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</a><h1 class="with-also" itemprop="name">Hypogonadotropic hypogonadism</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p><a test="test" href="./001195.htm">Hypogonadism</a> is a condition in which the male <a test="test" href="./002334.htm">testes</a> or the female ovaries produce little or no sex hormones.</p><p>Hypogonadotropic hypogonadism (HH) is a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus. </p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>HH is caused by a lack of hormones that normally stimulate the ovaries or testes. These hormones include:</p><ul><li>Gonadotropin-releasing hormone (GnRH)</li><li>Follicle stimulating hormone (FSH)</li><li>Luteinizing hormone (LH)</li></ul><p>Normally:</p><ul><li>The hypothalamus in the brain releases GnRH.</li><li>This hormone stimulates the pituitary gland to release FSH and LH.</li><li>These hormones tell the female ovaries or the male testes to release hormones that lead to normal sexual development in puberty, normal menstrual cycles, estrogen levels and fertility in adult women, and normal testosterone production and sperm production in adult men.</li><li>Any change in this hormone release chain causes a lack of sex hormones. This prevents normal sexual maturity in children and normal function of the testicles or ovaries in adults.</li></ul><p>There are several causes of HH:</p><ul><li>Damage to the pituitary gland or hypothalamus from surgery, injury, tumor, infection, or radiation</li><li>Genetic defects</li><li>High doses or long-term use of opioid or steroid (glucocorticoid) medicines</li><li>High prolactin level (a different hormone released by the pituitary)</li><li>Severe stress</li><li>Nutritional problems (both rapid weight gain or weight loss)</li><li>Long-term (chronic) medical diseases, including chronic inflammation or infections</li><li>Drug use, such as heroin or use or abuse of prescription opioid medicines</li><li>Certain medical conditions, such as <a test="test" href="./000327.htm">iron overload</a></li></ul><p>Kallmann syndrome is an inherited form of HH. Some people with this condition also lose their sense of smell (anosmia).</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Children:</p><ul><li>Lack of growth and sexual development at the standard age for puberty (development may be very late or incomplete)<br/></li><li>In girls, a lack of breast development and menstrual periods</li><li>In boys, no development of sex characteristics, such as enlargement of the testes and penis, deepening of the voice, and facial hair</li><li>Inability to smell (in some cases)</li><li><a test="test" href="./003271.htm">Short stature</a> (in some cases)</li></ul><p>Adults:</p><ul><li>Loss of interest in sex (libido) in men</li><li>Loss of menstrual periods (amenorrhea) in women</li><li>Decreased energy and interest in activities</li><li>Loss of muscle mass in men</li><li>Weight gain</li><li>Mood changes</li><li><a test="test" href="./001191.htm">Infertility</a><br/></li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>Your health care provider will perform a physical exam and ask about your symptoms.</p><p>Tests that may be done include:</p><ul><li><div>Blood tests to measure hormone levels such as FSH, LH, TSH, prolactin, testosterone and estradiol</div></li><li><a test="test" href="./003709.htm">LH response to GnRH</a></li><li><a test="test" href="./003335.htm">MRI</a> of the pituitary gland/hypothalamus (to look for a tumor or other growth)</li><li>Genetic testing</li><li>Blood tests to check for iron saturation level</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>Treatment depends on the source of the problem, but may involve:</p><ul><li>Injections of <a test="test" href="./003707.htm">testosterone</a> (in males)</li><li>Slow-release testosterone skin patch (in males)</li><li>Testosterone gels (in males)</li><li>Estrogen and progesterone pills or skin patches (in females)</li><li>GnRH injections</li><li>HCG injections</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>The right hormone treatment will cause puberty to start in children and may restore fertility in adults. If the condition begins after puberty or in adulthood, symptoms will often improve with treatment.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>Health problems that may result from HH include:</p><ul><li>Delayed puberty</li><li>Early menopause (in females)</li><li>
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Infertility
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</li><li>Low bone density and fractures later in life</li><li>Low self-esteem due to late start of puberty (emotional support may be helpful)</li><li>Sexual problems, such as low libido</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider if:</p><ul><li>Your child does not start puberty at the appropriate time.</li><li>You are a woman under age 40 and your menstrual cycles stop.</li><li>You have lost armpit or pubic hair.</li><li>You are a man and you have decreased interest in sex.</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Gonadotropin deficiency; Secondary hypogonadism</p></div></div></section><section><div class="section sec-mb"><div class="section-header"><div class="section-title"><h2>Images</h2></div><div class="section-button"><button type="submit" aria-controls="section-tnails" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/1093t.jpg" alt="Endocrine glands" title="Endocrine glands" class="side-img"/><a href="../imagepages/1093.htm">Endocrine glands</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/17227t.jpg" alt="The pituitary gland" title="The pituitary gland" class="side-img"/><a href="../imagepages/17227.htm">Pituitary gland</a></li>
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<li><img src="//medlineplus.gov/ency/images/ency/tnails/17228t.jpg" alt="Gonadotropins" title="Gonadotropins" class="side-img"/><a href="../imagepages/17228.htm">Gonadotropins</a></li>
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</ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. <em>J Clin Endocrinol Metab</em>. 2018;103(5):1715-1744. PMID: 29562364 <a href="https://pubmed.ncbi.nlm.nih.gov/29562364/" target="_blank">pubmed.ncbi.nlm.nih.gov/29562364/</a>.</p><p>Styne DM. Physiology and disorders of puberty. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. <em>Williams Textbook of Endocrinology</em>. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 26.</p><p>White PC. Sexual development. In: Goldman L, Cooney KA, eds. <em>Goldman-Cecil Medicine</em>. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 220.</p></div></div></section>
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