Hypogonadism is defined as testosterone deficiency with associated symptoms and / or decreased sperm production. It can result from an abnormality of the testeciles (primitive hypogonadism) or a disorder of the hypothalamohypophyseal axis (secondary hypogonadism). Both can be congenital or acquired with aging, illness, medication or other factors. In addition, a large number of congenital enzyme deficiencies result in varying degrees of androgen resistance in the target organs. The diagnosis is confirmed by the hormonal levels. Treatment depends on etiology but usually includes treatment with gonadotropin-releasing hormone (gonadotropin releasing hormone), gonadotropin or testosterone replacement therapy.
Symptomatology
The age at onset of testosterone deficiency determines the clinical picture: congenital hypogonadism, childhood or adulthood.
Congenital hypogonadism may appear in the 1st, 2nd or 3rd trimester. Congenital hypogonadism in the first trimester causes an abnormality in male sexual differentiation. The complete absence of effect of testosterone induces female external genitals of normal appearance. Partial testosterone deficiency results in abnormalities ranging from ambiguous external genitalia to hypospadias. The appearance of testosterone deficiency in the third trimester induces micropenis and cryptorchidism.
The testosterone deficiency beginning in childhood (male hypogonadism in children) has little consequence and is usually detected only in the presence of pubertal delay. Untreated hypogonadism impairs the development of secondary sexual characteristics. In adulthood, the patient has weak muscle development, a high tone of voice, a small scrotum, inadequate growth of the penis and testicles, rare pubic and axillary hair, and lack of hair on the rest of the body. . It can develop gynecomastia and eunuchoid proportions (span> 5 cm and pubic symphysis distance to the ground> pubic symphysis distance to the top of the skull> 5 cm) due to delayed epiphyseal fusion associated with continuous growth of long bones.
Testosterone deficiency beginning in adulthood includes various manifestations, which depend on the degree and duration of the deficiency. Decreased libido; erectile dysfunction; lower cognitive abilities, such as visuospatial interpretation; sleeping troubles; vasomotor instability (in acute, severe male hypogonadism); mood changes, such as depression and anger, are common. Decreased lean body mass, increased visceral fat, testicular atrophy, osteopenia, gynecomastia, and sparse body hair usually take months or years to develop. Testosterone deficiency can increase the risk of coronary artery disease.
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