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Male Hypogonadism In Depth: Symptoms, Diagnosis, And Treatment Options

Male hypogonadism, also referred to as low testosterone or low T, is a hormonal disorder that affects biological males. While it has many potential symptoms and affects everyone differently, low testosterone occurs when the body doesn’t produce enough testosterone, a vital sex hormone in men.

Low testosterone is one of the most common hormone problems that men can have, and between 2.1% and 38.7% of men struggle with it.1 However, because most men don’t get tested or even know they have hypogonadism, the percentage is likely much higher.

If you’re worried that you might have low testosterone levels and want to know what you should do next, you’ve come to the right place. From the most common symptoms to how it’s diagnosed and treated, this article will take a deep dive into everything you need to know about low testosterone.

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What is Male Hypogonadism? An Overview

Simply put, hypogonadism is a condition that affects males in which the Leydig cells in the testicles produce inadequate amounts of testosterone or no testosterone at all. This is problematic because testosterone is the primary sex hormone for males and is responsible for many functions throughout the body.

As the main male sex hormone in the body, testosterone helps with the production of sperm, which is essential for fertility. It’s also essential for muscle growth, bone density, mood stabilization, red blood cell production, and the development of the testicles.

Understanding The Types of Hypogonadism

There are two primary types of male hypogonadism, which are named for what part of the brain is responsible for inadequate levels of testosterone.

Primary hypogonadism occurs when your body doesn’t produce enough testosterone because of a problem with your testicles. With this type of hypogonadism, your brain is sending signals to your testicles that they need to produce testosterone. However, because of an issue inside the gonads, little to no testosterone is produced.

If your testicles are in working order, but your brain isn’t signaling them to produce testosterone, you have secondary hypogonadism. The problem could lie in either your pituitary gland or hypothalamus, which are responsible for stimulating the gonads.

Regardless of what type of hypogonadism you have, they will often cause the same symptoms. However, it’s important to determine what type of hypogonadism you have because the treatment options will be different.

Symptoms of Male Hypogonadism at Different Life Stages

As previously mentioned, the symptoms of primary and secondary hypogonadism are similar. However, they will vary according to how low your testosterone levels are, your age, and how advanced the condition is.

two vials with blood ready for testing

Symptoms of Fetal Hypogonadism

In some cases, as a male fetus is developing inside the mother’s womb, it doesn’t get enough testosterone. This can hinder its development and cause the following symptoms:

  • Developing female sex glands instead of male ones
  • Developing genitals that are difficult to distinguish
  • Small male genitals or only having one testicle

Symptoms During Puberty

Hypogonadism during puberty is fairly uncommon but possible nonetheless. A person may have low testosterone if they have the following symptoms:

  • Delayed puberty or missing puberty altogether
  • Insufficient muscle mass and bone density
  • Underdeveloped testicles and penis
  • Sparse body hair growth
  • Abnormally large arms and legs
  • Developing breasts

Symptoms in Adults

Hypogonadism is most commonly diagnosed in adult men after they reach the age of 30. Here are some of the symptoms that low T levels in adult men can cause:

  • Low energy levels
  • Loss in motivation
  • Loss in sex drive
  • Depression or mood swings
  • Erectile dysfunction
  • Weight gain
  • Decrease in hair growth, muscle mass, and bone mass
  • Decrease in sperm production, which can cause infertility
  • Hot flashes
  • Lack of concentration and inability to remember things

What Causes Low Testosterone?

Many factors can cause primary and secondary hypogonadism. Whether the problem manifests in the testicles or the brain, there is always an underlying cause.

Here are some of the most common and well-known causes of primary hypogonadism, which is when a problem with the testicles is the cause of your condition.

Genetic Disorders: Genetic or congenital disorders are where a person is born with a condition they inherited from their parents, most commonly Klinefelter Syndrome.

Testicular Problems: While problems in the testicles always cause primary hypogonadism, testicular issues refer to conditions that directly affect the gonads. This can include issues like undescended testicles, mumps, trauma/injury, or inflammation of the gonads.

Organ Problems: In addition to problems that directly impact the testicles, it’s also possible that conditions affecting other organs can hinder testosterone production. Certain liver and kidney diseases, for example, can affect the testicles’ ability to create testosterone and sperm.

Radiation Exposure: Finally, men can develop hypogonadism as a result of being exposed to radiation, such as those due to cancer treatment.

Secondary hypogonadism isn’t quite as common as primary hypogonadism. However, when there is an issue with the pituitary gland or the hypothalamus, resulting in no chemical messengers getting sent to the testicles, secondary hypogonadism can result. Here are some of the most common causes:

Brain Injury: A brain injury that affects the hypothalamus or pituitary gland can impact testosterone levels.

Genetic Disorders: In the same way that genetic disorders can damage the testicles, they can also damage the parts of the brain responsible for testosterone production. Kallman Syndrome, for instance, is a congenital disorder that causes the hypothalamus to develop abnormally.2

Surgery or Tumors: If you require brain surgery or have a tumor near the hypothalamus or pituitary gland, you may experience low testosterone levels.

Health Conditions: Health conditions such as HIV and inflammatory diseases like tuberculosis can negatively impact normal testosterone production.

Other Common Causes: Secondary hypogonadism can also happen when you rapidly lose or gain weight, are obese, have a nutritional deficiency, use steroids or opioids, or have too much iron in your system.

How is Low Testosterone Diagnosed?

If you suspect that you have low T levels, it’s important to talk to your doctor. Only they can diagnose you with hypogonadism using the following lab and imaging tests.

Testosterone Blood Test

The main way to diagnose hypogonadism is with a testosterone blood test to check for the current levels of this hormone. This test generally requires two blood draws two hours apart in the morning and is the most common way to confirm whether you have low testosterone.

Luteinizing Hormone Blood Test

If it’s confirmed that you have low testosterone, a Luteinizing Hormone Blood Test can help determine the cause.

Prolactin Blood Test

Prolactin is a hormone responsible for lactation and the development of breast tissue. If you have high levels of prolactin, it is a potential indicator of hypogonadism.

Genetic Testing

If your doctor suspects you have hypogonadism because of a genetic condition, they may perform genetic testing.

Ultrasounds and MRIs

Some forms of hypogonadism can happen because of tumors, cysts, and other growths on the testicles or in the brain. Therefore, your doctor may perform an ultrasound or MRI to check for these abnormalities.

How is Male Hypogonadism Treated?

Regardless of what type of hypogonadism you have or what the exact cause is, restoring low testosterone levels can counteract symptoms of male hypogonadism.

Testosterone replacement therapy is the most common course of treatment.

Testosterone replacement therapy (TRT) consists of self-administering extra testosterone on a regular basis to maintain healthy levels of this hormone. TRT comes in several forms, such as gels, patches, pellets, intramuscular injections, subcutaneous injections, or oral pills, offering patients a wide range of options to best suit lifestyle and personal needs.

doctor writing something down in a notepad

Enclomiphene is an oral medication primarily used to treat secondary hypogonadism. This treatment stimulates the body’s natural production of testosterone and has few side effects aside from mood swings, improved libido, and acne. Unlike TRT, it does not impact fertility. As an oral medication, Enclomiphene may be ideal for patients who are uncomfortable with needles, who want to maintain fertility during treatment, or who cannot take TRT for any reason.

In addition to these medications, certain vitamin and herbal supplements can help support healthy testosterone levels, including Zinc, Vitamin D, Ashwagandha, and Fenugreek. As with any supplement – even those that are natural – it’s essential to speak with your doctor first. They can advise as to whether there may be any health or medication interactions based on your medical history.

Risks and Complications if You Leave Hypogonadism Untreated

While low testosterone isn’t a life-threatening condition, it can severely reduce your quality of life and hamper your motivation. Therefore, if you have hypogonadism, it’s important to seek prompt diagnosis and treatment. Otherwise, you will continue to experience the side effects of low testosterone levels, such as infertility, fatigue, bone and muscle loss, and depression.

Can You Prevent Hypogonadism?

In most cases, you can’t prevent hypogonadism. A few exceptions may include when hypogonadism stems from rapid weight gain, weight loss, or other lifestyle modifications. Therefore, the best way to potentially prevent hypogonadism is to eat a healthy diet, avoid smoking, limit alcohol consumption, and exercise regularly.

Last Words

Low testosterone levels in men can be caused by primary or secondary hypogonadism. Regardless of the cause, symptoms can be uncomfortable, contribute to fatigue and low libido, and decrease quality of life.

Fortunately, low T levels are treatable. Treatment options generally consist of a combination of medications and lifestyle modifications such as diet changes, exercise, and limiting alcohol or tobacco use. Working with a medical professional is essential to help you address the root cause of hypogonadism and develop the most effective treatment option for your needs.

In-home Enclomiphene and TRT offer busy men a convenient and discreet treatment option for male hypogonadism. Your treatment plan is overseen by one of our medical professionals, and your shipment of Enclomiphene or TRT is delivered directly to you. Let us help save you the time and hassle of visiting a clinic by making an in-home appointment today!

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[1] Yeo S. - Burden of Male Hypogonadism and Major Comorbidities, and the Clinical, Economic, and Humanistic Benefits of Testosterone Therapy: A Narrative Review;

[2] Sonne J. - Kallmann Syndrome;