Congresses
- ASA 37th Annual Congress
21 Apr - 24 Apr, Tucson, Arizona, USA - European Urology Forum
04 Feb - 07 Feb, Davos, Switzerland - 27th Annual EAU Congress
24 Feb - 28 Feb, Paris, France
Etiology Of Hypogonadism
Risk Factors for Hypogonadism
Many systemic diseases (e.g. diabetes mellitus, metabolic syndrome, coronary artery disease, liver disease, chronic obstructive pulmonary disease, rheumatoid arthritis, other inflammatory conditions and generalized infections) correlate with low testosterone levels.1-3,4-8 Therefore, signs or symptoms of hypogonadism can be an early indication leading to diagnosis of an underlying condition. In addition, obesity, injury to the testes, genetic factors and normal aging can contribute to hypogonadism.1,5 (Table 2) Although many risk factors for low testosterone are not modifiable, improving diet, moderating alcohol consumption, losing weight and reducing stress can be helpful to men wanting to reduce the risk of hypogonadism.
| Risk factor | |
|---|---|
| Klinefelter’s syndrome | A genetic deficiency in testosterone production. Affects between 1 in 500 and 1 in 1000 men. |
| Injury to the testes | Damage to testes can cause reduced testosterone production. |
| Undescended testes | Failure of one or both of the testes to descend at birth (which occurs in approximately 1 in 4 boys born prematurely and 1 in 20 boys born at term) may lead to a failure of the testes to develop properly if the condition does not correct itself naturally within the first year of life or if not corrected in early childhood. |
| Mumps orchitis | A mumps infection that involves the testes as well as the saliva glands may result in long-term damage affecting testosterone production if it occurs during adolescence or adulthood. |
| Cancer and cancer treatment | Cancer of the testes or pituitary tumors can lead to low testosterone production. Chemotherapy or radiation therapy can also interfere with testosterone production. |
| Hormone system imbalance | Kallmann syndrome involves abnormal development of the hypothalamus and is a risk factor for low testosterone. Pituitary disorders can impair the release of hormones affecting normal testosterone production. |
| Chronic illnesses | Chronic illnesses such as liver or kidney disease, diabetes, metabolic syndrome and rheumatoid arthritis may be risk factors for low testosterone. In some instances it is not clear whether the chronic illness is a cause or a consequence of low testosterone. |
| Normal aging | There is some normal decline in testosterone level as men age. |
| Hemochromatosis | Hemochromatosis (a genetic disorder causing the body to absorb too much iron from the diet) can result in the deposition of iron in various body organs, including the hypothalamus, pituitary and testes. It is now recognized as a common disorder and 1 in 200 people of northern Europe may be at risk of developing iron overload. |
| Other | HIV/AIDS virus can cause low levels of testosterone by affecting the hypothalamus, pituitary and testes. Certain medications can affect testosterone production. Obesity. |
References:
1. Jockenhövel F, Schubert M. Male Hypogonadism. 3rd edition. Bremen: UNI-MED Science; 2009
2. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91(6): 1995-2010
3. Wang, C., E. Nieschlag, R. Swerdloff, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 2008, 159(5): 507-514.
4. Tung DS, Cunningham GR. Androgen deficiency in men. The Endocrinologist 2007; 17(2): 101-115.
5. Stanworth RD, Jones TH. Testosterone for the aging male; current evidence and recommended practice. Clin Interv Aging 2008; 3(1): 25-44.
6. Traish AM, Guay A, Feeley R, et al. The dark side of testosterone deficiency: I. Metabolic syndrome and erectile dysfunction. J Androl 2009; 30(1): 10-22.
7. Traish AM, Saad F, Guay A. The dark side of testosterone deficiency: II. Type 2 diabetes and insulin resistance. J Androl 2009; 30(1): 23-32.
8. Traish AM, Saad F, Feeley RJ, et al. The dark side of testosterone deficiency: III. Cardiovascular disease. J Androl 2009; 30(5): 477-94.
