Hypogonadism

Overview

Hypogonadism occurs when the body's sex glands (gonads) produce little or no hormones. In men, these glands are the testes. In women, these glands are the ovaries.

Causes

The cause of hypogonadism can be primary (testes or ovaries) or secondary (problem with the pituitary or hypothalamus). In primary hypogonadism, the ovaries or testes themselves do not function properly. Causes of primary hypogonadism include:

• Certain autoimmune disorders
• Genetic and developmental disorders
• Infection
• Iron excess (hemochromatosis)
• Liver and kidney disease
• Radiation (to the gonads)
• Surgery
• Trauma

The most common genetic disorders that cause primary hypogonadism are Turner syndrome (in women) and Klinefelter syndrome (in men).

If you already have other autoimmune disorders you may be at higher risk for autoimmune damage to the gonads. These can include disorders that affect the liver, adrenal glands, and thyroid glands, as well as type 1 diabetes.

In central hypogonadism, the centers in the brain that control the gonads (hypothalamus and pituitary) do not function properly. Causes of central hypogonadism include:

• Anorexia nervosa
• Bleeding in the area of the pituitary
• Taking medicines, such as glucocorticoids and opiates
• Stopping anabolic steroids
• Genetic problems
• Infections
• Nutritional deficiencies
• Iron excess (hemochromatosis)
• Radiation (to the pituitary or hypothalamus)
• Rapid, significant weight loss (including weight loss after bariatric surgery)
• Surgery (skull base surgery near the pituitary)
• Trauma
• Tumors

A genetic cause of central hypogonadism is Kallmann syndrome. Many people with this condition also have a decreased sense of smell.

Menopause is the most common reason for hypogonadism. It is normal in all women and occurs on average around age 50. Testosterone levels decrease in men as they age, as well. The range of normal testosterone in the blood is much lower in a 50 to 60 year-old man than it is in a 20 to 30 year-old man.