Male Infertility: Hypogonadism

Among several factors that may contribute to male infertility are conditions affecting the hormones responsible for maintaining reproductive health and balance within the male reproductive system. One of the hormones integral to this process is testosterone. A testosterone deficiency in men can seriously affect male fertility, and signal an underlying fertility disorder known as hypogonadism.

What is Hypogonadism?

Hypogonadism is a common cause of infertility in men and occurs as a result of disease or damage to the pituitary gland, the testicles, or the hypothalamus. This in turn can lead to a decreased production of the gonadotropin hormone, which can result in low levels of testosterone production in the body.

Testosterone production is essential to male fertility for several reasons. For example, low testosterone levels hinder sperm production, can contribute to a low sex drive and may also cause erectile dysfunction.

Types of Hypogonadism

There are two main types of hyponadism that may occur:

  • Primary Hypogonadism refers to low testosterone as a result of abnormal testicular function
  • Secondary Hypogonadism results from problems affecting either the pituitary gland or the hypothalamus, which are responsible for the secretion of pituitary hormones. This in turn affects testicular function

What Causes Hypogonadism?

There are several factors that may lead to hypogonadism and male infertility. The causes of primary hypogonadism can include the following:

  • undescended testicles
  • high iron levels in the blood (hemochromatosis)
  • testicular injury
  • mumps
  • chemotherapy
  • radiation treatment
  • Klinefelter's syndrome

The causes of secondary hypogonadism include the following:

  • pituitary disorders
  • inflammatory disease
  • Kallman’s syndrome
  • certain medications such as heartburn medication and mood disorder medications

Symptoms of Hypogonadism

The symptoms of low testosterone are often apparent since these hormones play an important role in the development of male sexual characteristics. In cases where hypogonadism is congenital, the development of internal reproductive organs as well as external genitalia will be affected at the fetal stage. During puberty, the symptoms of low testosterone may result in symptoms such as a lack of body hair and facial hair, no deepening of the voice, development of breast tissue, and little increase in muscle mass.

Hypogonadism can occur at any time, including in adult males. This can significantly change the individual’s appearance, and emotions often mirror that of women experiencing symptoms of menopause. The following are some common symptoms of hypogonadism in adult males:

  • lack of facial and body hair growth
  • smaller and softer testes
  • decreased muscle mass
  • osteoporosis
  • development of breast tissue
  • increased body fat
  • erectile dysfunction
  • hot flashes
  • irritability, mood swings
  • depression
  • decreased libido
  • loss of energy
  • infertility

Diagnosis and Treatment

A simple blood test is typically the first step in the diagnosis of hypogonadism. This is because a blood test can reveal low levels of testosterone. However, a complete diagnosis of hypogonadism will require assessment by an endocrinologist.

Typical treatment of hypogonadism will usually involve testosterone replacement therapy (TRT) in which synthetic testosterone hormones are administered to balance hormone levels. The most common forms of TRT use testosterone gels or patches.

In many cases – particularly in the treatment of primary hypogonadism – infertility does not fully recover, and ART methods will be necessary in order for successful conception to take place.