Dr Praveen Ramachandra
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Reproductive Endocrinology Clinic

You're ready for baby, and you've tried getting pregnant but it's not as easy as you thought it would be. Did you know that 10% of couples face fertility issues? Dia plus Reproductive endocrinologists are here to provide leading fertility services and treatment options - to help you create the family you're ready for. Our compassionate reproductive endocrinologists specialize in diagnosing fertility issues.

Conditions we treat:



Hirsutism (HUR-soot-iz-um) is a condition of unwanted, male-pattern hair growth in women. Hirsutism results in excessive amounts of stiff and pigmented hair on body areas where men typically grow hair — face, chest and back.

The amount of body hair you have is largely determined by your genetic makeup. Hirsutism may arise from excess male hormones called androgens, primarily testosterone. Hirsutism may also be due to a family trait.

A combination of self-care and medical therapies provides effective treatment for many women with hirsutism.


Female/Male Infertility- hormonal causes

When the delicate balance of several different hormones goes wrong at some point in the body, infertility is one possible result. There are several health conditions that are specific to the endocrine (hormonal) system of the body. Two of the more common infertility-causing endocrine conditions are:

·         Hyperprolactinemia

·         Thyroid disease

·         There can also be other hormones that cause problems to become fertile.


Hyperprolactinemia is an overabundance of the hormone prolactin. Sub-fertility as a result of this increased level can occur in both men and women, and is found in up to one-third of women experiencing amenorrhea. Prolactin is secreted by the pituitary gland and is used by the pregnant female body to prepare breasts for milk production. The term “lactating,” often used to refer to nursing mothers, comes from “prolactin.”  Galactorrhea, noticeable milk production from the breasts that occurs spontaneously during times other than when nursing, is often seen in patients with hyperprolactinemia. Being able to express milky fluid by pinching the nipples is normal.

Thyroid disease

Thyroid Disease is relatively common and refers to any disorder of the thyroid gland. The thyroid is located in the base of the neck on both sides of the lower part of the larynx and upper part of the trachea. In some cases of disease, the gland becomes noticeably enlarged. The thyroid has a crucial role in the body’s metabolism. Thyroid disease can cause female infertility by resulting in anovulation (lack of ovulation) and menstrual irregularity, luteal phase defect, and hyperprolactinemia.

Men with thyroid disease can have resulting low sperm count and reduced sperm motility. Generally, women with Hashimotos, Thyroiditis (a kind of hypothyroidism) appear to have a slightly higher than normal risk of miscarriage.

Impotency- hormonal causes

Impotence means that a man's penis doesn't get hard enough to have sexual intercourse. The man cannot get or maintain an erection. The medical term is erectile dysfunction (ED). There are a number of hormonal imbalances which can result in impotence. These usually impact upon testosterone levels, often resulting in reduced production of this hormone which has serious consequences. One of these consequences is the failure to get or sustain an erection.

Hormone disorders account for only a tiny percentage of cases of impotence.

The following examples of hormonal conditions can cause impotence:

  • Cushing’s syndrome
  • Hyperthyroidism (over active thyroid)
  • Hypothyroidism (under active thyroid)
  • Hypogonadism
  • Adrenal gland disorders
  • Pituitary gland disorders
  • High oestrogen levels

Any situation where there are low levels of testosterone or an increase in the female hormone oestrogen can result in impotence.

Cushing’s syndrome

This occurs when tissues of the body are exposed to high levels of the hormone cortisol. This results in weight gain, particularly in the upper body, skin which is fragile and bruises easily, severe tiredness and high blood sugar levels.

Women with Cushing’s syndrome experience irregular periods whereas men develop erectile dysfunction.

Treatment involves cortisol-blocking drugs, chemotherapy, radiation and in some cases, surgery.


The common name for this is an over-active thyroid. This occurs when the body’s thyroid glands produce an excess amount of the hormone thyroxine. This causes many functions of the body to speed up, for example, the metabolism which results in weight loss.

Other symptoms include heart palpitations, anxiety, muscular weakness and a loss of libido. A loss of libido can lead to erectile dysfunction. 

Treatment for hyperthyroidism includes medication, radioisotope therapy and surgery although that it is only performed in rare cases.


The opposite of hyperthyroidism: this is the medical term for an under-active thyroid. In this case, the thyroid glands produce insufficient amounts of thyroxine which slows down many processes within the body.

Symptoms of hypothyroidism include weight gain, constipation, pale facial appearance, osteoporosis and a dry, itchy skin. It can cause menstrual irregularities in women and a reduced libido (and impotence) in men.

This condition is treated by administering thyroxine tablets which help to boost low levels of thyroxine in the blood stream.


This is a condition which affects both men and women. In women, the ovaries fail to produce sufficient levels of oestrogen and progesterone.

In men, the testes fail to produce enough testosterone which is essential for male fertility and many other important functions. This causes a drop in libido and in men, an inability to get an erection.

Hypogonadism is caused by the ageing process, accident or injury to the testes, smoking, excess alcohol consumption or as a side effect of certain medications.

Adrenal gland disorders

The adrenal glands are responsible for the production of the hormones testosterone and adrenaline. These are usually produced as a reaction to stress “ the ‘ fight or flight’ response. 

But problems can occur with these glands which causes too little or excessive hormone production. Examples of these include Addison’s disease, Cushing’s syndrome and congenital adrenal hyperplasia.

These can cause a loss of libido, impotence and infertility.

Pituitary gland disorders

The pituitary gland is responsible for the production of several hormones within the body that include prolactin, growth hormone and luteinizing hormone.

But problems can arise with the pituitary gland which impact upon other areas of the body. For example, an excess of prolactin in men can cause reduced testosterone levels, impotence and infertility.

High oestrogen levels

Oestrogen is a female hormone but men too have this hormone although only in tiny amounts. But men can produce high levels of this hormone which cause them to develop female secondary sexual characteristics. These impair their ability to get an erection and their fertility in general. Liver diseases such as cirrhosis cause erectile dysfunction in men which is a result of the effects of this condition and excess alcohol consumption (if their cirrhosis is caused by alcohol).Damage to the liver also causes a buildup of female sex hormones which lead to breast enlargement and a shrinkage of the testes in men.

Hormone abnormalities are uncommon but nevertheless, it is important to be aware of these as they do occur in a small percentage of cases.


Premature Menopause

Menopause that happens earlier than the expected age of around 50 years is called premature or early menopause.  This may be due to primary ovarian insufficiency where the periods spontaneously stop, as a result of chemotherapy treatment for cancer or surgically induced menopause when the ovaries are removed.  The impact on physical health, emotions, mood, body image and relationships can be significant, but there are treatment options and ways to manage premature and early menopause, which can help.


Puberty Disorders

Normal puberty begins between eight and 14 years of age in girls and between nine and 14 years of age in boys. Pubic hair distribution is used to stage puberty, along with breast size and contour in girls and testicular volume in boys. Some children experience constitutional sexual precocity, but precocity is likely to be pathologic if it occurs in very young children, if there is contra-sexual development or if the sequence of normal pubertal milestones is disrupted. Delayed puberty may be constitutional, but pathologic causes should be considered. The etiology of a pubertal disorder can often be determined with the use of a focused medical history, a directed physical examination and appropriate diagnostic tests. Treatment for disorders of puberty is determined by the underlying cause.

Puberty is a process leading to physical and sexual maturation that involves the development of secondary sexual characteristics as well as growth, changes in body composition and psychosocial maturation.


Sexual Dysfunction

Sexual dysfunction refers to a problem occurring during any phase of the sexual response cycle that prevents the individual or couple from experiencing satisfaction from the sexual activity. The sexual response cycle traditionally includes excitement, plateau, orgasm, and resolution. Desire and arousal are both part of the excitement phase of the sexual response.

While research suggests that sexual dysfunction is common (43 percent of women and 31 percent of men report some degree of difficulty), it is a topic that manypeople are hesitant to discuss. Because treatment options are available, it is important to share your concerns with your partner and health care provider.

Sexual dysfunction generally is classified into four categories:

  • Desire disorders —lack of sexual desire or interest in sex
  • Arousal disorders —inability to become physically aroused or excited during sexual activity
  • Orgasm disorders —delay or absence of orgasm (climax)
  •  Pain disorders — pain during intercourse.