Hypogonadism in men is a condition that involves a lack of the hormone testosterone in the body, inadequate sperm production in the testes, or both. The condition impacts the lives of up to 5 million men in the U.S., notes Dr. Culley C. Carson III, of Boston University School of Medicine. Primary hypogonadism stems from malfunctioning of the testes, while the causes of secondary hypogonadism are due to problems with the hypothalamus and the pituitary gland. Treatments of male hypogonadism usually involve hormone replacement, but surgical interventions might also play a role in some cases.
Testosterone Replacement
Testosterone replacement features in most treatment regimens for male hypogonadism, notes the Merck Manuals. One testosterone delivery method is intramuscular injections every two weeks. Doctors may also prescribe a patch, which the patient places on his upper arm, abdomen, back, stomach or thigh every night; MayoClinic.com points out that in order to prevent skin reactions, the location should be rotated over a seven-day period. Testosterone gel provides another treatment option. The patient rubs the gel into the skin on his shoulder, the lower part of his abdomen or the upper part of his arm. Doctors may also suggest an oral delivery method involving a patch that the patient tucks above his front teeth between his gum and his lip.
Luteinizing Hormone Replacement
When problems with the pituitary gland cause secondary hypogonadism that results in infertility, doctors can prescribe luteinizing hormone--or LH--replacement therapy. That therapy involves regular doses of human chorionic gonadotropin--or hCG--a hormone that functions like LH to stimulate testosterone production in the testes. The Merck Manuals explains that men receive hCG doses two or three times a week, and doctors may adjust the dose after three months to ensure production of normal amounts of testosterone.
Follicle-Stimulating Hormone Replacement
When LH replacement does not succeed in stimulating sperm production after six to 12 months, doctors may prescribe follicle-stimulating hormone--or FSH--replacement therapy. FSH replacement involves three doses per week in combination with hCG therapy. If the man's female partner does not conceive during the first six months of combination therapy, his doctor may double the dose of FSH.
Surgery
Doctors may use surgical procedures to treat some of the problems associated with hypogonadism. One of those problems occurs when primary hypogonadism causes infertility. When that happens, hormone therapy does not restore spermatogenesis--the production of sperm in the testes. In cases of infertility caused by primary hypogonadism, men might have some residual sperm in the testes, which doctors can collect using microsurgical procedures.
Other cases in which doctors may perform surgery include those of male infants in whom hypogonadism is associated with cryptorchidism--the medical term for failure of one or both of the testes to descend. The Merck Manuals mentions that treatment for this condition might involve a surgical procedure known as orchiopexy. During that operation, the surgeon brings the testis into the scrotum and sutures it into place. In other cases, doctors may perform an operation known as an abdominal laparoscopy. This minimally invasive procedure involves the insertion of a tube carrying a camera into a small incision and the insertion of surgical instruments though other small incisions. The surgeon attempts to locate the testis and either fix it in place or remove it if it has become atrophied.
References
- Merck Manuals Online Medical Library: Male Hypogonadism
- Merck Manuals Online Medical Library: Male Hypogonadism in Children
- MayoClinic.com: Male Hypogonadism--Treatments and Drugs
- Boston University Schol of Medicine: Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice
- Merck Manuals Online Medical Library: Testicular and Scrotal Anomalies
