Low Testosterone (Hypogonadism)

Low testosterone, also referred to as male hypogonadism, is a medical condition which occurs when the body doesn’t produce sufficient testosterone or sperm (or both). Testosterone is a the hormone that is responsible for masculine development during puberty.

Male hypogonadism can occur at birth, or in some cases, it can develop later on in life most of the time from infection or injury.

Types of Hypogonadism

There are two main types of hypogonadism:

  • Primary – Also called testicular failure, this type involves a problem within the testicles.
  • Secondary – In this type of hypogonadism, the problem lies on the hypothalamus or the pituitary gland. Basically, these parts of the brain are the ones which signal the testicles to produce the male hormone testosterone. The hypothalamus is responsible for producing gonadotropin – releasing the hormone which then signals the pituitary gland to create follicle – stimulating hormone and luteinizing hormone. In turn, the luteinizing hormone signals the testicles to produce the hormone.

The effects of this condition largely depend on the underlying cause and on what stage in your life it occurs. In some cases, male hypogonadism can be addressed through testosterone replacement therapy.

Types of Hypogonadism

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Causes and Risk Factors of Low Testosterone

Primary and secondary hypogonadism may be inherited or may be acquired later on in life through an infection or an injury. In some cases, these two types of hypogonadism may occur together. Below are the most common causes of low testosterone:

Primary Hypogonadism

  • Klinefelter syndrome – A congenital abnormality of the sex chromosomes which lead to abnormal development of the testicles and insufficient production of testosterone.
  • Undescended testicles – In some cases where the testicles are not descended at birth, it is likely that the organ will not function normally and there will be an underproduction of testosterone.
  • Mumps orchitis – Testicles may malfunction and produce insufficient testosterone if mumps involving the testicles and the salivary glands occur during adolescent or adult stages of life.
  • Hemochromatosis – Excessive iron in your blood can lead to malfunctioning testicles or pituitary gland reducing your ability to produce testosterone.
  • Injury in your testicles – When your normally-developed testicles got injured, it can lead to hypogonadism. However, if the damage is only on a single testicle, it may not totally impair the production of the male sex hormone.
  • Cancer treatment – Chemotherapy and radiation therapy can adversely affect the production of both sperm and testosterone, and may even lead to permanent infertility.

Secondary Hypogonadism

  • Kallmann syndrome – This condition, which is associated with the abnormal development of the sense of smell and red-green color blindness, involves the impaired development of the hypothalamus, which can lead to secondary hypogonadism.
  • Pituitary diseases – The pituitary gland releases hormones which affect the production of testosterone, and because of this, medical conditions involving the pituitary gland can lead to hypogonadism.
  • Inflammatory diseases – Some inflammatory diseases including tuberculosis, sarcoidosis and histiocytosis involve the pituitary gland and hypothalamus. Therefore, these disorders can also cause hypogonadism.
  • HIV or AIDS – These diseases can affect the hypothalamus, pituitary gland and testicles, and can lead to low levels of testosterone.
  • Medications – Testosterone production is hampered by some medications, particularly opiate pain drugs and some hormones.
  • Obesity – Being overweight is associated with hypogonadism.
  • Normal aging – Compared to younger males, older ones have lower levels of testosterone.


Healthy Living Tips for Low Testosterone

There are no particular methods of preventing hypogonadism that is caused by genetic factors or injury to the testicles or the pituitary gland. However, maintaining a healthy lifestyle, eating a healthy diet, regular exercise, avoiding excessive consumption of alcohol, weight management and avoiding drugs can help keep your testosterone at their normal levels. Certain medications for low testosterone may be helpful.

If you have hypogonadism, you may want to consider doing the following to cope:

  • Learn about infertility and erectile dysfunction. Because this can have a psychological effect on you and adversely affect your relationships, it helps to educate yourself and your partner on these conditions.
  • Try to minimize stress. Consult with your doctor on how to reduce your stress and anxiety levels. You may want to join support groups and undergo psychological and family counseling.
  • Give yourself time to adjust. When hypogonadism occurs during the adolescence stage, the person with the condition may feel that he doesn’t fit in. By taking the time to adjust for physical changes when testosterone replacement therapy is conducted, there will be a lower risk of emotional and social problems.

Healthy Living Tips for Low Testosterone

When to See an Atlanta Urologist for Hypogonadism

It is recommended to consult with your physician when you notice the following symptoms of hypogonadism:

1. When the condition occurs during fetal development

Male hypogonadism during fetal development can lead to abnormal growth of the external sex organs, ambiguous genitals (neither clearly male nor female), or the development of female genitals despite being genetically male.

2. When hypogonadism develops during puberty

This condition can lead to a delay in puberty or impaired masculine development. Specific signs include:

  • The voice doesn’t become deeper.
  • There is impaired development of muscle mass.
  • Abnormal growth of the penis and testicles occurs.
  • There’s an inability to grow body hair.
  • The development of breasts happens.
  • There’s excessive growth of legs and arms in relation to the torso.

3. When hypogonadism occurs during adulthood

When this condition develops during adulthood, some masculine physical characteristics may be altered and reproductive function may also be adversely affected. Here are the some of the symptoms:

  • Infertility
  • Erectile dysfunction
  • Decrease in muscle mass and development of breasts
  • Decrease in bone mass
  • Decrease in the growth of facial and body hair.

This medical condition can also cause psychological and emotional changes including decreased sex drive, fatigue, hot flashes and concentration problems

What to Expect When Seeking Treatment for Low Testosterone

When you consult with your doctor to report your symptoms, a physical examination will be performed and the physician will check your blood level of testosterone to look for signs of a diagnosis of hypogonadism.

If the test results reveal that you have low levels of testosterone, further testing will be required to identify if you have primary (testicular problem) or secondary (issue with the pituitary or hypothalamus) hypogonadism. These tests include:

  • Semen analysis
  • Testicular biopsy
  • Hormone testing
  • Genetic studies
  • Pituitary imaging

Treatment Options for Hypogonadism

The treatment for low testosterone depends on the root cause of the problem and if the patient is concerned about fertility. Here are the available treatment options for hypogonadism:

  • Hormone replacement therapy – If your hypogonadism is caused by a testicular issue, hormone replacement therapy (testosterone replacement therapy or TRT) will be conducted. Through this treatment option, you will be able to regain muscle strength, get an energy boost, prevent loss of bone mass, as well as experience an increase in sex drive and enhanced erectile function. However, testosterone replacement therapy can involve various risks such as growing breasts, stimulating the growth of prostate gland, blood clots in the veins, limited production of sperm, worsening existing prostate cancer and it can contribute to sleep apnea. Meanwhile, if the cause is the pituitary gland, pituitary hormones may boost the production of sperm and improve fertility.
  • Assisted reproduction – While there is no fool-proof way of restoring fertility among those with primary hypogonadism, assisted reproductive technology which involves different strategies can be beneficial.

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