Diagnosis:
In this section we must differentiate hypogonadism from hypoactive sexual desire and loss of libido, although they often overlap and confuse because they can have a common origin.
The disorder of hypoactive sexual desire in the DSM-5 (Diagnostic Manual of Mental Illnesses) currently defines it as follows: it consists of the repeated and persistent absence of sexual fantasies or interest in carrying out some type of sexual activity, without alluding to the partner and on the condition that there is no physical or organic cause to explain it.
The low sexual desire is almost always accompanied by another disorder that precedes it either physical or psychic, being the most common, but not always, to suffer some type of erectile dysfunction.
Some medical and physiological causes of lack of libido:
Dysfunctions or difficulties in erection
Testosterone Deficiency Syndrome Occurring With Age
Hyperestrogenism
Hyperprolactinemia
Hypothyroidism
Vascular dysfunction
Diabetes
Hypertension
Untreated sleep apnea
Exposure to exoestrogens (they are everywhere)
Abuse of substances such as alcohol, cannabis and anabolic agents
Obesity and Metabolic Syndrome are among the most common.
Among the drugs, emphasis should be placed on antidepressants and antihypertensives and we discourage the use of alpha-reductase inhibitors, since their effects on libido can be devastating (Post Finasteride Syndrome).
Frequency of Hypogonadism:
The Baltimore project is a longitudinal study on the changes experienced by age and continues to develop until today, since 1958, from the results obtained was published by Mulligan more than 10 years ago (2006), some results, which revealed that about 39% of the male population aged 45 years or older, suffered from hypogonadism, and only 5%, are treated.
In Spain we do not have such exhaustive studies with the Baltimore, but we do have in mind that Metabolic Syndrome and visceral obesity are linked to hypogonadal states in 50%. and given that testosterone decreases from a certain age by 1% per year, we can extrapolate from Mulligan’s study that at 35 years of age, we can estimate that around 25% of males may suffer some type of hypogonadism, including subfertility or infertility, especially if they are obese, it is worth remembering at this point that sperm quality deteriorates by 1% annually due to environmental pollution.
What does hypogonadism consist of?
Hypogonadism in men (it also exists in women but is different) is a term to describe the deficit of free testosterone in blood, to produce sperm or both and its symptoms are varied, and sometimes easily camouflaged with other signs of other diseases.
In hypogonadism we can distinguish 3 main situations that can occur:
Genetic causes: as in the case of Kallman Syndrome or Klinefelter.
Secondary cause: such as pituitary or hypothalamic dysfunction.
Primary cause: they are the great majority in which the hormones are altered either by a testicular claudication with failure in the production of testosterone or other antagonistic hormones prevent it from exercising its function properly.
Which are the Symptoms:
The first most noticeable symptoms are tiredness, fatigue, and loss of vital energy up to presenting a sexual dysfunction. The first thing to do is to control the accompanying diseases, obesity, alcoholism, use of cannabis, cocaine, etc., the administration of drugs to treat other diseases and the use of anabolic.
How it affects sexuality:
When it debuts with an erectile dysfunction, sudden it is necessary to be alert since it can be what we call «a sentinel symptom», of a vascular disease, especially in older than 35 years.
The most frequent thing is that it appears little by little and progressively, until unleashing some form of sexual dysfunction or lack of desire, which surprises the patient, because it is no longer recognized in their sexual performance, tends to avoid sexual relations, lives it painfully and sometimes prefers to break a relationship of a consolidated couple, before resorting to a specialist.
It has a solution:
Solving this problem will depend on the underlying disease, whether the original cause is genetic or secondary to a dysfunction of the hypothalamus-hypophysis axis, (the center that commands the entire hormonal system, located at the base of the brain).
This neuro-endocrine complex is responsible for the production of various hormones such as FSH and LH, prolactin, TSH, among many others, which act as signals for the testicle to produce testosterone and sperm. Simplifying, in this case we will act substituting the deficient hormone or blocking that hormone that has an antagonistic effect.
How hypogonadism is treated:
However, if the cause is primary due to testicular failure, we will resort to hormone replacement therapy with bioidentic testosterone. The most common types of testosterone therapy are long-acting injections or gels.
Before prescribing these optional treatments to replace testosterone, the signs and symptoms of low testosterone will be addressed, such as extreme fatigue, depression, lack of sexual desire, loss of muscle mass, fat in the abdomen, and weight gain. If there is hyperestrogenism, oral antiestrogens will be prescribed.
Gels and patches are not always well tolerated and can hardly be adapted to individual needs. Injectable treatments can vary in frequency as well as in quantities, being the most common every two or three weeks.
There are also injectable presentations every three months, it should always be considered, if the patient wishes to preserve his fertility, since in that case the emphasis should be placed on stimulating the pituitary gland, periodically.
The medications of the Viagra family can help, above all to overcome insecurity, but they will be useless if there is not a solid base of circulating free testosterone.
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