What is Testicular Hypofunction
Testicular hypofunction basically means that you are not producing testosterone like you should. The testicles are responsible for the production of this hormone.
The male sex glands, or gonads , are the two testicles normally located in the scrotum . In addition to producing sperm, the testicles also manufacture the male hormone called testosterone . This hormone is responsible for the development and maintenance of secondary sex characteristics as well as for the male libido , or sexual impulse. Only one normal testicle is needed for full function.
Hypofunction of one or both of the testicles can result from an abnormality in prenatal development, from infections such as mumps or tuberculosis, from injury, or from the increased temperature to which undescended testicles are exposed.
When hypofunction occurs before puberty, there is failure in the development of secondary sex characteristics. The sex organs do not enlarge; facial, pubic, and armpit hair fails to appear; and the normal voice change does not occur. Fertility and libido also fail to develop. A person with this combination of abnormalities is called a eunuch .
If the disorder is secondary to anterior pituitary disease, it is called Froehlich's syndrome . When it occurs after puberty, the body changes are less striking, but there may be a loss of fertility and libido. The primary disease is usually treated by surgery, and testosterone may be given. If the disorder is secondary to anterior pituitary disease, the gonad-stimulating hormone should be administered.
Symptoms of Testicular Hypofunction
The clinical manifestations of testicular hypofunction depends on:
① is primary or secondary, medical history and physical examination to identify help.
(2) time of onset is before puberty or after puberty. Puberty onset of genital development is low and no puberty; onset after puberty, either primary or secondary, external genitalia, and puberty development, in addition to infertility, no other obvious abnormalities.
(3) secondary primary disease and different clinical manifestations.
Common clinical features of primary and secondary;
① reduced libido and infertility.
The ② men not developed secondary sexual characteristics Primary, secondary wilt if they retire.
③ primary external genitalia developmental retardation, hermaphroditism or in the form of female genital the secondary who vulva basic normal.
④ non-skilled or skilled reduction and other abnormalities.
What Causes Testicular Hypofunction
Causes of testicular hypofunction can be divided into two categories: primary and secondary, two types of identification that former blood follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was significantly higher; latter reduced or normal. According to the lesion site testicular hypofunction can be divided into the hypothalamus, pituitary, testis, testicular receptor and chromosome variability.
Testicular hypofunction is rare because it results only when both testicles are damaged in some way. Although mumps may involve the testicles, it is rarely the cause of sterility, even though this is greatly feared. Even so, everyone should be immunized against mumps in infancy.
It is advisable to wear an appropriate athletic supporter to protect the testicles when engaged in strenuous athletics or when there is a possibility that they might be injured. However, nothing that restricts scrotal movement should be worn regularly, since movement is essential for the maintenance of constant testicular temperature.
A sudden decrease in sexual drive or performance may be caused by disease, trauma, or emotional factors. In certain cases administering male hormones may relieve the condition. However, a decrease in sexual drive is one of the natural consequences of aging. It is not a disease and should not be treated with testosterone.
Tests and Diagnosis for Testicular Hypofunction
Low serum testosterone and dihydrotestosterone levels of endocrine examination, primary by pituitary FSH, LH levels overreacting LHRH stimulation test; secondary by normal or reduced. Reaction or delayed peak LHRH stimulation test, in addition to The diagnosis of the above functions, should be further etiology check, so that treatment for the cause. LHRH stimulation test to identify lesions in the hypothalamus, pituitary or testicular valuable.
Treatments of Testicular Hypofunction
(A) replacement therapy
That supplemental testosterone replacement therapy in order to promote the development of the external genitalia and secondary sexual characteristics, maintaining sexual function and libido. Where a primary testicular dysfunction or secondary testicular dysfunction testicular function can not be restored to normal after treatment, are suitable to use alternative treatment. Seminiferous tubules organic disease can not be restored by replacement therapy nor can the ability to restore fertility. Start in puberty age appropriate replacement therapy in children suffering from primary testicular dysfunction, start time, and the testosterone dose bigger, the plasma testosterone levels of male puberty considerable level in order to promote pubertal development to be sexually mature and then with a small dose to maintain plasma testicular in normal male YONGPING.
(B) secondary treatment of testicular hypofunction
To secondary testicular hypofunction testicular no organic disease. Available exogenous anterior pituitary hormones stimulate and regulate spermatogenic and interstitial cells produce and secrete testosterone treatment, in order to promote the recovery of testicular function. Choose drugs.
1. Chorionic gonadotropin (hCG)
Such hormone stimulates the Leydig cells produce and secrete testosterone, prompting the development of spermatogenic external genitalia and male secondary sexual characteristics. For each dose of intramuscular injection of 2000-3000u, 2 to 3 times a week. To be completed masculine, less to maintain for each intramuscular 1500u. Oral formulations of such hormone preparations, long-term injection of the patient is difficult to tolerate. Such hormones apply to have reduce the hypothalamus or pituitary disease caused secondary testicular function, such as a separate LH deficiency.
2 clomiphene (clomiphene citrate)
This the drug diethylstilbestrol antagonist, acts on the hypothalamic gonadotropin-releasing hormone (GnRH) secretion, and thus an increased release of pituitary gonadotropins (GnH), prompting spermatogenic and testosterone secretion. Kallmann syndrome of low GnH the athletes idiopathic low GnH testicular dysfunction psychosis effective. Dose of 50 mg twice a day, and even served 5 months, later reduced to 50mg daily.
3 recombinant FSH
Such hormones also can be used for low gonadotropin testicular dysfunction, but it should be combined with hCG. Or acquired adult male with severe congenital GnRH GnRH deficiency is also effective. Allows patients not only animate fine, restore fertility and testicular endocrine function is restored, and some patients after treatment. HMG and hCG can also be used in postmenopausal joint application. However, gene recombination into the FSH expensive. hMG every time intramuscular l ampoules (containing FSH and LH 75u), hCG 3000u, alternating between the two injections, for 3 to 4 months testicular function can be restored.
Gonadotropin-releasing hormone (GnRH)
Reduced testicular function Such hormone applicable to the GnRH and low gonadotropin testicular dysfunction secondary, congenital and acquired patient with the same efficacy. With portable infusion pump subcutaneous injection, injection every two hours. The dose varies from person to person, LH levels in the blood remains in the middle of the range of values of the normal male levels as the standard treatment for at least the last six months, the treatment can the testis nine dysfunction have been restored, and long-term treatment caught restore fertility.
(C) the cause of treatment
Whether primary or secondary, should be to identify the cause. Treatment is active for the cause. Causes such as removal of testicular hypofunction has resumed. If the patient is older, does not require recovery of sexual function, you do not need treatment.