glands - testicles in men and ovaries in women. In this case, the secret produced by the sex glands is not enough for the normal formation and functioning of internal and external genital organs.

As for secondary hypogonadism, in this case, the development of the disease is associated either with structural pathologies of the pituitary gland, negatively affecting its function, or with disruption of the hypothalamus, which controls the pituitary gland. Both forms of the disease can be both congenital and acquired.

pituitary and hypothalamus

Scheme of the location of the pituitary and hypothalamus - organs that affect the development of secondary hypogonadism

The primary form of the disease, manifested in childhood, attracts attention by developing a child's mental infantilism, and the secondary can lead to mental disorders.

In addition, endocrinologists distinguish the following types of hypogonadism:

  • hypogonadotropic - develops due to disruption of the hypothalamic-pituitary system, manifested in a decrease in the production of gonadotropins - pituitary hormones, which results in a decrease in the secretion of androgens in testicles in men and estrogen in the ovaries in women;
  • normogonadotropic - is the result of the same disorders as hypogonadotropic, but the decrease in the secretory activity of testicles and ovaries occurs against the background of a normal amount of gonadotropins;
  • hypergonadotropic, accompanied by the defeat of the glandular tissue of testicles and ovaries against the background of increased secretion of hormones by the pituitary gland.

Depending on the age at which hormone deficiency developed, hypogonadism is divided into these types:

  • fetal (embryonic period);
  • aditabatny (from birth to 12 years, when active sexual maturation begins);
  • post-puberty (from 12 years);
  • age (menopausal) in men and women, resulting from a decrease in the production of sex hormones.
hypogonadism in a child

Left - a boy with hypogonadism, on the right - a child without pathology

Causes of development of pathology in children and adults

Congenital primary hypogonadism can be caused by the following reasons:

  • Aplasia testicle (absence of one or both testicles in the scrotum);
  • underdevelopment of testicles, accompanied by an increase in breast glands in men, lack of spermatozoa and a decrease in testosterone secretion (Klinefelter's syndrome);
  • defects of chromosomes, causing short stature and malfunctions in the development of the reproductive system (Shershevsky-Turner syndrome);
  • complete absence of sperm production, causing infertility, with other general norm (syndrome del Castillo);
  • lack of perception of the organism by androgens (false male hermaphroditism).
formation of a male body by female type

When hypogonadism can occur, the formation of a male body by a female type

Congenital secondary hypogonadism develops in the following cases:

  • damage to the hypothalamus;
  • low level of gonadotropins - Kallman's syndrome, which includes external deformities ("hare lip", facial asymmetry, superfluous fingers, etc.), eunuchoidism, underdevelopment of testicles;
  • dwarfism of the pituitary nature;
  • congenital brain tumors;
  • insufficiency of hypophyseal functions, the consequence of which is infertility, underdevelopment of the organs of the genital sphere, eunuchoidism (Maddock syndrome).

Acquired primary hypogonadism occurs as a result of changes in testicles and ovaries under the influence of external and internal factors that occurred after birth. Among such factors we can mention:

  • damage and neoplasm of testicles and ovaries;
  • inadequate development of the epithelium, which forms the surface layer of the ovaries and testicles, manifested by high growth, enlargement of the mammary glands (in men) and underdeveloped external genital organs;
  • functional insufficiency of testicles and ovaries, developed due to medical procedures, for example, radiotherapy, and surgical operations on the organs of the scrotum, ovaries, hernia repair, etc.

Acquired secondary hypogonadism can develop due to the following factors:

  • pituitary insufficiency, provoking the development of obesity;
  • pituitary-hypothalamic insufficiency, i.e. decreased production of gonadotropins and androgens (LMBB syndrome);
  • craniocerebral trauma and tumors of the pituitary-hypothalamic region, in particular, pituitary adenomas;
  • excess prolactin, secreted by the pituitary gland (hyperprolactinemic syndrome).

In addition, in the development of hypogonadism, the role of a catalyst can play the following factors:

  • exposure to the body of toxic substances;
  • long-term use of antibacterial and steroid drugs;
  • alcohol abuse;
  • transferred infections.

Symptoms and signs

The symptomatic picture of hypogonadism in men is due to the degree of androgen deficiency. With the development of pathology in the embryonic period, the child can be born a hermaphrodite, i.e. simultaneously have both female and male sexual organs. If the disease began to develop before the puberty of the boy, the sexual development slows down and characteristic signs of eunuchoidism are formed - disproportionately high growth with a weak backbone, underdeveloped muscles, narrow chest, long arms and legs, squeaky voice. In other cases, on the contrary, a body can be formed according to the female type, an increase in breast gland and obesity can be observed. The penis and prostate gland are underdeveloped, there is no growth of pubic and facial hair, potency and libido are absent.

a boy with hypogonadism

A child with hypogonadism has a high growth with a weak backbone, undeveloped muscles, the sexual organ is underdeveloped

In those cases where hypogonadism develops in the post-pubertal period, its clinical manifestations are less pronounced. Moreover, with all types of disease, symptoms of a reduction in testicles in size, reduction in erection, decreased sperm production, infertility and lack of sexual desire are necessarily present. In addition, the patient complains of muscle weakness and rapid fatigue.

In women suffering from hypogonadism, the main symptoms can be considered:

  • violation of menstruation or their complete absence;
  • underdevelopment of genital organs and mammary glands;
  • lack of hair or sparse hair cellulose and underarms;
  • narrow flattened pelvis.

If the pathology developed in the girl after the onset of the puberty period, her sexual characteristics undergo regression - the genitals gradually atrophy, and menstruation ceases.

Not to mention the obvious signs of hypogonadism, such as hermaphroditism, in newborns, evidence of the presence of pathology can be the fact that the testicles are in a position from which they can not later descend into the scrotum-for example, they might be prevented by the connective tissue barrier. Normally the testicle is palpable either in the lower part of the inguinal canal, or in the region of the inguinal ring and it can be easily lowered manually into the scrotum. In addition, the presence of pathology is indicated by a deficiency of sex hormones.

hermaphroditism

Hermaphroditism - the formation of sexual organs with male and female signs

Basic diagnostic methods

The main diagnostic task is to differentiate hypogonadism with hypothyroidism, thyrotoxicosis, Cushing's disease and a number of others.

Diagnosis of hypogonadism, in the first place, is carried out on the basis of patient complaints, the analysis of its anthropometric indicators, including genitals, and also the correspondence of the level of puberty to the age of the patient.

In addition, a number of laboratory and instrumental studies are carried out:

  • radiography of the skeleton - allows to determine the stage of ossification of bone growth zones, on the basis of which the conclusion is made that their condition corresponds to the biological age of the patient;
  • spermogram for men - analysis of the qualitative composition of sperm, if it can be obtained, since in some cases this is not possible;
  • densitometry - determination of the mineral composition of bones, which allows to detect deviations from the norm and, in particular, osteoporosis;
  • Ultrasound of the uterus for women - detection of hypoplasia of the uterus and ovaries;
  • MRI of the brain for determining the condition of the hypothalamic-pituitary system;
  • blood and urine tests for hormones - in the presence of pathology, testosterone deficiency and excess estradiol (with a tendency towards feminization) are found in men, and in women - a decrease in the level of estrogens and an increase in the content of gonadotropins.

Treatment of pathology

For the treatment of hypogonadism, there are no general therapeutic methods - the strategy is chosen by the doctor purely individually and will depend on the type of disease, the nature of the functional disorders, the age of the patient in whom the pathology was detected, and so on.

It is important to know that the use of traditional medicine for the treatment of hypogonadism is at best useless, and at worst harmful, since the time necessary for the effective treatment of pathology will be missed.

Conservative therapy

Congenital forms of the disease, like hypogonadism, developed before the onset of puberty, can not be cured. Therapy in this case will consist of correcting the patient's condition with the help of life-long hormone replacement, but in general, infertility can not be cured.

In secondary forms of hypogonadism, stimulant drug therapy with gonadotropins in combination with sex hormones - testosterone and estrogen. In addition to hormone replacement, the patient may be recommended drugs that suppress the synthesis of unwanted hormones. An example is Anastrozole, which inhibits (inhibits) the synthesis of estrogen in the body.

In medicamentous therapy of hypogonadism, women in addition to special hormonal drugs successfully use oral contraceptives, which include a combination of two types of hormones - estrogens and gestagens. After 45 years, patients are recommended to take Estradiol, Cyproterone and Norethisterone.

hormonal preparations

Hormonal drugs are used to treat both female hypogonadism, and male

It is important to know that hormone replacement is contraindicated in cancer diseases of the mammary glands and organs of the genital area, with cardiovascular pathologies, kidney diseases, liver failure, etc.

In addition, the patient is also shown vitamin and immunotherapy, physical exercises, swimming in the pool and physical activity. There are no special recommendations for a diet, but the patient's diet should be balanced, it is especially important to limit the use of foods containing animal fats and light carbohydrates.

Surgery

Surgical methods of treatment can be used to compensate for missing testicles. This occurs either by organ transplantation (transplantation) or by implantation of an artificial testicle for cosmetic purposes. In addition, surgically, it is possible to lower the testicle located in the abdominal cavity in the scrotum. Huge psychological damage to the patient causes maldevelopment of the penis, which can also be eliminated by plastic surgery.

cryptorchidism

Ejaculation in the scrotum - frequent operation in hypogonadism

Such surgical interventions are performed using the methods of microsurgery followed by mandatory control of the transplanted organ and the hormonal state of the patient. The complex approach in the use of surgical methods of therapy allows us to resume the development of the organs of the sexual sphere, restore potency and even in some cases heal infertility. For the treatment of female hypogonadism, surgical methods are not used.

Prognosis and possible complications

Timely adequate hormone replacement can significantly affect the patient's condition. With the help of such therapy it is possible to achieve penile growth in men and restore spermatogenesis, return of the menstrual cycle in women, normalization of bone tissue, etc. Surgical methods help to eliminate not only cosmetic defects, but also to restore the functions of the organs of the reproductive system. As for the prevention of the disease, then, unfortunately, it does not exist.

Negative consequences of the disease can be considered serious functional disorders, which become significant obstacles in the process of human adaptation in society, especially in teenagers, where the realization of their difference from their companions causes the child moral suffering. A patient with hypogonadism can not build normal sexual relations with a partner, often is deprived of the opportunity to have a family.

Elena Malysheva about male hypogonadism - video

Noticing in yourself or your child the signs that may indicate the development of hypogonadism, you should immediately rush to the endocrinologist. Even in cases when the disease can not be cured, the patient's condition can be fully compensated with the help of adequate therapy and improve the quality of his life.

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