Hypogonadism Diagnosis and Treatment

Hypogonadotropic Hypogonadism

The American College of Endocrinology notes that hypogonadotropic hypogonadism results from impaired hypothalamic-pituitary function with low or inappropriately normal gonadotropin levels, and the gonads are structurally intact and capable of responding to gonadotropin stimulation 1, 2
The Endocrine Society recommends that FSH and LH levels are low or inappropriately normal despite low testosterone or estradiol levels, which is the critical biochemical distinction in hypogonadotropic hypogonadism 1
Common acquired causes of hypogonadotropic hypogonadism include exogenous testosterone/anabolic steroids, opiates, cranial/pituitary radiation, hyperprolactinemia, and systemic diseases like type 2 diabetes and obesity, as noted by the European Association of Urology 1, 3
The Endocrine Society notes that approximately two-thirds of congenital cases are Kallmann syndrome, with the remaining one-third being normosmic IHH 1
Fertility can be restored in hypogonadotropic hypogonadism because the gonads are functional, and patients can potentially achieve both fertility and normal sex steroid levels with gonadotropin therapy or pulsatile GnRH, as recommended by the European Urology association 2, 3
Exogenous testosterone therapy should never be prescribed to males interested in current or future fertility, as it suppresses the HPG axis and impairs spermatogenesis, according to the Journal of Urology 3, 1

The European Association of Urology states that hypergonadotropic hypogonadism results from primary gonadal failure with elevated gonadotropin levels, and the gonads cannot respond appropriately to gonadotropin stimulation due to intrinsic damage 2, 4
FSH and LH levels are elevated as the pituitary attempts to compensate for gonadal failure by increasing gonadotropin secretion, as noted by Blood Reviews 4
Among female survivors of pediatric cancer, the estimated incidence of primary gonadal impairment resulting in premature ovarian insufficiency is approximately 8-10%, according to Blood Reviews 4
Fertility cannot be restored through hormonal manipulation in hypergonadotropic hypogonadism because the gonads are intrinsically damaged and unresponsive, as stated by the European Urology association 2
Patients with hypergonadotropic hypogonadism can receive only sex steroid replacement therapy, which further compromises fertility by suppressing the HPG axis, as recommended by the European Association of Urology and Blood Reviews 2, 4