Primary And Secondary Hypogonadism Treatment - 3 Types HYPOGONADISM (Low Testosterone)

Summary

This 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

00:00

😀 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.

05:01

😐 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.

10:03

😥 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.

Keywords

💡Hypogonadism

Hypogonadism is a medical term referring to a deficiency in the function of the gonads, which are the testicles in men and ovaries in women. In the context of the video, it specifically denotes a low level of testosterone in men. The script discusses this condition as the main theme, explaining its different types and their treatment options.

💡Testosterone

Testosterone is the primary male sex hormone responsible for the development of male reproductive tissues and secondary sexual characteristics. The video script frequently mentions 'low T' as a shorthand for low testosterone levels, which is a central issue in the discussion of hypogonadism.

💡Primary Hypogonadism

Primary hypogonadism is a condition where the testicles are not functioning properly, leading to a deficiency in testosterone production. The script explains that this can be due to age-related decline, testicular injury, drug use, or other factors that affect the testicles directly.

💡Secondary Hypogonadism

Secondary hypogonadism occurs when the pituitary gland does not produce enough luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are necessary for the testicles to produce testosterone. The script mentions that this type is often related to stress, depression, anxiety, and other factors affecting the pituitary function.

💡Tertiary Hypogonadism

Tertiary hypogonadism is a condition where the hypothalamus does not release enough gonadotropin-releasing hormone (GnRH), leading to a deficiency in pituitary hormones that stimulate the testicles. The script points out that this is less common and often related to brain injuries or other traumas affecting the hypothalamus.

💡Luteinizing Hormone (LH)

LH is a hormone produced by the anterior pituitary gland that acts on the testicles to stimulate testosterone production. The script discusses LH levels as an indicator for diagnosing secondary hypogonadism when they are significantly low.

💡Follicle Stimulating Hormone (FSH)

FSH is another hormone produced by the pituitary gland that acts on the testicles, primarily for sperm production. The script explains that FSH is interrelated with LH and testosterone, and its deficiency can affect fertility.

💡Gonadotropin-Releasing Hormone (GnRH)

GnRH is a hormone released by the hypothalamus that stimulates the pituitary gland to produce LH and FSH. The script describes how a deficiency in GnRH can lead to tertiary hypogonadism by affecting the entire hormonal chain.

💡Testicular Function

Testicular function refers to the ability of the testicles to produce testosterone and sperm. The script discusses how this function naturally declines with age and can be affected by various factors, leading to hypogonadism.

💡Hormone Replacement Therapy (HRT)

HRT, specifically testosterone replacement therapy (TRT), is a treatment mentioned in the script for hypogonadism. It involves introducing testosterone to the body to alleviate symptoms of low testosterone levels.

💡Fertility

Fertility in the context of the video refers to the ability to produce healthy sperm and conceive offspring. The script explains that hypogonadism can impact fertility due to its effects on sperm count, motility, and quality.

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

before we continue just this if you

appreciate the content we bring to this

channel check out the Amazon links in

the description of this video these are

links to the products we use going from

supplements protein powder pre post

intra workout anti-aging cream sunscreen

needles and syringes to inject and so on

if you'd like to purchase one of those

products please use the direct link so

it will earn as a few cents as a tip and

you'll be guided directly to the product

we recommend thanks in advance

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]