Hypogonadism and where hormone replacement therapy begins. Part 2.

MusculeX

Well-known member
Etiology
Male hypogonadism is associated with insufficient testosterone secretion. Testosterone deficiency occurs in many diseases, including those associated with testicular pathology (primary testicular insufficiency) and with decreased stimulation of testicular function by gonadotropin (hypogonadotropic hypogonadism).

Primary testicular insufficiency (primary hypogonadism) may result from genetic or developmental abnormalities (Klinefelter syndrome) or from acquired diseases (e.g. viral orchitis). Hypogonadotropic hypogonadism (secondary hypogonadism) is associated with disorders of the hypothalamic-pituitary-ovarian axis, which are hereditary (Kallman syndrome) or acquired (pituitary adenoma) nature. In addition, various congenital, chromosomal, and acquired syndromes, their combinations, or other conditions, the nature of which is still unknown, can lead to testosterone deficiency.
Most forms of hypogonadism diagnosed in adults are acquired and most often develop due to obesity, severe systemic diseases and taking some medications. A relatively large number of men develop hypogonadism as a result of other acute and chronic diseases, including acquired immunodeficiency syndrome (AIDS), sickle cell anemia, cirrhosis of the liver and renal failure.

Testosterone levels in men may be decreased by certain medications, including ketoconazole, glucocorticoids, spironolactone, estrogens, progestagens, hGH analogues, cimetidine, phenytoin, carbamazepine, and flutemide. In addition, plasma testosterone levels may be decreased in men who consume large amounts of alcohol, marijuana, heroin, and methadone.

Although the earlier data were questionable, it is now proven that in men there is a slow and prolonged (1-2% per year) decrease in total testosterone levels and its bioavailability, starting at approximately 30 years of age. Age-related changes in the male reproductive system develop more slowly and are less pronounced than the decline in ovarian function during menopause in women. The first changes occur at testicular level and include reduction in the number of Leydig cells, decrease in metabolic activity enzymes and decreased testermosterone synthesis in response to gonadotropin stimulation. Other possible causes of decreased total testosterone levels and its bioavailability in older men include chronic diseases, medications, changes in circulating sex-steroid-binding globulin, epidemiological factors (e.g. smoking and alcohol consumption), and age-related changes in the hypothalamus and pituitary gland.

The main causes of male hypogonadism
Primary hypogonadism


- Klinefelter syndrome (47, XXY and its variants)

- Cryptorchidism

- Orchitis

- HIV/AIDS

- Trauma or radiation damage to the testicles

- Cancer chemotherapy

- Nutritional deficiencies Myotonic muscular dystrophy


Secondary hypogonadism

- Cullman syndrome (hereditary deficiency of gonadotropin-releasing hormone)

- Tumors of the pituitary gland

- Tumors of the Turkish saddle

- Hemochromatosis

- Pathology of hypothalamus or pituitary gland

- Hypothyroidism

- Prader-Willi syndrome Severe obesity

Primary or secondary

- Older age

- Severe systemic diseases

- Occupational hazards

- Liver cirrhosis

- Sickle cell anemia

- Medication use

- Uremia


1st part link: https://musclegurus.to/forum/thread...one-replacement-therapy-begins-part-1.866316/
 
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