Clinical picture of hypogonadism

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The clinical picture of androgen deficiency is dependent on the age at which this deficiency appears, and on its extent [1]. Prenatally, depending on the phase of development, it may result in intersexuality, or in abnormal positioning of the testes and an abnormally small penis (micropenis). Congenital penile deviations may also be the result of a temporary T deficiency or androgen insensitivity during fetal development [17]. Between birth and puberty androgen production is minimal and hypogonadism will not manifest itself. Hypogonadism at the normal time of puberty will result in a typical syndrome of eunuchoidism. Epiphyseal cartilage does not stop growing, so the long bones continue to grow, resulting in a ratio of upper to lower body <1, and arms extending beyond the torso by over 5 cm. Voice does not deepen, and hair development remains of the feminine type: horizontal pubic hair line, no facial hair, no body hair. Fat distribution is also of the female type, with pronounced hips. The penis and testes remain child-like, the scrotum is only slightly wrinkled and not very pigmented, and the prostate is small. Libido and potency do not develop. Spermato-genesis is not initiated, resulting in aspermia and infertility.

After puberty, the clinical picture may vary considerably according to the time elapsed since puberty and the degree of the androgen deficiency. Body proportions, size of penis, and pitch of voice do not change. Body and facial hair may decrease. The main clinical signs are reduced sexual desire and potency, and infertility. Size and consistency of testes vary from normal to significantly reduced. Long-term androgen deficiency usually causes atrophy of muscle mass, osteoporosis, loss of strength and energy, normochromic and normocytic anemia, fatigue, and mood disturbances.

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