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
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
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
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
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.
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
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
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
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 is highly useful in sexual
debility, resulting from perversions, dribbling of semen and prostatic
fluid during sleep
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.
The Indian drug is useful in Q
potencies to improve semen viscosity
Another effective drug in Q potencies
in erectile dysfunctions. The patient gives history of burning
The drug is useful in low potencies
and Q potencies for loss of libido. Yohimbinum and cantharis also
Haemamelis is a useful drug in
varicoceles. Pain along the course of spermatic cord calls the
remedy. Nitric Acid also useful
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.
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
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
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.