What is the Origin of Iatrogenic Secondary Hypogonadism?

The term combines three distinct clinical concepts: "Iatrogenic," from the Greek iatros (physician) and genesis (origin), meaning caused by medical activity; "Secondary Hypogonadism," indicating a pituitary or hypothalamic cause rather than a primary gonadal failure; and "Hypogonadism," a deficiency in sex hormone production. This precise nomenclature is necessary for accurate differential diagnosis and effective clinical management in endocrinology.

What is the Mechanism of Iatrogenic Secondary Hypogonadism?

The introduction of high levels of exogenous sex steroids, such as testosterone or estrogen therapy, activates a powerful negative feedback loop to the hypothalamic-pituitary axis. This feedback significantly suppresses the pulsatile release of Gonadotropin-Releasing Hormone (GnRH) from the hypothalamus, which in turn diminishes the pituitary's secretion of LH and FSH. Without adequate LH and FSH stimulation, the gonads cease or severely reduce their endogenous production of testosterone or estradiol, leading to the clinical state of secondary hypogonadism.

Iatrogenic Secondary Hypogonadism

Meaning

A clinical condition characterized by deficient function of the gonads, specifically the testes or ovaries, resulting from a suppression of the pituitary gland’s production of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH), which is caused by a medical intervention or treatment. The term emphasizes the secondary nature of the hypogonadism, meaning the primary failure lies in the pituitary or hypothalamus, and the iatrogenic origin, indicating it is physician-induced. The most common cause is the administration of exogenous sex steroids or certain opiate medications.