Hypogonadism and How It Relates to Bone Health

Also called gonadal deficiency, hypogonadism (hypo = under) means that the sex glands produce little or no hormones. In men the glands are the testes that produce androgens, and in women the ovaries that produce estrogens.

There are many possible reasons for this condition, and the cause can be primary or central. Primary means that the problem is located in the gland itself, while central means that the problem is to be found elsewhere, in this case in the brain. Hypogonadism is a sign and may point to a disease, but hypogonadism by itself is not considered a disease.

Primary hypogonadism causes include:

  • Genetic, such as Turner syndrome, Klinefelter syndrome,
  • Autoimmune disorders,
  • Liver and kidney disease,
  • Radiation,
  • Surgery

In central hypogonadism the hypothalamus and pituitary gland do not function properly. Causes can include:

  • Infections
  • Bleeding
  • Certain medication
  • Genetic problems such as Kallman syndrome and Hyperprolactinemia
  • Nutritional deficiencies
  • Hemochromatosis
  • Radiation
  • Surgery
  • Trauma
  • Tumors


In girls if hypogonadism occurs during childhood, they will not begin menstruation, and the body height will be affected as well as the appearance of sexual characteristics such as breast growth and body hair. If it occurs after puberty, symptoms include:

  • Hot flashes
  • Loss of body hair
  • Low libido
  • Amenorrhea

In boys before puberty it affects sexual characteristics such as beard growth, muscle growth and height. After puberty the symptoms include:

  • Gynecomastia
  • Decreased beard and body hair
  • Muscle loss
  • Sexual problems

If a brain tumor is the cause symptoms can be:

  • Headaches or vision loss
  • Galactorrhea, in case of an prolactinoma

Quick weight loss such as in anorexia nervosa and gastric bypass surgery may also cause central hypogonadism.


Doctors use blood tests to diagnose hypogonadism. Checks include:

  • Estrogen level
  • Testosterone
  • Follicle Stimulating Hormone (FSH) level
  • Luteinizing hormone (LH) level
  • Prolactin level
  • CBC (complete blood count)
  • Sperm count (from semen analysis)
  • Thyroid hormone level ( T3, T4, TSH)

Imaging Techniques

  • Ultrasonography
  • MRI
  • CT scan of the brain

Treatment is almost always hormone replacement therapy. Many forms of Hypogonadism are treatable and patients have good prognoses.


Turner syndrome

Turner syndrome is a genetic condition in which cells are missing one or part of one sex chromosome, it occurs in 1 out of 2000 live births.


  • Swollen hand and feet
  • Wide and webbed neck
  • Absent or incomplete development at puberty
  • Broad and flat chest
  • Drooping eyelids
  • Dry eyes
  • Infertility
  • Absent menstruation
  • Short height
  • Vaginal dryness


  • Before birth by prenatal testing
  • Physical exam
  • Blood hormone levels
  • Echocardiogram
  • Karyotyping
  • Chest MRI
  • Ultrasound of reproductive organs and kidneys


The aims of the treatment are a) to ensure a proper height with growth hormone, because without it the patient stays very short, and b )to ensure the sexual characteristics with estrogen replacement therapy.


The patient can have a normal life if monitored carefully by an experienced doctor.


Klinefelter syndrome

Alternative name for Klinefelter syndrome is 47 XXY syndrome. Klinefelter syndrome is one of a group of sex chromosome problems, and results in males who have one or more extra X chromosomes, for example XXY instead of XY. It occurs in 1 out of 500 – 1000 newborn boys.


  • Abnormal body proportions
  • Gynecomastia
  • Infertility
  • Sexual problems
  • Less than normal amount of armpit, facial, and pubic hair
  • Small, firm testicles
  • Tall height


Usually it is diagnosed when a man comes to a doctor because of infertility
The following test may be performed:

  • Karyotyping
  • Semen count
  • Blood test to check hormone levels: Estradiol, FSH, LH, and testosterone.


Testosterone therapy can be used, to improve the growth of body hair, muscles, increase energy, and sex drive, self esteem, concentration and strength.

Most men with this syndrome are not able to reproduce; however an infertility specialist may be able to help.

Kallman syndrome

This is a rare genetic condition, characterized by hypogonadism, eunuchoidism, and anosmia. It results from the failure of the hypothalamus which results in hormonal imbalance.


  • Anosmia
  • Reduced hormone production by testes or ovaries
  • Progressive loss of vision
  • Cleft palate
  • Delayed puberty
  • Small genitalia
  • Delayed growth
  • Infertility

Kallman Syndrome is treated with hormone replacement therapy.


Hyperprolactinemia is a condition in which too much Prolactin is present in the blood of women who are not pregnant and in men. In women it results in a decline in the body’s production of progesterone which in turn can lead to irregular ovulation and menstruation.


  • Galactorrhea
  • Impotence
  • Reduced libido
  • Infertility
  • Amenorrhea
  • Osteoporosis
  • Vaginal dryness
  • Headache
  • Vision problems
  • Gynecomastia (in men)


  • Thyroid hormone replacement therapy
  • Radiation treatment in case of tumors
  • Dopamine agonist such as bromocriptine mesylate.

SARMs for the treatment of osteoporosis and hypogonadism.

Hormone Replacement Therapy

Selective Estrogen Receptor Modulators (SERMs) are medicines intended to produce some of the effects of the natural hormone estrogen. Not too long ago women were routinely given estrogen supplements after menopause in hopes that the replacement hormone would prevent some of the ravages of aging, including bone loss. The popularity of hormone replacement therapy among doctors has declined as doctors have come to feel the downsides outweigh to benefits. The drug category SERMs - one reason for the interest in them is that they promise the bone-building benefits of replacement estrogen without the downsides.

For a time it was fashionable to give post menopausal women estrogen. Called Hormone Replacement Therapy (HRT) this was a preventative therapy prescribed by doctors to millions of women. These were oral supplements of a form on estrogens. Estrogen acts through two receptors called ERa and ERb. Osteoblasts express ERb, but it isn’t clear that ERb agoinsts promote bone density.(Estrogen is also a class of compounds. These drugs are derived from plants.)


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