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Acquired primary hypogonadism
Last reviewed: 04.07.2025
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Acquired primary hypogonadism may have various genesis. It may be the result of infectious and inflammatory lesions of the testicles and/or their appendages. A common cause of male hypogonadism and infertility are inflammatory processes directly in the testicles (orchitis, orchoepididymitis) and in the vas deferens (epididymitis, differentitis, vesiculitis ). In orchitis caused by epidemic parotitis before puberty, the disease proceeds more favorably than in adult men.
Causes acquired primary hypogonadism
The cause of hypogonadism may be hydrocele, which in children is almost always congenital, and in adults occurs as a result of acute epididymitis.
Partial testicular atrophy may occur as a result of an operation for an inguinal hernia, circulatory problems in the testicle, or torsion of the spermatic cord. First, the venous and then the arterial blood supply changes, and eventually an infarction occurs in the testicle. These changes are irreversible.
Pathological anatomy of acquired primary hypogonadism. Acquired primary hypogonadism is caused by atrophic changes in the testicles, affecting both the seminal epithelium and the glandular epithelium. They occur in status thymico-lymphaticus, in adiposogenital dystrophy. Irradiation of the testicles is accompanied by cell death and pronounced degenerative transformations of Sertoli cells. Leydig cells may not only survive, but also undergo pronounced hyperplasia.
Degenerative changes in the seminal epithelium are observed in many infectious diseases (epidemic mumps, smallpox, etc.). Leydig cells either remain intact or become hyperplastic. Hyperplasia is relative, since the size of the testicles decreases due to the death of the seminal epithelium, hyalinosis of the basement membrane, and obliteration of the lumen of the tubules.
Pathogenesis
Testicular atrophy can also be caused by a tuberculous process in them. In this case, the success of treatment depends on the timeliness of diagnosis and the appointment of specific treatment.
Unfavorable environmental factors include temperature effects. It should be taken into account that general cooling of the body, as well as its overheating, especially in the genital area, sometimes causes degenerative changes in the sex glands. Exposure to high-frequency currents, chronic intoxication with industrial poisons, ionizing radiation can lead to hypogonadism.
Testicular trauma is a common cause of hypogonadism. Traumatic damage to the testicles includes all types of mechanical impact that disrupt normal spermatogenesis and lead to their atrophy. The anamnesis of patients who have suffered trauma includes blows to the genitals with a ball, a foot, bruises from falling from a bicycle, a horse, etc.
Symptoms acquired primary hypogonadism
Symptoms of acquired primary hypogonadism. If testicular damage occurs in an adult male, his secondary sexual characteristics disappear: facial and body hair loss, thinning of scalp hair, rapid skin aging (geroderma), impaired sexual function (loss of sexual desire and erections, oligo- and azoospermia). If the testicles die before puberty, a typical clinical picture of eunuchoidism occurs.
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Treatment acquired primary hypogonadism
Treatment of acquired primary hypogonadism. In any case of primary hypogonadism, androgen replacement therapy is indicated, and in some cases, testicular transplantation. Usually, patients are prescribed sustanon-250 (or omnadren-250) injections of 1 ml intramuscularly once a month or injections of a 10% testenate solution of 1 ml every 10 days. Oral medications may be used: proviron-25 (mesterolone), 1 tablet 3 times a day; if the patient has impaired liver function, it is advisable to take andriol, 1 capsule (40 mg of testosterone per capsule) 2-4 times a day.