Hypogonadism in the Male

Hypogonadism in the Male

When the testes of a male fetus are nonfunctional during fetal life, none of the male sexual characteristics develop in the fetus. Instead, female organs are formed. The reason for this is that the basic genetic characteris-tic of the fetus, whether male or female, is to form female sexual organs if there are no sex hormones. But in the presence of testosterone, formation of female sexual organs is suppressed, and instead, male organs are induced.

When a boy loses his testes before puberty, a state of eunuchism ensues in which he continues to have infan-tile sex organs and other infantile sexual characteristics throughout life. The height of an adult eunuch is slightly greater than that of a normal man because the bone epiphyses are slow to unite, although the bones are quite thin and the muscles are considerably weaker than those of a normal man. The voice is childlike, there is no loss of hair on the head, and the normal adult masculine hair distribution on the face and elsewhere does not occur.

When a man is castrated after puberty, some of his male secondary sexual characteristics revert to those of a child and others remain of adult masculine character. The sexual organs regress slightly in size but not to a childlike state, and the voice regresses from the bass quality only slightly. Conversely, there is loss of mascu-line hair production, loss of the thick masculine bones, and loss of the musculature of the virile male.

Also in a castrated adult male, sexual desires are decreased but not lost, provided sexual activities have been practiced previously. Erection can still occur as before, although with less ease, but it is rare that ejacu-lation can take place, primarily because the semen-forming organs degenerate and there has been a loss of the testosterone-driven psychic desire.

Some instances of hypogonadism are caused by a genetic inability of the hypothalamus to secrete normal amounts of GnRH. This often is associated with a simultaneous abnormality of the feeding center of the hypothalamus, causing the person to greatly overeat. Consequently, obesity occurs along with eunuchism. A patient with this condition is shown in Figure 80–11; the condition is calledadiposogenital syndrome, Fröhlich’ssyndrome, or hypothalamic eunuchism.