Hypogonadism and fatherhood: causes, symptoms and treatment

What is hypogonadism?

Hypogonadism (androgen deficiency) is a condition characterized by a reduction in the level of male sex hormones, mainly testosterone, due to a dysfunction of the testes. Testosterone plays a key role in the normal development and functioning of the male body, particularly in the sexual sphere, bone health, cardiovascular system, muscle mass, mood, and overall well-being. A deficiency in testosterone can affect men's health and increase the risk of serious illnesses such as fertility issues, kidney problems, or prostate cancer.

Hypogonadism can be congenital or acquired and is often accompanied by underdevelopment of sexual organs or metabolic disorders. The main treatment usually involves taking hormonal medications.

According to a study conducted in the United States in 2012, over 6 million men have low testosterone levels. This condition can cause male infertility, depression, decreased work capacity, as well as cardiovascular and vascular diseases. In Sweden, observations of men aged 33 to 46 confirmed that testosterone levels decrease with age and are significantly lower in men aged 45 than in those aged 33.

Causes of hypogonadism in men

Hypogonadism can be congenital or acquired.

Congenital hypogonadism

• Genetic anomalies, such as Klinefelter syndrome, when a man has more than two sex chromosomes.
• Exposure to X-rays, toxic substances, or hormonal preparations during pregnancy.
• Pathologies in case of absence of one or both testes, troubles in the development of seminiferous tubules.

Acquired hypogonadism

• Varicocele (dilation of the veins of the testicle).
• Consequences of surgical procedures on the testicles.
• Testicular torsion.
• Infections and inflammations: mumps, orchitis, syphilis.
• Pituitary tumors, adenoma, excessive prolactin production.
• Diseases of the CNS: meningitis, encephalitis.
• Excessive iron accumulation in tissues, prolonged use of corticosteroids, opioids, or powerful antidepressants.

Advice: regular examinations by an andrologist allow early detection of the disease and timely initiation of treatment.

Symptoms of hypogonadism in men

The manifestations depend on age and severity. Symptoms can be observed in children and adults.

In case of congenital hypogonadism

• In childhood, bi-sexual manifestations may appear.
• In case of testosterone deficiency before puberty, signs of delayed sexual maturation are observed: tall stature, limited development of the chest and shoulder girdle, deposition of female-type fat.

In adulthood: absence of facial and inguinal hair, decreased libido, dysfunction of the testicles and prostate.

In case of secondary hypogonadism

• Obesity, decreased sexual potency and libido.
• Depressive states, apathy, emotional instability.
• Reduced function of other endocrine glands (thyroid, adrenal glands).

Important: low levels of testosterone not only affect physical health but also psycho-emotional well-being.

Diagnosis of hypogonadism

To establish the diagnosis, the following are used:

Medical history collection and physical examination.

Scrotal and prostate ultrasound.

Doppler to assess blood flow.

Laboratory tests: free testosterone levels, FSH, LH, prolactin, estradiol, TSH, free T4, vitamin D, blood glucose, lipid profile, liver function tests.

Spermogram to evaluate reproductive potential.

Advice: hormone level analyses are especially important for men over 40 years old.

Treatment of hypogonadism

Therapeutic methods depend on the form of the disease, age, and overall health.

• Young patients are prescribed non-hormonal medications to stimulate testosterone production.
• In case of hyperprolactinemia, medications are used to reduce prolactin levels.
• Adults are most often treated with hormone therapy (injections, gels, patches).
• In the absence of testicular reserve function, lifelong androgen replacement therapy is prescribed.

Advice: lifestyle changes enhance treatment effectiveness. Physical activity, a balanced diet, and stress management are important. Zinc, L-arginine, L-carnitine, vitamins B, C, and D, as well as antioxidants (CoQ10, resveratrol) are beneficial.

Surgical treatment of hypogonadism

Surgical methods are used in case of cryptorchidism (undescended testes), underdevelopment of sexual organs, or for aesthetic purposes (implantation of an artificial testicle).

Complications of hypogonadism

Without treatment, the disease can lead to:

• Erectile dysfunction.
• Infertility.
• Loss of bone density (osteoporosis).
• Decreased muscle mass.
• Gynecomastia.
• Cognitive function disorders.
• Sexual dysfunction and emotional instability.

Prognosis: with early treatment, it is usually favorable, but in severe genetic forms, complications are possible.

Prevention of hypogonadism

Recommendations include:

• Regular physical activity.
• Fulfillment of a fulfilling sexual life.
• Prevention of sexually transmitted infections.
• Healthy diet and vitamin level monitoring.
• Examinations by a urologist with hormonal assessment.
• Abandoning unhealthy habits and treating chronic diseases.

Hypogonadism and fatherhood

Hypogonadism has a direct impact on male fertility. A decrease in testosterone levels and testicular dysfunction can lead to a reduced number and motility of sperm, making natural conception difficult. However, modern treatment methods, including hormone therapy and assisted reproduction techniques, enable many affected men to become fathers.

In mild forms, restoring hormonal balance helps improve sperm quality and increases chances of natural conception. In severe cases, when spermatogenesis is disturbed, procedures such as IVF (in vitro fertilization), donor egg IVF, or double donation IVF can be used. These methods help couples achieve their dream of having a child, even if natural conception is impossible.

It is important to remember that regular follow-up with an andrologist, appropriate treatment, and psychological support play key roles in maintaining men's health and realizing the desire for fatherhood.

Practical conclusions

Hypogonadism is a serious disease that affects men's quality of life, including their reproductive and psycho-emotional health. Early diagnosis and appropriate treatment usually lead to a favorable prognosis. Men should be attentive to warning signs from their bodies and undergo regular examinations with specialists. A healthy lifestyle, monitoring testosterone levels, and taking care of one's health help maintain activity and energy for many years.