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Condition

Hypogonadotropic Hypogonadism

Symptoms, Doctors, Treatments, Research & More

Condition 101

What is the definition of Hypogonadotropic Hypogonadism?

Hypogonadism is a condition in which the male testes or the female ovaries produce little or no sex hormones.

Hypogonadotropic hypogonadism (HH) is a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus.

What are the alternative names for Hypogonadotropic Hypogonadism?

Gonadotropin deficiency; Secondary hypogonadism

What are the causes for Hypogonadotropic Hypogonadism?

HH is caused by a lack of hormones that normally stimulate the ovaries or testes. These hormones include gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH).

Normally:

  • The hypothalamus in the brain releases GnRH.
  • This hormone stimulates the pituitary gland to release FSH and LH.
  • These hormones tell the female ovaries or the male testes to release hormones that lead to normal sexual development in puberty, normal menstrual cycles, estrogen levels and fertility in adult women, and normal testosterone production and sperm production in adult men.
  • Any change in this hormone release chain causes a lack of sex hormones. This prevents normal sexual maturity in children and normal function of the testicles or ovaries in adults.

There are several causes of HH:

  • Damage to the pituitary gland or hypothalamus from surgery, injury, tumor, infection, or radiation
  • Genetic defects
  • High doses or long-term use of opioid or steroid (glucocorticoid) medicines
  • High prolactin level (a hormone released by the pituitary)
  • Severe stress
  • Nutritional problems (both rapid weight gain or weight loss)
  • Long-term (chronic) medical diseases, including chronic inflammation or infections
  • Drug use, such as heroin or use or abuse of prescription opiate medicines
  • Certain medical conditions, such as iron overload

Kallmann syndrome is an inherited form of HH. Some people with this condition also have anosmia (loss of the sense of smell).

What are the symptoms for Hypogonadotropic Hypogonadism?

Children:

  • Lack of development at puberty (development may be very late or incomplete)
  • In girls, a lack of breast development and menstrual periods
  • In boys, no development of sex characteristics, such as enlargement of the testes and penis, deepening of the voice, and facial hair
  • Inability to smell (in some cases)
  • Short stature (in some cases)

Adults:

  • Loss of interest in sex (libido) in men
  • Loss of menstrual periods (amenorrhea) in women
  • Decreased energy and interest in activities
  • Loss of muscle mass in men
  • Weight gain
  • Mood changes
  • Infertility

What are the current treatments for Hypogonadotropic Hypogonadism?

Treatment depends on the source of the problem, but may involve:

  • Injections of testosterone (in males)
  • Slow-release testosterone skin patch (in males)
  • Testosterone gels (in males)
  • Estrogen and progesterone pills or skin patches (in females)
  • GnRH injections
  • HCG injections 

What is the outlook (prognosis) for Hypogonadotropic Hypogonadism?

The right hormone treatment will cause puberty to start in children and may restore fertility in adults. If the condition begins after puberty or in adulthood, symptoms will often improve with treatment.

What are the possible complications for Hypogonadotropic Hypogonadism?

Health problems that may result from HH include:

  • Delayed puberty
  • Early menopause (in females) 
  • Infertility
  • Low bone density and fractures later in life
  • Low self-esteem due to late start of puberty (emotional support may be helpful)
  • Sexual problems, such as low libido

When should I contact a medical professional for Hypogonadotropic Hypogonadism?

Call your provider if:

  • Your child does not start puberty at the appropriate time. 
  • You are a woman under age 40 and your menstrual cycles stop.
  • You have lost armpit or pubic hair.
  • You are a man and you have decreased interest in sex.
Endocrine
The
Gonadotropins

REFERENCES

Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. PMID: 29562364 www.ncbi.nlm.nih.gov/pubmed/29562364.

Styne DM, Grumbach MM. Physiology and disorders of puberty. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 25.

White PC. Sexual development and identity. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 220.

Latest Research

Latest Advance
Study
  • Condition: Infertility in Men
  • Journal: The Journal of clinical endocrinology and metabolism
  • Treatment Used: Follicle-stimulating hormone Treatment
  • Number of Patients: 0
  • Published —
The study researched the outcomes of follicle-stimulating hormone treatment for men with infertility.
Latest Advance
Study
  • Condition: Effect of Excess Body Fat on Female and Male Reproduction
  • Journal: Metabolism: clinical and experimental
  • Treatment Used: Weight Loss
  • Number of Patients: 0
  • Published —
This review summarizes the evidence on the association of obesity and reproductive health on both the molecular and the clinical level, and the effect of weight-loss interventions on reproductive potential.

Clinical Trials

Clinical Trial
Device
  • Status: Not yet recruiting
  • Study Type: Device
  • Participants: 160
  • Start Date: December 1, 2020
Growing up With the Young Endocrine Support System (YESS!): Innovative E-technology to Improve Transition From Paediatric to Adult Care
Clinical Trial
Drug
  • Status: Not yet recruiting
  • Study Type: Drug
  • Participants: 32
  • Start Date: October 1, 2020
Pharmacodynamics and Safety of Human Recombinant Luteinising Hormone in Hypogonadotropic Hypogonadal Men