thanks for the clarification.
what is the difference between primary and secondary hypogonadism?
and where would one (a layman in Australia) be ABLE To view ismail and Baths 2002 white paper “The Endocrinology of Gynecomastia”? if possible?
On a very basic level;
Primary hypogonadism is a failure of the testicles to produce testosterone despite there being adequate instruction to do so by the pituitary (one such genetic example is Klinefelters Syndrome).
Conversely;
Secondary hypogonadism is a failure of the pituitary to adequately send enough instruction to the testicles in order for them to produce testosterone.
But it is far less simple than that in reality. Deficiency of both types can occur both pre and post puberty; it can occur because of genetic factors, illness, trauma, the result of treatments such as chemotherapy/radiotherapy, age related delecine or be idiopathic (of unknown origin).
If deficiency occurs pre-puberty then skeletal formation is greatly affected as are the size of the testes and the penis (if TRT is not instigated at the time of puberty).
If secondary hypogonadism occurs pre puberty this often results in a failure of the testes to mature and this itself means that the testes cannot function (as demonstrated in Kallmans Syndrome) even if the correct function from the pituitary is restored. This is something that is radically different in secondary hypogonadism post puberty where testicles can and will return to a functional level if the pituitary stimulus is restored.
There is then the situation that relates to metabolic hypogonadism of varying types. This can occur when androgen to testosterone ratios are poor and elevated estradiol suppresses the hypothalamus/pituitary from correctly functioning. This can also occur due to high SHBG either singularly or in conjunction with high estradiol.
Many men have combinations of problems such as a failure of the testicles and pituitary, otherwise known as central hypogonadism, or metabolic hypogondism coupled with partial testicular failure.
Then you have dihydrotestosterone deficiency otherwise known as alpha 5 reductase deficiency and various testosterone insensitivity syndromes which are part of the genetic/chromomal conditions that I barely mentioned.
On the illness front many conditions cause temporary and permant problems at either the pituitary, testicular or metabolic level. Most obvious of all are pituitary tumors such as prolactinomas, testicular and breast cancer, hemochromatosis (iron overload), autoimmune syndromes, Mumps, sleep apnea.
The above is not exhaustative information- just what I wrote as it came to mind from my laymans knowledge.
Ismail and Barth’s white paper was in pdf format on the internet but has since been removed as all old links are broken. This is unfortunate to say the least as it was and still is the most authoritative article on the subject to date. If anyone knows how to locate the said paper and can do so for the benefit of members of the site I am sure we would all be grateful.
I do have a hardcopy of Glen D Braunsteins original white paper from which the statistics that Ismail and Barths paper originate (thanks to the New England Journal of Medicine) and am willing to photocopy and send it to those that wish to view it.