Feb 2015|Vol 12|Is 2

   
 
Case
 
   
Dynamic perspectives in Male Hypogonadism
 

 

Dr.R.Gnanasambandam, a renowned clinician and academician, research scholar writes and shares his views in this article for efficacy of Homoeopathy in Hypogonadism treatment. He had authored books and articles published in scientific journal. He also presented many papers in the scientific conferences, lectured in many Homoeopathic Medical Colleges. He served in many positions in the state and central Government. He can be contacted at 6, Llyod's II Lane Royapettah, Chennai -600014

 
 
 

Introduction

      We know that the deficiency of critical hormone Testosterone results in Male hypogonadism which is responsible for sexual, cognitive and body development. Clinically low testosterone levels can lead to the absence of secondary sex characteristics which ultimately lead deviation in masculinity of an individual. Less beard and moustache cause social embarrassment, Gynacomazia is trouble some, dragging many psychosomatic complaints. Low testosterone levels may be due to testicular, hypothalamic, or pituitary abnormalities.. Clinically similimum applications are hopeful than hormone replacement therapy.

Understanding the pathophysiology

      We know that the Testosterone, male sex hormone, is secreted more from the testes and small amount from adrenal cortex and skin. The Leydig cells in the testes are responsible for production of this hormone and Sertoli cells are for spermatogenesis.

      The secreted testosterone enters the blood stream, liver metabolised mostly to Sex Hormone binding globulin (SHBG) and less amount with serum albumin. Only a small portion is unbound and “Free” Like other hormones, the relative binding ability of SHBG with various hormones to reach the target cells. Undergoes changes as Dihydrotestosterone by a special enzyme 5 a reductase, which is responsible for beard and Moustache growth, accelerated growth with musculature and deepening of voice. The hair growth involves pubic, axillary, chest, hands and legs. The effects of testosterone are visible as libido, penile erections, aggression, and mental and physical energy.

      The hormones are the derivative of Cholesterol , hence the deviation in Testosterone – oestrogen ratio ultimately raise the adiposity , when testosterone falls, raised oestrogen will increase in development of Breast tissue resulting in Gynacomazia, over all flabbiness and disorders in cognition.

      The Leydig cells are controlled by Luteinising hormone (LH) and Follicular stimulating Hormone (FSH). The amount of testosterone synthesized is regulated by the hypothalamic–pituitary–testicular axis. When testosterone levels are low, gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, which in turn stimulates the pituitary gland to release FSH and LH. These latter two hormones stimulate the testis to synthesize testosterone. Negative feedback mechanism to hypothalamus in increase or decrease will have inhibition on the pituitary and hypothalamus.

      Hence evaluation of Total Testosterone along with free testosterone, SHBG gives valuable information to locate underlying problems. A simple test of seminal analysis could give whole understanding of a patient.

Clinical Organon

      Hahnemann had classified the clinical presentations in to different classes, types, and sub-types with a clear message. Each class of the cases demands a different method of prescription and approach. We can fix the causative factors of Hypogonadism to Hahnemann’s classical Classification.

      The ailment is purely, poorly developed symptoms and chronic in nature, hence we can fix the causation of testicular failures, atrophy and congenital malformations to the one sided disease, and apparently the physical and mental manifestations can be established. Here we can attribute that affection of internal kind, bringing the affection externally as local maladies disseminating in retarding the moustache, beard growth, which calls for complete portrait of the disease in accordance with Aphorism No 5

      The causative factors such as infections, exciting, maintaining causes, unbalance mental equilibrium make every one consider the classification under the main class as “Disease with fully developed symptoms” which calls a special attention on understanding on miasms. Its expression may be single or overlapping each other
The etiology of trauma falls under surgical Disease, the Testicular failure due to several factors with fully developed symptoms. The congenital deformity is internal, hence the clinical application is very easy considering the classification of the disease offered by Hahnemann to out line the portrait of a patient fixing to a totality, constitutional and miasmatic perspectives

Clinical Materia Medica

      Homoeopathic Materia Medica is pooled with much symptom similarity on Male Hypogonadism cases. Anamnesis can be made out on several remedies which could make a physician to prescribe and arouse the dynamism. Drug of choice of a physician may vary, but understanding the constitution of the patient with miasmatic interpretation would shorten the time and also benefits the patient.

      Clinically anamnesis of drug Aurum Metalicum would appear every one’s mind since the most of the symptoms categorised to make similarity. The key features “Boyish Go”, poor cognition, poor physical activity, syphilitics traits and undecended testes usually drag a patient to depression to express his frustrations as “Constantly dwelling on suicide”.

      The drug pulsatilla had been clinically appreciated by many for its clinicity on mumps and its sequele “Orchitis”. Bromium has left sided orchitis and in clematis the induration of testes results from gonorrhoea. The drugs Rhododendron, Mercurius, Cantharis, Canabis Sativa, Terebinth are quite useful in infections of Genito urinary tract. The drugs Lycopodium Clavatum and Selenium are quite useful in sexual neurasthenia.

Some glimpses on Therapeutics could give more inspiration

Aurum Metallicum

      The signs and symptoms of Hypogonadism matches the similarity of symptoms of this drug may call prescription. The indications are undeveloped testes, constantly dwelling on suicide. Lacking in Boyish Go, withered cognition impaired, physical mental activity are poor, Syphilitic features may call a physician to prescribe

Pulsatilla

      The cases with history of Orchitis following mumps may call this remedy since the Pulsatilla, has metastatic features of mumps and induration of testes. Affinity over left sided mumps. When Orchitis is suspected without mumps the drugs Bromium phytoccaca Decandra mercurius may fit the similarity

Lycopodium Clavatum

      The principle remedy which matches the Hypogonadism patients matching the functional dysfunction, Most suitable for Hypothalmus Piturary. Testicular axis failures. Erectile dysfunction with sycotic manifestations, testicular cyst, Epididymal cysts, obstructs may invite this remedy. Erectile Dysfunction in young or old with penis relaxed during excitement.

Selenium

      Selenium is highly useful in sexual debility, resulting from perversions, dribbling of semen and prostatic fluid during sleep

Agnus castus

      The drug is useful in erectile dysfunction following Urinary tract infections. Selenium and caladium follows well after. In caladium the penis is relaxed during excitement results from mental depression, Lycopodium also has similar relaxed. Nuphar leuteum, Voluntary emissions, during stool or urine. Picric acid sudden dysfunction.

Tribulus Terrestris

      The Indian drug is useful in Q potencies to improve semen viscosity

Damiana

      Another effective drug in Q potencies in erectile dysfunctions. The patient gives history of burning micturition

Salix Nigra

      The drug is useful in low potencies and Q potencies for loss of libido. Yohimbinum and cantharis also helpful

Hamamelis

      Haemamelis is a useful drug in varicoceles. Pain along the course of spermatic cord calls the remedy. Nitric Acid also useful

Clinical applications

      We are about to neglect the cases of male Hypogonadism fixing the causative factors as chromosomal, congenital disorder and hopeless. Even though certain group falls, most of them falls under acquired or failure in inhibition in the hypothalamo – pituitary- testicular axis.
      While handling a case of Hypogonadism, a though past history, family history, treatment history will illustrate the pathophysiology in every individual. The cases usually comes for screening when abnormal obesity or flabbiness with gynecomazia during the age of puberty. Failure in beared, moustache growth may bring to parents attention when a boy is depressed on social embarrassment. The patient usually raises doubts on personal development of sexual organs and doubts on libido. Many of them are depressed, feel shy, and refuse marriage, cumulating with psychosomatic illness
In early days of my practice I came across a case of Male Hypogonadism. A boy aged 20 years was brought to me retarded beard and moustache growth. Initially he consulted a endocrinologist and advised him to undergo testosterone study. The reading was 158ng/dl( Plate 1) His parent’s opted Homoeopathic treatment since the endocrinologist advised him to take course of hormone injections. Personal history and physical examination revealed normal. Lycpodium 1M was prescribed on understanding the psoric manifestations followed with selenium 200. After four months treatment, the serum testosterone level increased to 501ng/dl.(Plate II) During the course of treatment, he had facial hair growth improved and voice deepened

      Here we can understand that failure in stimulation from the Hypothalamus Pituitary – testes axis is stimulated by action of dynamic medicines on dynamic plane. Hence action is sustained to release the male hormone testosterone attributing changes in SHBG – Dihydro testosterone levels to stimulate the hair apparatus
Another boy aged 20 years was brought to homoeopathic treatment for obesity. He was so lethargic, flabby and weighed 81 kg. Observation revealed that his face without hair growth; breasts were enlarged on both sides and also had feminine voice. The physicians advised him to undergo surgery for Gynacomastia Blood study for serum testosterone was 485 ng/ dl and SHBG was 30.2 nmol/L (Plate III) and the ultra sonogram studied to have small testes. He had homoeopathic treatment, after one year's treatment his musculature, facial hair growth, voice change to masculinity and reduction in breast size was observed Blood studies also corroborated the bodily changes – Testosterone Total 533 ng/dl and SHBG was 32.2 nmol/L. (Plate III)

      Here the boy had sedentary habits from childhood, Fearful and never assign any work on his own. The choice of remedy was Calcarea Car fitting constitutionally and miasmatic expressions

      Clinically obstruction in the blood flow may cause deficient functioning of testicular function. Varicocele in young adults may sufer from low testosterone levels, consequently fall in seminal count, sparse facial hair growth. Similimum has clinical proved in many cases with successful result without surgery.

 

      A male aged 39 years, who is longing for a child since three years consulted me for low sperm count with bilateral varicocele. After one year of married life the couple underwent routine checkup. Male partner was reported after screening oligospermic with bilateral varicocele (Plate V). Past History revealed flabbiness from childhood, moderate increase in size of the breast and diminished facial, chest hair growth. He also suffered from erectile dysfunction. He received Lycopodium constitutionally and miasmatically, later on followed with Nitric Acid 200 on key expression of pain.

      The seminal count which was 1-2 /ml (Plate VI) had improved to 50 millions/ml.(PlateVII) This case illustrates that marginal increase in testosterone increased the sperm count and libido

Conclusion

      Homoeopathy will be the choice of Medicine in Hypogonadism. Even though the service is limited hopefully gives unexpected results, benefiting the community. Best results can be achieved by understating the constitution of the patient and applying the integral part miasmatic expressions which shortens the time and benefits

References
1. Organon of Medicine 6th Edition
2. Allen’s Key Notes and Characteristics – H.C.Allen
3. Leaders In Homoeopathic Therapeutics by E. B. NASH
4. Homœopathic Materia Medica by William BOERICKE, M.D.