Sexual Hormone Disorders Treated in the Department
Polycystic Ovarian Syndrome (PCOS)
This disorder is characterized by oligomenorrhea (irregular menstrual cycles) or amenorrhea (no menstrual cycles) with symptoms of hyperandrogenism (extra male like hormones) such as acne and hirsutism (extra male like hair growth). This is the most common endocrine disorder in young females. Blood tests which may be elevated in this condition are testosterone and DHEAS. Cysts may be present on the ovaries but are not necessary for diagnosing this disorder. The underlying cause of this disorder is thought to be insulin resistance (poor response of body tissues to insulin). Therefore, blood sugar and insulin levels may also be evaluated. PCOS can result in obesity, infertility, diabetes, heart disease and uterine cancer. Exercise, weight loss and medications can be used to improve insulin sensitivity. Menstrual cycles can also be regulated with birth control pills.
Hirsutism is the growth of excessive hair in a male pattern. This would include face, chest, abdomen and back. This is usually due to the increased production of androgens (male hormones). Disorders in which hirsutism is seen include: polycystic ovarian syndrome, congenital adrenal hyperplasia, ovarian tumors or adrenal tumors. Blood tests are used to help determine a cause. Occasionally, there is no cause found for the hair growth (idiopathic hirsutism). Medical treatment varies by the underlying cause of the hirsutism. Topical treatments including electrolysis and laser can be used to decrease hair growth.
Androgen excess refers to the overproduction of male hormones. This can result from ovarian or adrenal tumors. Other disorders such as polycystic ovarian syndrome, Cushing’s syndrome (the overproduction of cortisol), hyperprolactinemia and congenital adrenal hyperplasia can cause extra male hormones to be produced. In women androgen excess can cause hirsutism ( excessive hair growth), acne, male pattern baldness, menstrual cycle irregularities and infertility. Diagnosis is generally made through blood tests. CT scans of adrenal glands and ovaries are occasionally needed. Treatments vary by the underlying cause of the androgen excess.
Menopause is defined as the cessation of menstrual cycles. This usually occurs at about the age of 50 in most women. For 2 to 8 years preceding this, menstrual cycles may be irregular. This is referred to as the menopausal transition or perimenopause. As estrogen and progesterone levels decline women may experience a variety of symptoms. These symptoms can include hot flashes, sleep disturbances, fatigue, irritability, decreased sex drive, vaginal dryness and depression. Long term estrogen deficiency can result in osteoporosis (thinning of the bones). Menopause is generally diagnosed by symptoms though blood tests can at times assist the diagnosis. A variety of treatments both estrogen and non-estrogen based can be used to treat menopausal symptoms. Several clinical trials have raised concerns about increased risk of breast cancer, heart disease, blood clots and stroke in women treated with hormone therapy. Because of these potential risks, hormone therapy needs to be individualized. Additional non-hormonal based treatments are available for treating symptoms associated with menopause and osteoporosis (thinning of the bones). For additional information on menopause, visit the Women's Health Center at Cleveland Clinic.
Hypogonadism refers to the decreased production of testosterone. This can result from the pituitary gland (master gland in the brain for hormone production) not stimulating the testicles to make testosterone or the failure of the testicles to produce adequate testosterone. When testosterone levels are low, men can experience decreased libido (sex drive), erectile dysfunction, decreased energy, decreased muscle mass and thinning of the bones. Testicle size may also decrease and sperm count decrease. Blood testing is done to diagnose hypogonadism and determine the cause. MRI (magnetic resonance imaging) of the pituitary or testicular biopsy may be needed in some cases. Testosterone when low can be replaced by injection, patches or topical gels.
Erectile Dysfunction (ED)
Erectile dysfunction is the inability to acquire or maintain an erection that is satisfactory for sexual intercourse. This may also be referred to as impotence. Any medical condition which can decrease blood flow to the penis may result in ED. Common causes of ED are smoking, diabetes, high blood pressure, alcohol and depression. Additionally, some prescription medications can also cause ED. A physical exam as well as history and blood tests can help determine the cause of the ED. When ED is caused by Hypogonadism then testosterone replacement therapy may be prescribed. Testosterone can be given in patches, gel or injections. For other causes of ED prescription medications may be tried. There are also vacuum erection devices, penile injections or penile prostheses which may be recommended. To learn more about ED visit the Glickman Urological Institute.
The increase in breast tissue in a man is referred to as gynecomastia. This can occur during puberty and resolve on its own. Gynecomastia can also be due to medications, hypogonadism, thyroid disease, malnutrition, testicular cancers, adrenal cancers, liver disease or kidney disease. The cause of the gynecomastia is usually determined by physical exam, history and blood tests. Additional testing may include testicular ultrasounds or CT scan.