Hypogonadism (Low Testosterone)

What is Hypogonadism?

Low testosterone, also known as hypogonadism, is a condition where the body does not produce enough of the hormone testosterone. Testosterone is crucial for maintaining muscle mass, bone density, and sexual function. Low levels can affect overall health and quality of life.

Symptoms of Low Testosterone May Include

• Decreased libido or sexual desire
• Erectile dysfunction
• Fatigue and decreased energy
• Loss of muscle mass and strength
• Increased body fat
• Mood changes, such as depression or irritability

The Two Types of Hypogonadism (Low Testosterone)

Primary Hypogonadism

This type of hypogonadism, also known as primary testicular failure, originates from a problem in the testicles.

Common causes of Primary Hypogonadism

• Klinefelter syndrome: This condition results from a congenital abnormality of the sex chromosomes - X and Y. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.
• Undescended testicles: Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum.
• Mumps orchitis: If a mumps infection involving the testicles in addition to the salivary glands (mumps orchitis) occurs.
• Hemochromatosis: Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
• Injury to the testicles: Because they're situated outside the abdomen, the testicles are prone to injury.
• Cancer treatment: Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production.

Secondary Hypogonadism

In secondary hypogonadism, the testicles are normal but function improperly due to a problem with the pituitary or hypothalamus.

Common Causes of Secondary Hypogonadism

• Kallmann syndrome: Abnormal development of the hypothalamus, the area of the brain that controls the secretion of pituitary hormones, can cause hypogonadism.
• Pituitary disorders: An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production.
• Inflammatory disease: Certain inflammatory diseases, such as sarcoidosis, histiocytosis, and tuberculosis.
• HIV/AIDS: Can cause low levels of testosterone by affecting the hypothalamus, the pituitary, and the testes.
• Medications: The use of certain drugs, such as opiate pain medications and some hormones, can affect testosterone production.
• Obesity: Being significantly overweight at any age may be linked to hypogonadism.
• Normal aging: Older men generally have lower testosterone levels than younger men do.
• Concurrent illness: The reproductive system can temporarily shut down due to the physical stress of an illness or surgery, as well as during significant emotional stress.

Potential Complications of Hypogonadism

The complications of untreated hypogonadism differ depending on what age it first develops — during fetal development, puberty, or adulthood.

Fetal development: A baby may be born with:

• Ambiguous genitalia
• Abnormal genitalia

Puberty: Pubertal development can be delayed or incomplete, resulting in:

• Diminished or lack of beard and body hair
• Impaired penis and testicle growth
• Disproportional growth, usually increased length of arms and legs compared with the trunk
• Enlarged male breasts (gynecomastia)

Adulthood: Complications may include:

• Infertility
• Decreased sex drive
• Fatigue
• Muscle loss or weakness
• Enlarged male breasts (gynecomastia)
• Decreased beard and body hair growth
• Osteoporosis

Additional Complications:

Carries various risks, including contributing to:

• Sleep apnea
• Stimulating noncancerous growth of the prostate
• Enlarging breasts, limiting sperm production
• Heart attack
• Stimulating growth of existing prostate cancer
• Blood clots forming in the veins

Who is at Risk for Low Testosterone?

Risk factors for low testosterone may include:

• Genetics: A family history of hormonal disorders can increase the risk.
• Sex: Low testosterone primarily affects men, but women can also experience low levels due to various health issues.
• Age: Testosterone levels naturally decline with age, starting around age 30.
• Other Risk Factors: Obesity, chronic illnesses (such as diabetes or liver disease), certain medications, and stress can contribute to low testosterone levels.

How Many Americans Have Low Testosterone?

It is estimated that approximately 4 to 5 million men in the United States have low testosterone levels, though many cases remain undiagnosed.

Diagnosis & Management

Treatment Options for Low Testosterone (Hypogonadism)

Medical and Pharmaceutical Treatments

• Hormone Replacement Therapy (HRT): Includes testosterone injections, patches, gels, or oral medications to restore testosterone levels.
• Medications: Other medications might be used to address underlying causes of low testosterone or manage symptoms.

Lifestyle Interventions

• Exercise and Diet: Regular physical activity and a balanced diet can improve overall health and support hormonal balance.
• Weight Management: Maintaining a healthy weight can help manage and potentially improve testosterone levels.
• Stress Reduction: Managing stress through techniques like mindfulness or therapy can support hormonal health.

Treatment for Young Males

In boys, testosterone replacement therapy (TRT) can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis. Pituitary hormones may be used to stimulate testicle growth. An initial low dose of testosterone with gradual increases may help to avoid adverse effects and more closely mimic the slow increase in testosterone that occurs during puberty.

Types of testosterone replacement therapy: Several testosterone delivery methods exist. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost. Methods include:

• Injection: Testosterone injections (testosterone cypionate, testosterone enanthate) are safe and effective.
• Patch: A patch containing testosterone (Androderm) is applied each night to your back, abdomen, upper arm, or thigh.
• Gel: There are several gel preparations available with different ways of applying them. Depending on the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo), apply with an applicator under each armpit (Axiron), or pump on your front and inner thigh (Fortesta).
• Gum and cheek (buccal cavity): A small putty-like substance, gum and cheek testosterone replacement (Striant) delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity). This product quickly sticks to your gumline and allows testosterone to be absorbed into your bloodstream.
• Nasal: Testosterone can be pumped into the nostrils as a gel.
• Implantable pellets: Testosterone-containing pellets (Testopel) are surgically implanted under the skin every three to six months.

Oral testosterone isn't recommended for long-term hormone replacement because it might cause liver problems.

Have You Been Diagnosed with Low Testosterone?

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Resources

• Male hypogonadism - Symptoms & causes - Mayo Clinic
• Mayo Clinic Minute: How low testosterone can affect men's health - Mayo Clinic News Network
• Mayo Clinic Minute: Low testosterone levels can affect men - Mayo Clinic News Network
• Top 3 Myths vs. Facts when it comes to Low Testosterone - American Urological Association (auanet.org)

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