What is hypogonadism?
Hypogonadism is when the gonads (ovaries or testicles) produce little or no hormones. In young people, hypogonadism can be associated with delayed puberty and the failure to develop secondary sexual characteristics. In adults, hypogonadism can be associated with infertility, premature menopause, and loss of sexual ability.
What causes hypogonadism?
Primary hypogonadism is when the gonads themselves develop in such ways that they do not produce sufficient sex hormones to produce or maintain various aspects of sexual and reproductive anatomy and physiology. Sometimes this can be due to what kind of chromosomes a person has, such as Turner's syndrome or Klinefelter's syndrome.
Secondary hypogonadism is when the hypothalamus does not produce enough gonadotropin releasing hormone (GnRH) to stimulate the gonads to produce sex hormones. This can be due to a genetic condition, such as Kallmann syndrome. It can also be due to traumatic brain injury that affects the hypothalamus. Infections such as mumps, severe injury to the gonads, or certain drugs that affect the gonads such as prolonged opioid use can cause it.
Will my hypogonadism affect my gender affirming hormone treatment?
Having hypogonadism will not impact your gender affirming hormone treatment. Just like anyone else who is receiving gender affirming hormone treatment, your testosterone and oestrogen levels will be monitored regularly and your hormone doses will be adjusted accordingly.
I was born with testes and I'm receiving testosterone for my hypogonadism, but I identify as female and want feminising hormone treatment.
If you want to proceed with feminising hormone treatment, it would be fine to stop the testosterone and commence oestrogen at the same time. Your testosterone and oestrogen levels will be tested after three months to check your progress. This will indicate whether the dose of oestrogen needs to be adjusted and whether the addition of an antiandrogen is also advisable.
I was born with ovaries and I'm receiving oestrogen for my hypogonadism, but I identify as male and want masculinising hormone treatment.
If you want to proceed with masculinising hormone treatment, it would be fine to stop the oestrogen and commence testosterone at the same time. Your testosterone and oestrogen levels will be tested after three months to check your progress. This will indicate whether the dose of testosterone needs to be adjusted.
References
Madsen, M. C., Heijer, M. D., Pees, C., Biermasz, N. R., & Bakker, L. E. H. (2022). “Testosterone in Men with Hypogonadism and Transgender Males: A Systematic Review Comparing Three Different Preparations”. Endocrine Connections, 11 (8): e220112.
Meyenburg, B., andSigusch, V., (2001). “Kallmann’s Syndrome and Transsexualism”. Archives of Sexual Behavior, 30 (1): 75–81.
Renukanthan, A., Quinton, R., Turner, B., MacCallum, P., Seal, L., Davies, A., Green, R., Evanson, J., and Korbonits, M. (2015). “Kallmann Syndrome Patient with Gender Dysphoria, Multiple Sclerosis, and Thrombophilia”. Endocrine, 50: 496–503.