Male hypogonadism FAQs

1. What is BPH? How do I know if I have it?

The Prostate gland is small gland situated at the base of the urinary bladder in males, through which the urethra passes. As men age, it is common to have an uncomplicated enlargement of the gland - medically called as Benign Prostatic Hyperplasia (BPH).

The signs and symptoms of BPH develop gradually and are often related to urination and urine frequency. Commonly following symptoms are seen-

• Frequent urination
• An increased tendency to pass urine at night (nocturia)
• Difficulty in starting while urinating
• Dribbling/staining of trousers at the end of urination
• Need to straining to urinate
• Feeling of incomplete urination

2. What is erectile dysfunction? How does one confirm it?

Erectile dysfunction (ED) refers to the inability of a man to get and maintain an erection in order to perform sexual intercourse. This is a type of impotence and could have psychosomatic caused behind it. While many men would have some problems in having and maintaining an erection occasionally, but if it becomes a regular phenomenon it can start affecting a person’s confidence, cause stress and even create problems in a relationship. Erectile dysfunction may also be a sign of a heart disease that may be serious.

ED is diagnosed through a medical history and physical examination. Generally tests are not needed to diagnose ED, but they may be required to know the underlying case behind ED.  These involve routine blood tests, urine analysis, penile ultrasound and even a psychiatric assessment.

3. How does a male realize that he is infertile?

The only signs or symptom of male infertility is the inability to sire a child in-spite of regular unprotected sexual activity.

Some males may observe some of the following as well –

• Problems with sperms or ejaculation
• Pain or swelling testicles
• Low facial hair
• Gynecomastia (or male breasts)
• Poor immunity

4. Why do men have premature ejaculation? Is it a serious condition?

Premature ejaculation (PE), is the condition where a man finishes a sexual act earlier than his partner. Generally it refers to ejaculation by the male within a very short time of beginning sexual activity. Causes of PE could be psychological and biological factors or a mix of both.

PE is actually very common and almost all men experience it at some time in their lives. It is a cause for concern only when it occurs frequently and hampers a person’s relationship.

5. How do I know if I have prostate cancer?

The signs and symptoms of prostate cancer develop gradually and are similar to that seen in BPH since both show growths of the organ. Commonly following symptoms are seen-

• Frequent urination
• An increased tendency to pass urine at night (nocturia)
• Difficulty in starting while urinating
• Dribbling/staining of trousers at the end of urination
• Need to straining to urinate
• Feeling of incomplete urination
• Blood in urine may be seen

6. What is hypogonadism? How is it caused?

Male hypogonadism refers to the condition where the gonads (testes) have not developed, causing a low production of testosterone in the males leading to a low masculinity and poor secondary sexual characteristics. This may show up as an abnormality since birth or may develop in some men later on in life due to any disease or surgery.

The causes of male hypogonadism are grouped into primary and secondary.

• Primary hypogonadism is when the source of the problem is in the testes themselves, such as some abnormality in cells, functioning, undescended testes, mumps etc. are not known.
• Secondary hypogonadism refers to the source of problem beyond the testes, e.g. in the nervous system or a hormonal imbalance, obesity, certain drugs etc that leads to poor testosterone production.

7. What is a varicocele? How do I know if I have it?

Variocele refers to the condition in males where there is swelling of the veins around the testicles inside the scrotum. This condition is similar to that of varicose veins seen at the back of legs except that it happens inside the scrotum. Varicocele can also cause male infertility.

While the causes of this condition are not well understood but it is believed that the veins dilate due to accumulation of blood – resulting from a stagnation in their flow – because of failure of the valves of the veins. These valves are supposed to prevent backflow of the blood.

You may suspect of having a varicocele if you find or feel a net like formation of veins on touching your scrotum. You may have pain in the scrotum or around it and if this pain increases on standing for long and reduces on lying down; you may suspect a varicocele and approach a doctor.

8. I do not feel as sexually active as in the past? Have I lost my libido?

Loss of libido means the loss of desire for sexual activity. It is a natural phenomenon for men to have a reduced sexual drive as they age or if they are involved in work leaving little time for self. Generally men experience a loss of libido after the age of 60 but it may happen earlier as well. Sometimes this condition can occur much earlier due to an underlying medical condition or psychological issues.

If you notice a marked change in your sex drive compared to the past, getting evaluated for libido loss and its reasons are recommended. Your doctor may diagnose your loss of libido by asking you a few questions on your medical history and taking note of your complaints. Your doctor may also perform a detailed physical examination.

9. I am a 40 year old man with no specific complaints but a family history of heart problems. How do I know if I have a heart problem or not? Should I wait until there is a symptom or pain in chest?

Generally men are at a greater risk of a heart disease as compared to women. Heart diseases are basically various conditions that can affect the heart, and include high blood pressure, disease of the vessels like a coronary artery disease, problems with beating of the heart like an arrhythmia.

Since there is family history of heart problems, this puts you at a higher risk and a regular preventative check up is recommended.

Diagnosis of any heart disease is done in a systematic manner to exclude other conditions and find out the exact cause of the complaints. Apart from physical examination and detailed questioning of the symptoms, your doctors may require you to perform the following tests -

• Blood pressure measurement
• Electrocardiogram (ECG): to test for the heartbeat
• 2D or 3D Echocardiogram (ECHO): ultrasound test to look for heart irregularities
• Holter monitoring: Portable device to record heart’s activity
• A cardiac stress test or treadmill test: Exercise test to measure heart’s capacity for load
• Cardiac catheterization: Inserting a catheter into a blood vessel to diagnose and treat heart diseases
• Cardiac imaging

10. I keep hearing about STDs. How does a sexual contact cause a disease? How is it identified?

STDs or Sexually transmitted diseases, are caused by microorganism that spread through sexual contact. These organisms can be either bacteria (these cause gonorrhea, syphilis, and chlamydia) or a parasite (that causes trichomoniasis) or viruses (that cause human papilloma virus, genital herpes and HIV). The risk of getting an STD increase if one has unprotected sexual contact with multiple partners, sharing of needles for taking drugs etc.

While STDs may not show any symptoms in initial stage, they show multiple symptoms later on. These are -

• Presence of sores in the mouth or genital region
• Having pain during urination
• Burning sensation in urine
• Foul pus discharge through the penis/vagina
• Bleeding from the penis or vagina
• Presence of painful and swollen lymph nodes in the groin area
• Pain in abdominal region
• High fever
• Skin rashes
• Bleeding during urination or ejaculation.
• Changes in the ejaculation
• Discharge from penis
• Lesion with numbness
• Swelling/edema in the genitals and surrounding area