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Decreased testosterone production or action

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Reduced testosterone production or action is often associated with increased plasma gonadotrophin levels but not necessarily, with increased plasma oestrogen.

Congenital causes include:

  • Klinefelter's syndrome - seen in about 80% of Klinefelter patients, these patients clearly carries an increase risk (10-fold to 20-fold greater than normal) of breast cancer (1)
  • testicular feminisation and Reifenstein syndrome
  • congenital anorchia - rare - individuals are 46, XY males with normal male phenotype but missing testes. The testes are thought to have been present originally but then to have regressed late in embryonic life
  • biochemical defects in testosterone synthesis

Secondary testicular failure may also occur in:

  • viral orchitis - the most common cause of testicular failure after puberty; especially, mumps
  • trauma - the second most common acquired cause in adults
  • castration
  • renal failure - gynaecomastia is found in half of the men undergoing haemodialysis for renal failure
  • neurological diseases such as myotonic dystrophy - gynaecomastia occuring in three quarters of cases - and spinal cord lesions
  • granulomatous disease such as leprosy

Reference:


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