Hormonal disorders in men
Hormonal imbalances in men bring about sexual dysfunctions and infertility and can also provoke aesthetic and psychological problems. Frequently, hormonal disorders manifest via general symptoms, such as fatigue, agitation or anxiety, headaches, all of which, of themselves, are not easily associated with endocrinological problems by anyone who is not specialized in hormonal disturbances. Thus, it is the endocrinologist who is best able to investigate hormone imbalances and administer hormone therapy and thus promptly deal with the abovementioned issues.
Sperm disorders – Male infertility / Subfertility
Reduction in men’s reproductive capacity is an ever increasing problem in our modern world. The causes may be environmental (environmental pollution, certain clothes materials and/or over-tight clothing, deodorants, cosmetics, food packaging, etc.), neurological disorders, obesity, genetics, diet. Other causes are morphological / anatomical problems of the testes, the prostate and the seminal vesicles: in all these cases, a urology surgeon is specialized to assess the condition. Hormonal disorders are a common cause nowadays, and here the endocrinologist is able to look into the origins of the damage to hormonal action as well as to assess the severity of the damage and to what extent this will eventually necessitate treatment. A type of hormone treatment will then be decided upon which must target the problem and achieve maximum effectiveness in a minimum amount of time. However, there are also some problems that will demand longer-term hormone-replacement treatment. Given that various hormone formulations exist in different forms of administration, a choice will be made that is entirely individualized.
Hormone treatment aiming at improvement of sperm for increased fertility will be instituted after due investigation into sperm quality and quantity. It is carried out in combination with administration of one or more preparations. Throughout treatment, the patient is monitored for assessment of the effectiveness of the therapy.
Erectile disorder – Erectile dysfunction
Erection is a cerebral-brain origin function in which hormones play an important role. During erection, the corpora cavernosa of the penis fills with blood causing it to swell. Erectile dysfunction (or impotence) is a sexual disorder in men in which there is inability to develop or maintain an erection (a swelling of adequate length and hardness) of the penis during sexual activity. Erectile disorders are nowadays fairly frequent among men and their precise cause should be investigated through the collaboration of an endocrinologist, a urologist surgeon and a psychiatrist-psychoanalyst. It is recommended that the diagnosis of erectile dysfunction be carried out via a special questionnaire which will determine the cause and severity of the problem. The cause could be cardiovascular, neurological or hormonal, or else due to the side effects of certain medications. Regarding the hormonal aspects, the endocrinologist will look into the type of hormone disruption and, based on this, will prescribe the appropriate treatment: this could be hormone formulations that are either oral or injectable and are of course prescribed depending on the cause. There are also treatments using a non-hormonal formulation, both oral and injectable, to increase penis blood flow. These last are relatively successful. However they are prescribed to the patient only when possible hormonal causes have been ruled out and it has been determined that they will produce no side effects on the heart or on blood pressure and will not long-term have any negative impact on the penis. Finally, surgery can be performed on the penis or on the male reproductive system, an option which will be taken into consideration by the urologist.
Alopecia – Hair loss / Baldness
These conditions are frequently caused by autoimmune diseases such as thyroid diseases, vitiligo, lupus, rheumatoid arthritis, ulcerative colitis, dermatological diseases, psychological problems (anxiety, stress), medical causes such as iron deficiency, as well as hormonological causes, or else they may be hereditary. They all demand collaboration between the endocrinologist and the dermatologist. The first requirement is staging of the hair loss / baldness and mapping. Regarding hormonal causes, once a hormonological investigation has been carried out, the endocrinologist can in some cases recommend treatment with an antiandrogen drug. When taken topically they can be very beneficial. However, when taken orally they may produce side effects, among others, adverse effects on the endocrine glands.
Gynaecomastia
This is a swelling of the male breast (in either one or in both breasts) because of a benign enlargement of breast tissue, i.e. of the mammary gland. It is accompanied by an increase in diameter of the areola, the ring of colour around the nipple. It constitutes an aesthetic problem and is most commonly seen in adolescent boys and older men, though it can appear at any age. In all cases it provokes considerable psychological distress. The first priority for the endocrinologist is to make an accurate diagnosis, since quite often the swelling is due to fatty deposits in the chest area. The causes of gynaecomastia can be metabolic, hormonal, endocrine tumours, side effects of medications used by the patient in treatments, aging, testicular tumours, malabsorption, kidney or liver deficiency as well as intake of anabolic steroids or opioids. Depending on the cause, formulations are used that exert hormonal action, either singly or in combination. Surgery is a last resort, when the swelling is large and previous treatments have failed.
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| Stages of baldness – Alopecia |
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| Gynaecomastia in a male | Clinical assessment: stages in the development of
secondary sex characteristics in males |
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| Small testicles, gynaecomastia and infertility
in a patient with Klinefelters syndrome |