HORMONAL ABNORMALITIES

A severe deficiency in the production of GnRH is known as hypogonadism. This condition negatively affects sperm production and can cause male infertility. In some cases, the condition can be reversed with appropriate treatments.

There are a wide range of hypogonadism classifications, including primary and secondary forms. Primary hypogonadism is a defect inherent within the gonad. Conversely, secondary hypogonadism (also known as central hypogonadism) originates outside the gonad and is caused by pituitary or hypothalamic defects.

Examples of primary hypogonadism include Noonan syndrome, Turner syndrome, and Klinefelter syndrome. Primary hypogonadism may also develop as a result of hemochromatosis (too much iron), testicular injury, undescended testicles, or the mumps virus. An example of secondary hypogonadism is Kallmann syndrome. Other conditions may also lead to secondary hypogonadism such as HIV/AIDS, certain medications, obesity, inflammatory disease, pituitary disorders, and concurrent illness.

Hypogonadism is an uncommon condition and usually present at birth. It is generally the result of a genetic defect that compromises pituitary gland function. In some cases, hypogonadism develops later in life in response to tumours of the brain of pituitary gland. Radiation treatments may also lead to hypogonadism.

Testosterone replacement therapy (TRT) is the usual treatment for hypogonadism as a result of gonad failure^[1]“Petak, S. et.al. (2002). American Assoication of Clinical Endocrinologists Medical Guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male … Continue reading. This can help to restore sexual function, prevent bone loss, and increase muscle strength. Often men receiving TRT also report an increase in sex drive, energy, and overall sense of well-being. Secondary hypogonadism as a result of pituitary problems may be treated with pituitary hormones. This can help to improve sperm production and treat infertility.

The opposite of hypogonadism, hypergonadism refers to excessive gonad hormone production. It can lead to an abnormally high level of testosterone. This condition can also negatively impact fertility and ultimately decrease sperm production. This condition is rare and usually associated with adolescence and precocious puberty. In adult males hypergonadism may be triggered by anabolic steroid use, autoimmune disease, or tumours. These tumours can be malignant, although they are usually benign.

Surgery may be offered to remove the tumours and restore normal adrenal function. In some cases, part or all of the adrenal gland may need to be removed. If a tumour is found to be cancerous, radiation treatment may be necessary. If no tumours are detected, hormone treatment may be an option. This can be more difficult compared with hypogonadism, as it’s easier to add hormones to the body rather than remove them.

Between 10 and 40% of infertile males have elevated prolactin levels. Also known as the luteotropic hormone, one of the main roles of prolactin is to facilitate lactation in mammals. Mild elevations of prolactin do not negatively affect male fertility. However, elevated prolaction levels can reduce libido, promote erectile dysfunction, and decrease sperm production.

The treatment for hyperprolactinemia will depend on the cause. If the condition is due to a tumour medications such as cabergoline and bromocriptine are often effective^[2]“Verhelst, J. et.al. (1998). Cabergoline in the Treatment of Hyperprolactinemia: A Study in 455 Patients. The Journal of Clinical Endocrinology & Metabolism. Volume, 84, Issue 7, (pp. … Continue reading. Surgery to remove a tumour may be used in medications are ineffective^[3]“Molitch, M. (1992). Pathologic hyperprolactinemia. Endocrinology and Metobolism Clinics of North America. Volume 21, Issue 4, (pp. 877-901)”.. Often as a last resort, radiation treatment may be necessary. In instances where there is no known cause for hyperprolactinemia hormone replacement therapy with synthetic thyroid hormones can help to balance prolactin levels. There are medications which can also help to restore hormone balance.

Men suffering from low levels of thyroid hormones can experience poor testicular function, low libido, and poor semen quality. Only approximately 1% of infertile men suffer from this condition. It can be caused by too much iodine in a man’s diet.

Generally hypothyroidism is easily treated with hormone replacement therapy. The medication commonly used is thyroxine^[4]“Nystrom, et.al. (2011). Treatment of Hypothyroidism. Thyroid Disease in Adults. Chapter 12 (pp. 119-126).”.

Abnormally high levels of adrenal androgens can suppress pituitary gland function. This can cause low sperm count, decreased motility, and an increase in immature sperm cells. This is a rare condition, only affecting around 1% of infertile men. This condition may be treated with cortisone replacement therapy using medications such as hydrocortisone or dexamethasone^[5]“Phyllis, W. et.al. (2003). Congenital adrenal hyperplasia. The New England Journal of Medicine, Volume, 349, (pp. 117-88).”.

This condition is characterised by total failure of pituitary gland function. This leads to erectile dysfunction, poor sperm quality, decreased libido, lethargy, undersized testicle, and loss of secondary sex characteristics. Supplementation with human chorionic gonadotropin (hCG) and other missing pituitary hormones may help to stimulate testosterone production and improve semen parameters^[6]“Liu, P. (2001). Predicting pregnancy and spermatogenesis by survival analysis during gonadotrophin treatment of gonadotrophin-deficient infertile men. Human Reproduction. Volume 17, Issue 3, (pp. … Continue reading.

Hormones are not only influenced by specific conditions. Lifestyle can also affect fertility by altering hormones. Stress, nutrient deficiencies, insufficient sleep, tobacco and alcohol use, inactivity; these are some factors that can impact hormone production. Unlike pre-existing hormonal abnormalities, these situations can usually be easily reversed by making positive lifestyle adjustments.