GONADS (TESTES AND OVARIES)

General: The gonads (testes or ovaries) help the body maintain normal physiological function. They secrete hormones that are essential for reproductive function, development of secondary sexual characteristics, body composition, and mood.

The male gonads (testes) produce testosterone, while the female gonads (ovaries) secrete estrogen and progesterone.

Hypogonadism: Hypogonadism is a hormonal disorder that occurs when the gonads are underactive. Hypogonadism disorders are more common among males than females.

Primary hypogonadism occurs when the gonads are directly affected. Common causes of primary hypogonadism in males include Klinefelter's syndrome, undescended testicles, mumps orchitis, hemochromatosis, testicle injury, or cancer treatment. Common causes of primary hypogonadism in females include cancer treatment and injury to the ovaries.

Secondary hypogonadism occurs when other parts of the body, such as the hypothalamus or pituitary gland, are causing the gonads to be underactive. Common causes of secondary hypogonadism in males and females include Kallman syndrome, medications called opiates, inflammatory diseases (such as sarcoidosis), and obesity.

If the body does not produce enough testosterone during fetal development, the growth of sex organs may be impaired. Male children born with hypogonadism may have female genitals, ambiguous genitals that are neither male nor female, or underdeveloped male genitals. If hypogonadism occurs during puberty, the male may experience decreased development of muscle mass, impaired growth of body hair, impaired growth of genitals, excessive growth of the arms and legs in proportion to the trunk of the body, development of breast tissue, and lack of deepening of the voice. Males who develop hypogonadism during adulthood may experience erectile dysfunction, infertility, decreased body hair growth, increased body fat, decreased testicle size, decreased muscle mass, development of breast tissue, and osteoporosis (hollow, brittle bones).

Female children with hypogonadism may not menstruate or develop breasts. They are typically short in stature. Females who develop hypogonadism after puberty may experience a loss of menstruation, decreased libido, hot flashes, and loss of body hair.

Hypogonadism is diagnosed when a patient experiences symptoms that are characteristic of the disorder and has low levels of sex hormones in the blood. Males will have low levels of testosterone, while females will have low levels of estrogen and progesterone. Additional tests may be performed to determine the underlying cause.

Patients with hypogonadism typically receive hormone replacement therapy (HRT). Males with hypogonadism typically receive testosterone injections. This treatment has been shown to stimulate puberty and restore fertility in patients. Females may take estrogen pills by mouth, injection, or skin patch. Females usually take progesterone as well because it helps prevent the overgrowth of the uterine lining and uterine cancer.

Menopause/Andropause: Males and females experience a natural decrease in their sex hormones with age.

As females age, they are less likely to become pregnant because the ovaries no longer release estrogen. This gradual decline in fertility usually starts very subtly in the late 20s to age 35. Once a female goes through

menopause, she is no longer able to become pregnant. Most females go through menopause when they are 40 years old or older. Common symptoms of menopause include hot flashes, irritability, vaginal dryness, mood swings, anxiety, difficulty concentrating, loss of sex drive, weight gain, depression, and tender breasts. After menopause, women have an increased risk of developing osteoporosis, a condition which causes the bones to become hollow and brittle. This is because the lower levels of estrogen in the body accelerate bone loss.

As males age, they tend to experience a decrease in their sex hormone, which is called testosterone. This process is called andropause. Most males go through andropause when they are between the ages of 40 and 55 years old. Common symptoms of andropause include fatigue, depression, hot flashes, night sweats, infertility, decreased sex drive, and erectile dysfunction. Erectile dysfunction, also called impotence, occurs when a male is unable to achieve or maintain an erection. After andropause, men have an increased risk of developing osteoporosis.

If it is suspected that a patient is going through menopause, a blood sample may be taken to measure the amount of follicle stimulating hormone (FSH). Patients who have high levels of the hormone (50 international units of FSH per liter of blood or more) have undergone menopause.

If it is suspected that a male patient is going through andropause, a blood sample may be taken to measure the amount of testosterone in the blood. Males who have undergone andropause will have low levels of testosterone in their blood.

Patients experiencing menopause may benefit from hormone therapy with estrogen to help alleviate symptoms. However, according to research, patients who receive estrogen have an increased risk of stroke. Patients should consult their healthcare providers to determine the potential health benefits and risks associated with hormone therapy.

Hormone therapy is not used to treat andropause. However, males who experience erectile dysfunction as a complication of andropause may receive treatment. Several drugs, including sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) have been used treat males who experience erectile dysfunction as a result of aging. These drugs are taken by mouth a few hours before sexual activity. These drugs should not be taken more than once every 24 hours. In general, side effects may include headache, upset stomach, diarrhea, dizziness, flushing, or stuffy nose. Serious side effects may include sudden severe loss of vision, blurred vision, changes in color vision, painful erection, priaprism (prolonged erection lasting longer than four hours), fainting, chest pain, difficulty breathing, hoarseness, itching or burning during urination, and rash. Patients should seek immediate medical treatment if any of these serious side effects develop.