Primary And Secondary Hypogonadism Treatment - 3 Types HYPOGONADISM (Low Testosterone)
Summary
TLDRThis informative video discusses hypogonadism, a medical condition characterized by low testosterone levels. It differentiates between primary, secondary, and tertiary hypogonadism, explaining their causes and the importance of identifying the root cause for appropriate treatment. The script emphasizes the significance of baseline hormone levels and the impact of modern lifestyle factors on testosterone levels, offering insights into hormone optimization and the potential effects on fertility and overall health.
Takeaways
- 😀 Hypogonadism is a medical term for low testosterone levels, with 'hypo' indicating a deficiency.
- 🔬 The clinical code for hypogonadism is E290.1, used for insurance claims and reimbursements in the medical field.
- 📊 Understanding the cause of low testosterone is crucial before treatment to determine viable treatment options and to diagnose the type of hypogonadism.
- 🌡️ Baseline hormone levels, particularly gonadotropins like LH and FSH, are essential for diagnosing the root cause of hypogonadism.
- 🚫 Introducing testosterone replacement therapy can suppress the release of pituitary hormones, making it difficult to determine the root cause of hypogonadism after treatment begins.
- 📉 Low LH levels in the morning can indicate secondary hypogonadism, where the pituitary gland is not adequately stimulating the testicles.
- 💊 High levels of LH suggest primary hypogonadism, where the testicles are not functioning properly, possibly due to age, injury, or other factors.
- 🧠 Tertiary hypogonadism involves a deficiency in the hypothalamus' release of gonadotropin-releasing hormone (GnRH), affecting the pituitary gland's function.
- 👴 Primary hypogonadism is often age-related, with testicular function naturally decreasing as men age, but can also occur due to injury or illness.
- 🤯 Secondary hypogonadism is more common in younger individuals and can be caused by chronic stress, depression, anxiety, and other stressors affecting pituitary function.
- 🏥 Treatment approaches may differ based on the type of hypogonadism, and understanding the specific cause is important for effective management.
Q & A
What is hypogonadism?
-Hypogonadism is a medical term referring to a deficient state of gonadal function, meaning low testosterone levels in men and low levels of ovarian function in women.
Why is it important to understand the cause of low testosterone before treatment?
-Understanding the cause of low testosterone is crucial because it determines the viable treatment options and provides a single opportunity to identify the root cause during the initial baseline checkup.
What are gonadotropins and why are they important in hypogonadism?
-Gonadotropins are specific hormones that act on the gonads, released primarily by the anterior pituitary gland. They include luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are important in diagnosing the type of hypogonadism.
How does LH indicate secondary hypogonadism?
-If LH levels are significantly low, it suggests that the testicles are not being stimulated to produce sufficient testosterone, indicating a deficiency in the pituitary gland's function, which is a sign of secondary hypogonadism.
What is primary hypogonadism and how is it indicated?
-Primary hypogonadism occurs when the testicles themselves are deficient, often indicated by a super-physiological level of luteinizing hormone (LH), showing that the pituitary is trying to stimulate the testicles but they are not responding adequately.
What is tertiary hypogonadism and how does it relate to the hypothalamus?
-Tertiary hypogonadism is a condition where the hypothalamus is not releasing enough gonadotropin-releasing hormone (GnRH), which in turn affects the pituitary's ability to release LH and FSH, leading to a deficiency in the entire hormonal chain.
Why is the initial baseline checkup for hypogonadism essential?
-The initial baseline checkup is essential because it allows for the measurement of gonadotropin levels before any treatment is introduced, which can suppress these hormones and make it impossible to determine the root cause of hypogonadism.
What are some common causes of primary hypogonadism in older individuals?
-In older individuals, primary hypogonadism is often age-related, as testicular function naturally declines with age. It can also be caused by testicular cancer, injury, drug use, or abuse.
Why are younger individuals more likely to experience secondary hypogonadism?
-Younger individuals may experience secondary hypogonadism due to factors such as chronic stress, depression, anxiety, and the impact of social media, which can lead to a state of constant stress affecting the pituitary's function.
What factors could contribute to tertiary hypogonadism?
-Tertiary hypogonadism can be caused by factors that affect the hypothalamus, such as traumatic brain injuries, surgeries impacting brain function, or conditions like PTSD that disrupt the hormonal signaling from the hypothalamus to the pituitary.
How might testosterone replacement therapy impact fertility?
-Testosterone replacement therapy can suppress endogenous testosterone production, which may impact sperm count, motility, and quality, thus affecting fertility.
Outlines
😀 Introduction to Hypogonadism and Testosterone
This paragraph introduces the concept of hypogonadism, which is a medical term for low testosterone levels in men. It explains that hypogonadism can be categorized into primary, secondary, and tertiary types, each with different underlying causes and treatment options. The importance of understanding the type of hypogonadism is emphasized to determine the appropriate treatment. The paragraph also highlights the significance of baseline hormone levels, particularly luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are crucial for diagnosing the type of hypogonadism and understanding its root cause. The potential impact of hypogonadism on fertility is mentioned, as well as the importance of not suppressing the body's natural hormone production with testosterone replacement therapy without first identifying the cause.
😐 Diagnosing Hypogonadism: Primary, Secondary, and Tertiary Types
The second paragraph delves into the specifics of diagnosing hypogonadism by examining the levels of LH and FSH. It explains that a significantly low LH level in the morning, when it should peak, can indicate secondary hypogonadism, which is due to pituitary gland dysfunction. Conversely, a high level of LH suggests primary hypogonadism, where the testicles are not functioning properly. The paragraph also introduces tertiary hypogonadism, which is caused by a deficiency in gonadotropin-releasing hormone (GnRH) from the hypothalamus, affecting the entire hormonal chain. The importance of distinguishing between these types is emphasized for proper diagnosis and treatment planning. Additionally, the paragraph mentions the potential for individuals to have a combination of primary and secondary hypogonadism due to various causes.
😥 Causes and Prevalence of Hypogonadism
This paragraph discusses the common causes of primary, secondary, and tertiary hypogonadism. It notes that primary hypogonadism is often age-related but can also occur in younger individuals due to factors such as testicular cancer, injury, drug abuse, or other external influences. Secondary hypogonadism is more prevalent in younger individuals and is linked to chronic stress, depression, anxiety, and the pressures of modern life, which can lead to pituitary gland malfunction. Tertiary hypogonadism is less common and often associated with traumatic brain injuries or surgeries affecting brain function. The paragraph also reflects on the historical context of testosterone levels, suggesting that modern lifestyles and stressors have significantly reduced natural testosterone levels compared to previous generations.
Mindmap
Keywords
💡Hypogonadism
💡Testosterone
💡Primary Hypogonadism
💡Secondary Hypogonadism
💡Tertiary Hypogonadism
💡Luteinizing Hormone (LH)
💡Follicle Stimulating Hormone (FSH)
💡Gonadotropin-Releasing Hormone (GnRH)
💡Testicular Function
💡Hormone Replacement Therapy (HRT)
💡Fertility
Highlights
Hypogonadism is a medical term for low testosterone levels.
The importance of understanding the cause of low testosterone before treatment.
The role of gonadotropins in testicular function and their impact on fertility.
The significance of baseline hormone levels in diagnosing hypogonadism.
Differentiating between primary, secondary, and tertiary hypogonadism based on the root cause.
The impact of aging on testicular function and the prevalence of primary hypogonadism in older individuals.
External factors such as injury, drug use, and cancer that can lead to primary hypogonadism.
Stress and its role in causing secondary hypogonadism in younger individuals.
The physiological effects of chronic stress on pituitary function and gonadotropin secretion.
The influence of modern lifestyle factors on testosterone levels and fertility.
The potential impact of testosterone replacement therapy on fertility.
The role of the hypothalamus in controlling the pituitary gland and its relation to tertiary hypogonadism.
The rarity of tertiary hypogonadism and its association with brain injuries or surgeries.
The importance of an accurate diagnosis for determining appropriate treatment options.
The potential overlap in treatment options for different types of hypogonadism.
The impact of testosterone levels on various aspects of male health and well-being.
The importance of considering individual differences when diagnosing and treating hypogonadism.
The role of the TRT and Hormone Optimization YouTube channel in providing science-based information.
Transcripts
welcome back Gil oh yeah I am doing well
thank you a very general question today
so let's discuss the different types of
gap organism with those typical low D
symptoms so there's primary secondary
and tertiary and the treatment options
may be for each of them so you do the
explaining okay additive so this is the
TR T and hormone optimisation YouTube
channel and if you want to learn all
about the science-based information on
this topic consider subscribing hit that
notification bell and you'll be on your
way very basically hypogonadism is just
a fancy medical term for the state of
low testosterone okay the word hypo as
we know suggests that something is low
just like hyper suggests it is high we
know hypoglycemia low blood sugar
hypotension is low blood pressure and
hypogonadism is a deficient state of
gonna function and the gonads happen to
be the testicles in men and the ovaries
in women so hypogonadism is a low level
of testicular function in men and the
clinical code for hypogonadism when you
put in an insurance claim for
reimbursement in the medical field is
called testicular hypofunction
and there is a code for it called e 29th
at 0.1 which is just insurance code so
this essentially is all that means when
you see the word hypogonadism it's it's
low t for sure well t comes in several
forms and it's essential to understand
why someone has low t before you begin
treatment and the reason it's important
to know before you begin treatment is
twofold
first and foremost the treatment options
that are viable to fix this condition
are going to be determined partially by
the course now there may be treatment
options that are overlapping meaning
that regardless of the diagnosis of why
the loti existed the way they're going
to be treated may be identical but it
may not be and they that is something
that we can get a little deeper into
secondly you only get one opportunity to
find out the truth
cause of hypogonadism and that is at
what we call the initial baseline
checkup and that initial baseline is
very important because you have certain
gonadotropins which again is a fancy
word for specific hormones that act on
the gonads
they're known as tropic hormones and
tropic hormones are generally reduced by
what's called the master gland of the
endocrine system aka the pituitary gland
and it is specifically the anterior
pituitary
the anterior pituitary release is
primarily two hormones that asked on the
testicles in men
they're called luteinizing hormone
shortened for LH on lab values and
follicle stimulating hormone short for
FSH LH acts on the latex cells which are
responsible for testosterone production
in testicular li and FSH acts on a group
of cells in the testicles known as
sertoli cells which is primary function
is spermatogenesis or production of
sperm they do correlate to one another
because spermatogenesis does require
endogenous testosterone as well as 17
beta s Trudel conversion within the
glands so they are interrelated which is
why a hypo gonadal a loti male may have
impact on his fertility both in terms of
sperm count as well as motility and
quality of sperm so oftentimes a sperm
analysis will be followed by a androgen
analysis in order to determine if there
is a deficiency this is also one of the
reasons why a genius hormone replacement
often impacts fertility because you are
now suppressing or shutting down the
endogenous production so now
understanding that you have these group
of gonadotropins the tropic hormones
from the pituitary acting on the gonads
combined with the fact that the
testicles are responsible for the
production of testosterone it's
important to understand why the baseline
labs are so essential the minute you
introduce testosterone replacement
therapy in any form and I'm not talking
about secrete agarra analogues that help
produce more endogenously
I'm talking about the actual
molecule of testosterone being
introduced
whether it's injectable transdermal or
otherwise you are suppressing the
traffic hormones released by the
pituitary gland or they're gonna add
atropine such as LH and FSH and
therefore you will never have another
opportunity so long as you're under
treatment to find out if the root cause
of your low tea or hypo gonadal state
was due to testicular failure or
pituitary failure or deficiency so when
you check your baseline I'm gonna add
atropine level there are a couple of
markers we're looking for for starters
if your LH level is significantly low
primarily in the morning hours when it
is supposed to peak then it is a fairly
sufficient indicator unless of course
you had a really poor night's sleep or
you had alcohol or anything else right
if we are mitigating any of these
external variables which are dependent
variables based on this this test
assuming you had a good night's sleep
and you know clean nutrition clean clean
from any toxins your LH level should in
the morning for a healthy otherwise
healthy male with well-functioning
pituitary should be in that 5 to 7 to 8
range
ideally now if you come in at 22.5 3
you're somewhat deficient in your
luteinizing hormone secretion which
would be no surprise that your testicles
are not producing sufficient levels of
testosterone because they're not being
asked to go to work this will give you a
clinical diagnosis of secondary
hypogonadism why secondary because we
look at the actual excreting gland in
this case two testicles as the primary
gland responsible for the production of
a hormone the gland that acts on the
requesting signal aka the pituitary is
what we see is the secondary gland in
this formula and therefore if that is
the deficiency we have a secondary
hypokinetic state if the testicles are
deficient which is very easy to indicate
with a super a physiological level of
luteinizing hormone that is what we call
a primary hypogonadism it is possible to
be both primary and such
this could be due to a number of reasons
which I'll circle back to in a minute
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tertiary hypogonadism is taking it a
step further up the chain what controls
you master gland aka the pituitary and
the answer there is the hypothalamus the
hypothalamus releases hormones known as
gonadotropin-releasing hormone or GnRH
so GnRH will go down and hit the
pituitary and that will activate the
signal for the LH and FSH so if the
initial requesting signal from the
hypothalamus is deficient everything
down the chain will be deficient so
essentially what we're testing is where
has the link failed in this HP ta system
has that at the primary gland is it in
the secondary grande gland is it in the
tertiary gluten so this is the main
difference between a primary secondary
or tertiary hypogonadism type of
diagnosis and like I said they're not
always one could be one could be two
could be all three and that depends on
the individual so if you like we can go
into a handful because there's a million
different causes a handful of the most
common of each okay primary - at ISM is
something that is most often leaked are
found in a class of people or a group of
people primarily they tend to be older
because testicular function is primarily
designed for one aspect from a
biological standpoint the fact that we
now have modern medicine and science to
keep us alive for extended periods of
time actually kind of goes against the
intended biology of humans because if we
go back to our primitive days by the
time you're 40 years old you should no
longer even be here right an average
lifespan was significantly shorter
no one died of cancer diabetes heart
disease or strokes in those days there
either fell off a cliff got mauled by a
saber-toothed lion or they simply died
of infection because there was no
antibiotics to treat it so you may live
until your teens you may live into your
20s maybe even into get 30s if you were
super lucky your childbearing days or
from puberty until you died and you
didn't die that far past it once you've
reached your 40s 50 60s etc you're a
testicular function is no longer
relevant and therefore you are no longer
designed to father children your
testosterone adds a layer of aggression
a layer of libido a layer of defense and
strength and ability to to fight for and
support a family in an otherwise
dangerous world well now we're sitting
behind a desk signing pieces of paper
getting a paycheck
and getting in our safe little cars and
going home to our safe little homes we
no longer need to run down the mountain
with a spear in order to hunt for food
so that the stash drone levels over time
and evolution have decreased
significantly and therefore fertility as
we age begins to decrease significantly
so your testicular function is
essentially dead or no longer needed as
you begin to age and this is often what
we see in primary hypogonadism cases
again it is usually age-related it can
come a sooner in a younger individual if
there is testicular cancer injury drug
use abuse or things that are external
factors outside of just timeline of
biology what we often see in younger
guys more often than not is secondary
hypogonadism we're living in us in a
phase right now in time where depression
anxiety stress peer pressure and the
stigmas of social media painting a
perfect life from everyone around you
tends to cause all these stressors to
become what we call al aesthetic lobes
al aesthetic clothes is just a fancy
word for saying constant and chronic
state of stress that never goes away
and this has a pure physiological sense
of breaking down your body systems and
efficacy to repair and do what they're
supposed to do and this leads to the
pituitary malfunction of secreting
gonadotropins and becoming deficient to
a state of causing secondary
hypogonadism the sad truth is we're
seeing guys in their early in mid-30s
now more and more and recently we've
started to get in a lot of patients in
their mid 20s with all of the Adams core
responses of poor libido poor erectile
quality depression anxiety poor sleep
weight gain inability to function during
the day no energy level no motivation
and it's really really sad to see but
it's literally the way the world has
been moving if we go back and check our
grandfather's natural testosterone
levels 50 years ago working physically
no iPhones no nonsense
they were probably triple what you'll
find today is unknown so this is where
we find most of the secondary cases
tends to be the younger crowd or guys
who abuse drugs or alcohol which again
has an effect on suppression all across
our cherry you're probably going to find
more soon people who have had surgeries
that impacted their brain function or
TBI which was traumatic brain injuries
guys with PTSD guys who you know had
military related injuries car accidents
or literally traumatic injuries to the
brain those guys are generally going to
be the ones more susceptible to tertiary
it is significantly more rare to see
primary and secondary or the common and
it's usually predictable by age group
for the most part if we have to classify
the way we treat them and I don't know
if this is something you want to get
into a little bit differently but the
way we treat them may differ it may not
differ and that's totally a whole other
topic as well thank you so much so my
project thank you so for the viewers if
you want to ask any personal things or
your labs please join the Facebook group
with the same name as this channel tea
or tea and hormone optimization news in
it and he's very helpful there as well
if you want to contact him directly the
link is under the video in the
description of each video that Gil is
helping us
so again thank you so much good thank
you Steve Oh pleasure beer
and now do this next click on one of
these thumbnails and go watch another
video to learn a ton more about TRT and
hormone optimization
[Music]
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