Hypogonadotropic hypogonadism (HH) is a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus.
Gonadotropin deficiency; Secondary hypogonadism
HH is caused by a lack of hormones that normally stimulate the ovaries or testes: gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH).
- The hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH).
- This hormone stimulates the pituitary gland to release FSH and LH.
- These hormones tell the female ovaries or the male testes to release hormones that lead to normal sexual development in puberty.
- Any change in this hormone release chain causes a lack of sex hormones and prevents normal sexual maturity.
There are several causes of HH:
- Damage to the pituitary gland or hypothalamus from surgery, injury, tumor, infection, or radiation
- Genetic defects
- High doses or long-term use of opioid or steroid (glucocorticoid) medicines
- Severe stress
- Nutritional problems (both rapid weight gain or weight loss)
- Chronic medical diseases, including chronic inflammation or infections
- Certain medical conditions, such as iron overload
Kallmann syndrome is an inherited form of HH. Some people with this condition also have anosmia (loss of the sense of smell).
- Lack of development at puberty (development may be very late or incomplete)
- In girls, a lack of breasts and menstrual periods
- In boys, no development of sex characteristics, such as enlargement of the testes and penis, deepening of the voice, and facial hair
- Inability to smell (in some cases)
- Short stature (in some cases)
- Loss of interest in sex (libido) in men
- Loss of menstrual periods (amenorrhea) in women
- Decreased energy and interest in activities
- Loss of muscle mass in men
- Weight gain
- Mood changes
Exams and Tests
Tests that may be done include:
- Blood tests to measure hormone levels such as FSH, LH, and TSH, prolactin, testosterone and estradiol
- LH response to GnRH
- MRI of the pituitary gland/hypothalamus (to look for a tumor or other growth)
- Genetic testing
- Blood tests to check for iron level
Treatment depends on the source of the problem, but may involve:
- Injections of testosterone (in males)
- Slow-release testosterone skin patch (in males)
- Testosterone gels (in males)
- Estrogen and progesterone pills or skin patches (in females)
- GnRH injections
The right hormone treatment will cause puberty to start and may restore fertility. If the condition begins after puberty or in adulthood, symptoms will often improve with treatment.
Health problems that may result from HH include:
- Delayed puberty
- Early menopause (in females)
- Low bone density and fractures later in life
- Low self-esteem due to late start of puberty (emotional support may be helpful)
- Sexual problems, such as low libido
When to Contact a Medical Professional
Call your health care provider if:
- Your child does not start puberty at the appropriate time
- You are a woman under 40 and your menstrual cycles stop
- You have lost armpit or pubic hair
- You are a man and you have decreased interest in sex
Haddad NG, Eugster EA. Delayed puberty. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 122.
Molitch ME. Anterior pituitary. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 224.
Silveira LF, Latronico AC. Approach to the patient with hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 2013;98(5):1781-1788. PMID: 23650335 www.ncbi.nlm.nih.gov/pubmed/23650335.