Low Testosterone Treatment Delhi India Symptoms Causes Cure Specialist Cause Qualified Therapy Doctor India New Noida East West North South Central Gurgaon Gurugram Faridabad Ghaziabad

How Testis Develops: In all male child testis is small. It remains small until the onset of genital development i.e. puberty which usually starts at age of 14 years. At this time L.H. & F.S.H. hormone is secreted from pituitary gland in brain. These hormone act as Germ cell & Sertoli cells in testis leading to there growth. This enlargement is size continues upto 18 years, ultimately reaching size of 12 to 25 ml. Other hormones which control testis size are growth hormone IGF-1 & others.

Cause of small Testis: There are many causes of small testis. These are as follows :-

1) Hypogonadotropic Hypogonadism: Hypogonadism, Hypothyroidism, Testosterone deficiency, hyperprolactinema, Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiency) Hypogonadotropic states: Hypothalamic � pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome , Hypothalmic deficiency, pituitary hypoplasia, Trauma, post surgical, postoradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, tuberculosis, fugal infection, hemochromatosis) Autoimmune hypophysitis, drug-induced hyperprolactinemia, Untreated endocrinopathies , Glucorticoid excess, Hypopituitarism, Cushing disease, Addison disease.
Isolated gonadotropin deficiency (non acquired) : Pituitary , Hypothalamic
Associated with multiple pituitary hormone deficiencies : Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngiomas, Rathke pouch cycts, hypothalamic tumors, pituitary adenomas), Following surgery, Following cranial irradiation, Following CNS chemotherapy, Following inflammation, Infiltrative or destructive processes (autoimmune, hemosiderosis), Associated with syndromes involving hypthalamic function, Laurence-Moon-Beidl sundrome Prader-Willi syndrome , Frohlich syndrome
Isolated gonadotropic deficiency with or without anosmia, Fertile eunuch syndrone, Idiopathic hypopituitarism, CNS disorders : tumors, infections, pituitary agenesis or hypoplasia, hydrocephalus, Septooptic dysplasia, CNS radiation for leukemia or brain tumor, Prader-Willi and Laurence-Moon-Biedly Syndrome, Thalassemia major

(2) Hyperogonadotropic hypogonadism:

testicular failure, development defect, drugs, trauma, congenital defect, congenital adrenal hyperplasia, Chromosomal defect, testosterone hormone biosynthetic defect, Mumps orchitis leading to testicular atrophy,
Primary testicular defect-disorders of testicular differentiation or inborn errors of testosterone synthesis, Klinefelter syndrome, Other X polysomies (i.e. XXXXY, XXXY)
Rainbow syndrome,
(3) Partial androgen insensitivity
(4) Growth Hormone Deficiency
(5) Idiopathic small Testis: In many patients all the hormone growth factor & every thing else is normal ,still they have small testis with or without small pennis i.e. genitalia. This occurs due to Decreased capacity of testicular tissue to grow.This occurs due to defective development of the testis in utero so that its growing capacity decreases later in life

(6)Vanishing Testis Syndrome

(7) Dysmorphic Syndrome

(8) Post Mumps Orchitis.

Consequences of Small Testis :

When testis is small it denotes that testis is not fully developed thus it will not be having normal function also.

The two functions of fully developed testis are:
(1) Production of normal amount of semen including sperms. So people with small testis has less i.e. decreased semen amount, subnormal sperms count or may be even nil sperms called Azoospermia. This leads to infertility.

(2) The second function of testis is to produce male hormone testosterone. This hormone then acts on various organ system of body like hair of face & body leading to development of beard & moustache, development of muscular body, increase in penile size, male pattern of behavior, having genital desire & power. Thus small testis meaning underdeveloped testis leads to less beard & moustache, less muscular body, feminine behavior, soft skin, infertility, impotency. Patient may have one symptom or more of above symptoms & signs.

Investigation & Diagnosis: For proper diagnosis of cause of small testis we do following tests.
For diagnosis of cause of investigation following tests are required. These tests include
complete male hormone profile. This profile includes all the male hormone tests which affects testicular development , growth & other genital organ development as well as genital functions.
Thyroid test
serum prolactin
SHBG
Semen analysis
ultrasound of testis
Growth Hormone analysis
DHT Level

Other tests depending on likelihood of other possibilities
Tests may show low testosterone. L.H. & F.S.H. may be decreased or increased may be low. Thyroid test may show low free T3 & free T4 & TSH may be increased or decreased. Similarly prolactin hormone may be low or high.
other tests which may be required depending on likelihood of the any of above causes.
In biochemistry liver function or kidney function tests are done.
Dynamic test to judge functional capacity of testis whether testis has the capacity to function normally or not. In this test we inject single injection of gonadotropin as intramuscular injection then three day later the rise in concentration of male hormone is seen to asses whether testis has capacity to function normally or not.
Chromosomal analysis is done to see the genetic structure of testis, because there are many chromosome disorders, which lead to small pennis.
Capacity of generation of active testosterone i.e. DHT is tested. This DHT generation test is abnormal in some cases of small pennis / thin pennis /underdeveloped pennis.
Tests to locate testis as ultrasonography or C.T. Scan abdomen is needed if testis is not palpable.
MRI / CT SCAN head if suspecting hypogonadotropic hypogonadism.
Serum inhibin is tested which tells that whether testis is functioning or not.
Serum Iron, T.I.B.C. & ferritin concentration tested for hypogonadism due to hemochromatosis. Combined Pituitary hormone tests are performed when suspecting pituitary disorder.
Molecular genetic studies done in some special cases.
Serum estrogen increased whenever testicular function is decreased.
Serum DHT is low in some conditions when generation of dihydrotestosterone is decreased.

Assessment of androgen receptor is done when needed,
Dynamic tests as HCG test, response to antiestrogen & gonadotropin releasing hormone tests.
Interpretation of all above tests one need to be expert of hormone diseases with good experience. Based on above test result diagnosis of cause of small /or thin pennis is made. Once the cause is found then treatment becomes very easy with good results.
If needed growth hormone & some other tests.

Treatment : After finding the cause appropriate treatment started in form hormone replacement therapy. The treatment s as follows:
1) Gonadotropin therapy is also very effective in testis enlargement. This is available as injections which has no side effects with very good results. After start of treatment testis starts enlarging in three months time. With in one year time testis enlarges to normal size. Its function also normalizes in most patients. Later testis starts producing normal level of male hormone testosterone. Once testosterone production normalizes, erection & genital desire becomes normal. Physical weakness disappears & mentally becomes more active & alert. All other symptoms also normalizes. Bone strength recovers. Testosterone treatment is harmless if given by expert in hormone in proper doses.

2) Gonadotropin Releasing hormone therapy is effective in many cases of underdeveloped testis even when gonadotropin therapy has failed in normalizing testicular size & function.

3) Growth hormone therapy in many cases where somatrop deficiency is found.

4) Growth Factor Therapy

5) Male Hormone Replacement: Treatment with male hormone testosterone is available as oral tablets, skin patch, skin gels or injection is given with very good results.

The various preparation of testosterone & route of administration are:

1) Oral preparation that is available in capsule form. It need to be given one to three capsule daily.

These have no side effects.

2) Transdermal Testosterone given as testosterone gel preparations. It need to be applied any part of skin once a day.

It is very effective & has no side effects.

3). Transdermal Testosterone scrotal patch are also available which are very effective even if used in small doses. It is very effective & has no side effects.

4) Sublingual Testosterone cyclodextrin is now available which is very fast acting & very effective is fast & bettergenital organ secondary genital character development. It is used as one tablet daily to be kept under the tongue for few minutes. It has no side effect and it is very effective

5) Local application of D.H.T. gel available as Andractim gel is a new preparation for male hormone replacement.

6) Injection Testosterone esters these includes Testosterone enanthate & testosterone cypionate given intramuscular injections every 10 to 14 days.

7) Long acting testosterone as testosterone bucilate given once in 4 months.

8) Testosterones implants are now available which once injected remain effective for up to six months.

Response: Once we start the treatment testis starts enlarging in size. After start of treatment testis starts enlarging in three months time. With in one year time testis enlarges to normal size. Its function also normalizes in most patients.

Side Effects: As this treatment consist of replacement of defective hormones. These hormones are given in physiological replacement doses as prescribed in our scientific text books. Thus this treatment does not have any side effects.

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