Hypogonadism

Male hypogonadism is a clinical syndrome caused by a failure of the testes to produce adequate levels of testosterone that are needed for the normal growth and development of a male. The condition may be congenital or may develop later in life.

Causes

Hypogonadism can be classified into primary and secondary hypogonadism. Primary hypogonadism may be due to testicular failure that refers to any dysfunction of the testicles which interrupts the normal hormone production. The common causes of primary hypogonadism include Klinefelter syndrome, which is a congenital abnormality of the sex chromosomes (an extra X chromosome) causing abnormal development of the testicles. Other causes of primary hypogonadism include undescended testicles, mumps orchitis, hemochromatosis, testicular injury, chemotherapy and radiotherapy.

Secondary hypogonadism may result from a dysfunctioning of the hypothalamus or pituitary gland that interrupts their normal functions. Certain conditions such as Kallmann syndrome (abnormal development of the hypothalamus), pituitary disorders, inflammatory diseases, HIV, certain medications, obesity and normal aging may also result in hypogonadism.

Symptoms

The symptoms of hypogonadism generally depend on the age of the affected individual. During fetal development it may result in impaired growth or underdevelopment of external male or ambiguous genitals. The symptoms during pre-puberty include impaired growth of external male genitals, improper distribution of body hair, decreased muscle mass, gynecomastia or development of breast tissues, lack of deepening of the voice and disproportional growth of arms and legs in relation to the trunk of the body. Certain symptoms such as erectile dysfunction, infertility, lack of facial or body hair, reduced muscle mass and gynecomastia may be seen in adult patients. Sometimes affected individuals may experience emotional and mental disturbances, fatigue, and loss of libido, hot flushes and lack of concentration.

Diagnosis

The diagnosis of male hypogonadism includes medical history, physical examination and laboratory investigations. Other tests such as estimation of hormonal levels, semen analysis, pituitary imaging, testicular biopsy and other genetic studies may be used to diagnose the underlying causes of the disorder.

Treatment

Hormone replacement therapy is the most common approach for the management of male hypogonadism. Testosterone replacement therapy can be used in young as well as adult patients. Testosterone replacement therapy is useful for restoring sexual function, muscle and bone strength as well as to provide a sense of wellbeing in adult patients. In young patients it stimulates puberty and the development of secondary sexual characteristics.

Ejaculatory Dysfunction

Ejaculatory dysfunction is a type of sexual dysfunction in which the male ejaculates too early, too late or not at all during the sexual act. There are three types of ejaculatory dysfunction: premature, delayed or retrograde ejaculation.

On average, once the penis enters the vagina, there is a delay of 5 to 6 minutes before ejaculation. Premature ejaculation occurs when the male partner ejaculates too quickly over 50% of the time. Delayed ejaculation occurs when you have difficulty reaching climax after prolonged sexual activity (>30 minutes) even if your erection is adequate. Most cases of premature or delayed ejaculation develop over time, but some cases may be life-long. Retrograde ejaculation is rare type of ejaculatory dysfunction resulting in the backward ejaculation of sperm into the bladder.

Ejaculatory dysfunction may be caused by medical conditions such as high blood pressure, diabetes, neurological disorders, or prostate and thyroid problems. Psychological causes for dysfunction may include stress, anxiety about your problem, causing you to hasten the sexual act, marital problems, depression or the negative effects of past sexual experiences. Certain medications as well as substance abuse can also contribute to ejaculatory dysfunction.

If you or your partner experience dissatisfaction as a result of ejaculatory dysfunction, you must not hesitate to contact your physician as these problems are common and often treatable. Your doctor will review your symptoms as well as your medical and family history and may perform certain tests to rule out physical problems that could be causing ejaculatory dysfunction. You will be asked questions to gauge your mental state, attitude towards sex, and find out if you have any psychological issues contributing to the problem.

Your doctor may prescribe medication to treat ejaculatory dysfunction. Couples therapy or sex therapy may be recommended to resolve marital issues, improve intimacy, remove psychological blocks, and teach you sexual techniques that either delay or enhance ejaculation. Topical anesthetics or thick condoms may be recommended in cases of premature ejaculation to decrease sensation thereby delaying ejaculation. Medications contributing to ejaculatory dysfunction are either stopped or altered. Retrograde ejaculation does not usually affect sexual life, but may affect childbearing for which medication or artificial fertility methods are suggested.