Male hypogonadism in children

Male hypogonadism is a condition in which the testicles do not produce the hormone testosterone, sperm, or both. Hypogonadism can affect many organ functions and negatively impact a child's quality of life.

Male hypogonadism or low sperm count is what many parents are concerned about when having a child with this condition. This is a condition in which the body does not produce enough of the hormone that plays an important role in male growth and development during puberty (testosterone) or does not produce enough sperm, or both.
Children can have congenital male hypogonadism or it can develop later in life, usually as a result of trauma or infection. The effects depend on the cause and timing of male hypogonadism. Some types of male hypogonadism can be treated with testosterone replacement therapy.

Signs and symptoms of male hypogonadism in children depend on when the condition develops.
Fetal stage: Testosterone is not produced enough during fetal development, which can result in impaired development of the external sex organs. Depending on when hypogonadism occurs, a genetically male child can be born with: Female genitalia; Genitals that are not clearly male or are not clearly female (indistinct genitals); Underdeveloped male genitalia. Puberty: Hypogonadism can delay puberty or cause incomplete or underdeveloped development. It may interfere with: Developing muscle mass; Voice change; Body and beard growth; Development of the genitals. And it can cause an overgrowth of the arms and legs relative to the body or an overgrowth of breast tissue (gynecomastia).

There are two types of male hypogonadism:
Primary: Also known as primary testicular failure, it stems from a problem in the testicles. Secondary: This type of hypogonadism indicates a problem with the hypothalamus or pituitary gland, which are parts of the brain that signal the testes to produce testosterone. Either type of hypogonadism can be caused by a genetic (congenital) or acquired trait, such as an injury or infection. Occasionally, primary and secondary male hypogonadism occur together.

Causes of primary male hypogonadism include:
klinefelter syndrome : The extra X chromosome in this syndrome causes abnormal development of the testes, which in turn leads to less testosterone production; Undescended testicles: Before birth, testicles develop inside the abdomen and usually move down to a fixed position in the scrotum. An undescended testicle is when one or both testicles fail to descend into the scrotum at birth. An undescended testicle usually resolves on its own within the first few years of life without treatment. If not corrected in childhood, it can lead to testicular activity and decreased testosterone production; Mumps orchitis: Mumps involving the testicles that occurs in adolescence or adulthood can damage the testicles, affecting their ability to produce testosterone; Excess iron can cause testicular failure or pituitary dysfunction, affecting testosterone production; Testicular damage: Damage to both testicles can cause hypogonadism; Cancer treatment: Chemotherapy or radiation therapy for cancer can interfere with testosterone and sperm production. Side effects from both of these treatments are usually temporary, but permanent infertility can occur. Although many men regain fertility within a few months of treatment, preserving sperm before starting cancer treatment is a good option for men. In secondary hypogonadism, the testicles remain normal but do not function well due to a problem with the pituitary gland or the hypothalamus. Several causes of secondary hypogonadism include:
Kallmann syndrome: An abnormal growth of the area of ​​the brain that controls pituitary hormone secretion (the hypothalamus). This abnormality can also affect the ability to smell and cause red-green color blindness; Pituitary Disorders: Decreases the release of hormones from the pituitary gland to the testes, affecting the normal production of testosterone; Inflammatory diseases: Some inflammatory diseases, such as sarcoidosis, leukaemia, and tuberculosis, involve the hypothalamus and pituitary gland and can affect the production of male sex hormones; HIV/AIDS can affect the hypothalamus, pituitary gland and testes, affecting testosterone production; Medications: The use of certain medications and certain hormones can affect testosterone production; Obesity at any age may be associated with hypogonadism; Aging: As men age, the production of testosterone gradually decreases.

Complications of untreated hypogonadism vary depending on when it develops. Complications of male hypogonadism may include:
Abnormal genitalia; Large male breasts (gynecomastia); Infertility ; Erectile dysfunction ; Osteoporosis.

For male hypogonadism in children, treatment for delayed puberty in boys depends on the underlying cause. Your doctor may order 3 to 6 months of testosterone supplements in an injectable form to stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and hair growth as well as penis growth.
Infertility due to hypogonadism, if the cause is related to pituitary gland problems, can be treated with pituitary hormone injections to stimulate sperm production and restore fertility. A patient with a pituitary tumor may need surgical removal, drug treatment, radiation therapy, or other hormone replacement.
However, whether male infertility is curable with primary hypogonadism is a very difficult problem. There is usually no effective treatment to restore fertility, but assisted reproductive technology can now help couples who want to have children.
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