Male hypogonadism, also known as testosterone deficiency, is a failure of the testes to produce the male sex hormone testosterone, sperm, or both.Testosterone play an important role in sperm production.This condition can be due to a testicular disorder or the result of a disease process involving the hypothalamus and pituitary gland.

This is of two types including:
Primary type of hypogonadism is also known as primary testicular failure, which originates from a problem in the testicles.
Secondary type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland through which parts of the brain that signal the testicles to produce testosterone
Either type of hypogonadism may be caused by an inherited (congenital) trait or something that happens later in life (acquired), such as an injury or an infection. At times, primary and secondary hypogonadism can occur together.

Common causes of primary hypogonadism include:
1. Klinefelter syndrome
2. Undescended testicles
3. Mumps orchitis
4. Hemochromatosis
5. Injury to the testicles
6. Cancer treatment

Causes of secondary hypogonadism:
A number of conditions can cause secondary hypogonadism, including:
1. Kallmann syndrome
2. Pituitary disorders
3. Inflammatory disease
4. HIV/AIDS
5. Medications
6. Obesity
7. Concurrent illness

How Is Hypogonadism Diagnosed?
Your doctor will conduct a physical exam to confirm that your sexual development is at the proper level for your age. They may examine your muscle mass, body hair and your sexual organs.

Treatment
Testosterone replacement therapy (TRT) is the most commonly administered as a topical gel, transdermal patch or by injection and is the recommended treatment for male hypogonadism.

You can get testosterone replacement therapy by:
injection
patch
gel
lozenge
Injections of a gonadotropin releasing hormone may trigger puberty or increase your sperm production.

Patients can also improve testosterone levels with lifestyle changes, including:
1. Losing weight
2. Exercising
3. Managing stress
4. Getting adequate sleep
5. Avoiding alcohol
6. Giving up smoking.

In adult males, hypogonadism may alter certain masculine physical characteristics and impair normal reproductive function.

Types and Causes of Male Hypogonadism

Syphilis is a STD caused by the bacterium Treponema pallidum. It has several stages, like primary, secondary, latent and tertiary and is common in homosexual men. It should be remembered that Syphilis is curable. It can be treated, if diagnosed in early stage. It can be cured, if medical help is sought for. Sharing toilets, clothes, or utensils doesn t cause this disease. It will vanish forever, if treated at once. However, it can be reinfected if exposed to the bacteria through new syphilis sore. It can also spread, if transmitted by direct touch or contact with Syphilitic sore via anus, skin surface, vagina, mouth and lips. It is very rare though that syphilis can be spread during a kiss.

Syphilis can live within the body for months, even years or decades. Initially, it remains as a painless sore on the genitals like anus, vagina, mouth or skin surface. If present for many years, there is an increased risk of contracting HIV.

Causes
The major causes of syphilis are unsafe sex with homosexual partners and the practice of having unprotected sex like anal, vaginal and oral sex. Individuals who have multiple sexual partners and are specially sexually linked to HIV-infected persons have the highest risk of contracting Syphillis.

It can not only be spread through multiple sexual unsafe intercourses, but also has its high risk in spreading from mother to baby during pregnancy; commonly unknown as congenital syphilis. In such cases, the baby has low birth weight and can develop cataract, deafness or seizures. In some cases, even new born babies die from the disease.

Diagnosis
The doctor will first conduct a physical examination of the patient. Thereafter, blood and urine are collected for bacterial test. If a sore is found on the body, the doctor may collect a sample from the sore to examine the presence of syphilis bacteria. If there are nervous system disorders in the patient, a spinal tap or lumbar puncture is done to collect the spinal fluid. The fluid is then tested for syphilis bacteria.

Treatments for syphilis
Initially, syphilis is treated with penicillin. It has to be kept in mind that long-term exposure to the disease can have life-threatening consequences. Patients suffering from syphilis are either given a single dose or multiple doses of penicillin. The quantum of the dose depends on the nature of symptoms and the infection. Individuals must use condoms to reduce the risk of transmitting the disease while having sexual intercourse. In the case of penicillin allergy, the patient is recommended to have alternative medicines. Infants and newborns born with syphilis undergo antibiotic treatment.

Syphilis - How to Diagnose And Treat It?

From a medical standpoint, sex during menstruation is completely fine. Most men have claimed that period sex seems messier when compared to intercourse on normal days, but, other than that, there aren t any risk regarding period sex. In fact, it is advisable to engage in vaginal intercourse during periods for a variety of reasons.

Here are a few things you should know about period sex:

Intercourse during periods isn t harmful: Contrary to the popular myth, period blood doesn t contain impurities which might affect the penis in any way. Instead, menstrual blood is normal blood mixed with disposed off tissues from the lining of the uterus and the penis isn t affected by menstrual blood in any way. The menstrual blood serves as excellent lubricant to make the process of intercourse smoother.
Chances of pregnancy still persist: It is not okay to completely ward off protective measures during periods because even though it is safer than other days, there might be a small chance that the sperm of a man lives on in the female body till early ovulation. Besides, the chance of getting a sexually transmitted disease is the same during period sex.
Can relieve cramps: Some women claim that having sex during their period helps ease their cramps as having an orgasm releases  pain- reducing endorphins  into the bloodstream. Also, some medical practitioners believe that sex provides relief by using up chemicals which are responsible for cramps. Thus, having period sex can prove to be relaxing and less painful than normal days.
Sexual arousal ups during menstruation: Most women feel hornier and more aroused during periods because of the increase in the hormonal levels. Some women feel heavier in the pelvic area which increases the sex drive; precisely the reason why having sex during this time is a good idea. So, for all you know, you might actually have a brilliant intercourse session when she s on her period.

Sex During Periods - What Should You Know About It!

Knowing Premature Ejaculation - PART 2: Diagnosis, Types & Causes

As many as 30-40 % men across the world including India experience problem of PE at some time of life. In Part 1, we learnt about the condition called Premature Ejaculation (PE). In this 2nd part, let’s understand about it’s diagnosis & types of PE - why and how it happens.

How to Diagnose PE:

The specific criteria for premature (early) ejaculation are as follows:
- In almost 75-100% sexual activity, the experience of ejaculation occurring during sexual intercourse within 1 minute after vaginal penetration and before the individual wishes it.
- The problem has persisted for at least 6 months and is a cause of mental stress to the person.
- The dysfunction cannot be better explained by any other nonsexual mental disorder, any medical disease, the effects of a drug or medication, etc
 
Severity of PE:
 
The severity of premature (early) ejaculation is broadly defined as follows:
1. Mild (occurring within approximately 30 seconds to 1 minute of vaginal penetration)
2. Moderate (occurring within approximately 15-30 seconds of vaginal penetration)
3. Severe (occurring even before sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration). In such cases conception will not be possible unless artificial insemination is used.
 
TYPES and Characteristics of P.E. :
Premature ejaculation can be Chronic (lifelong) or Acquired (recent).
Chronic PE:
With chronic (lifelong) premature ejaculation, the person has been experiencing premature ejaculation since he became sexually active (ie, post puberty). 
Acquired PE:
Acquired (recent) premature ejaculation means that the condition began in an individual who previously experienced an acceptable level of ejaculatory control and only recently has developed PE.

What are the Causes?
The causes of PE can be divided into two broad sub-heads, which are psychological or biological cause:
 
 
1. Psychological Causes:
Premature ejaculation is believed to be a psychological problem and does not represent any known organic / physical disease involving the male reproductive organs or any known defect in the brain or nervous system. It is usually due to a pattern that is hard to change and is a result of your previous sexual experiences.
 
One of the most common reason is childhood habit of reaching climax/ ejaculation quickly because of fear of discovery when masturbating or during early sexual experiences with a female partner. This pattern of rapid attainment of sexual release is difficult to change in later stage of life (in marriage or long-term relationships).
 
Other reasons are situations in which one may have hurried climax/ ejaculation in order to hide any problem or feelings of guilt that make you rush through sexual encounters. Also, psychological causes include anxiety and relationship issues which can also result from deep anxiety about sex that relates to bad experiences encountered by the patient during development (eg: incest, sexual assault, conflict with parents, etc ).
 
2. Biological Causes
 
A number of researchers have found differences in nervous stimulations and hormonal differences in men who experience premature ejaculation compared with individuals who do not.
 
Some believe that some men have hyper-excitability or oversensitivity of their genitalia.
 
Abnormal functioning of the ejaculatory system can be attributed to:
- Thyroid problems; infection or inflammation of the urethra or prostate.
- Nerve damage occurring due to trauma or surgery (a very rare cause).
- Abnormal levels of hormones and/or neurotransmitters (chemicals present in the brain)
- Higher free and total testosterone levels or varied other biochemical markers
*The research however has been non-conclusive.

In Part 3 and 4, we will discuss the right approach and therapy for the men / couple suffering due to PE.



Knowing Premature Ejaculation - PART 2: Diagnosis, Types & Causes

Testosterone is often the subject of jokes but an insufficiency of this hormone is no laughing matter. Along with affecting your sex drive, low levels of testosterone can also affect your ability to concentrate on tasks, lead to high blood pressure and cholesterol. Additionally, it can increase your risk of obesity and type 2 diabetes. Here are a few signs that could indicate low levels of testosterone-

Decreased Libido: With age, you may experience a lowered libido but a sudden decline in your sex drive could be caused by a lack of testosterone.

Erectile Dysfunction: Lowered levels of testosterone in the body can affect the release of nitric oxide necessary for an erection. Men suffering from lowered testosterone levels often find themselves either not able to have an erection or have erections that are not firm enough for intercourse.

Fatigue: Feeling tired at the end of a day is normal but men who have lowered testosterone levels may find themselves feeling extremely tired by lunchtime. You may also notice a loss of drive and enthusiasm.

Moodiness: Men with low levels of testosterone often become depressed and dejected. They feel less optimistic than normal and become more irritable.

Reduced Muscles: Testosterone is linked to muscle building and hence a lowered level of testosterone can be indicated by a reduction in the arm, chest or leg muscles. Men with low testosterone also find it difficult to build muscle mass.

Lowered Attention Span: Testosterone is responsible for focus and attention. Hence, trouble concentrating on work and memory problems can be seen as signs of lowered testosterone levels.

Development of Breasts: The lack of testosterone can cause an imbalance of oestrogen to testosterone ratio in the body. As the oestrogen levels get higher, men may find themselves growing breast tissue. This condition is also known as gynecomastia.

Bone Problems: A lack of testosterone can affect bone density. This may lead to osteoporosis like conditions and joint pains. Men with low testosterone levels are also more prone to injuries.

Lowered Semen Production: Testosterone is directly linked to semen production. The lower a man s testosterone levels, the lesser the amount of semen produced.

Hair Loss: Many men experiencing lowered testosterone levels suffer from hair loss on their head and other parts of the body as well.

The good news is that this disorder can be treated. Hence, if you find yourself experiencing any of these symptoms, consult a doctor at the earliest.  

10 Warning Signs of Low Testosterone

Female infertility is considered as the inability of conceiving. As per WHO it is described as the inability to be pregnant, maintain and carry forward a pregnancy to its full term. It is often of two types:

    Primary Infertility: This is the inability to give birth to a baby either due to the inability to become pregnant or maintain a pregnancy, which includes stillborn and miscarriage.
    Secondary Infertility: This refers to the inability to give birth when there is already a live birth or the woman was pregnant.

The causes of infertility can vary from being acquired or genetic. However, following factors are largely responsible for infertility:

    Genetic: Some genes can lead to mutation leading to infertility like, in case of BMP15 gene there is a hypergonadotrophic ovarian failure which causes infertility.
    Acquired: This is caused by factors like age, smoking, sexually transmitted diseases, obesity, body weight, eating disorders, diseases like diabetes, thrombophilia and also radiation and chemotherapy.

The treatment for infertility usually depends on the cause, age, duration of time for which a person has been infertile and preference of the patient. Infertility is believed to be a complex disorder and the treatment involves a huge amount of physical, financial and psychological commitments. All this also requires a lot of time. Some women might need just a minimum of two therapies to attain fertility while others might require different treatment before they can conceive.

Treatment is largely aimed to restore the fertility either by means of medication and surgery or help in reproduction with the help of some procedures.

Fertility Restoration through medication

This is the main treatment for women who are infertile because of ovulation disorders. These drugs include:

    Gonadotropins: These are injected to stimulate the ovaries. Drugs like Menopur, Repronex, Follistim AQ, Gonal-F, Bravelle restore the production of eggs, while Ovidrel and Pregnyl are used for maturing the eggs and for their release.
    Clomiphene citrate: This is taken orally and stimulates ovulation by releasing more Follicle Stimulating Hormone and Luteinizing Hormone from the pituitary gland.
    Metformin: This is used in females who have PCOS and also when insulin resistance plays a major role in infertility.
    Bromocriptine: Used when the infertility is caused due to excess prolactin production.
    Letrozole: This also induces ovulation

Fertility Restoration through surgery

Surgical procedures can amend the problem of infertility. However, these treatments are very rare these days owing to the success of other fertility treatments. These include:

    Tubal ligation reversal surgery: In case a tubal ligation has been performed it can be reversed by reconnecting the tubes again through surgery.
    Hysteroscopic surgery: This corrects or removes the abnormalities that cause infertility. This surgery can correct the shape of the uterus, remove endometrial polyps and improve chance of getting pregnant.
    Tubal surgeries: In case of blocked fallopian tubes laproscopic surgery can be performed to dilate the tubes, removed blockages or create a new opening.

Assistance in Reproduction through techniques

The most common used techniques for reproduction assistance are:

    Intrauterine insemination or IUI: In this about million healthy sperms are put in the uterus at the time of ovulation.
    Assisted reproductive technology: In this mature eggs are retrieved from a woman and this is then fertilized with sperms in a dish in the lab. Once the fertilization is done the embryo is placed in the uterus for further development. IVF is the most common and effective assisted reproductive technology. This procedure takes place over weeks with several blood tests and hormone injections.

Dealing with infertility is not easy and can be emotionally and physically draining. To cope with the various tests and treatments of infertility one should be fully prepared, eat a healthy diet, exercise reach out for help and support of family and friends and look for other options like a donor egg, adoption or no children.

Treatments of Infertility

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