Definition

What is male hypogonadism?

Male hypogonadism is a condition in which the body doesn’t produce enough testosterone — the hormone that plays a key role in masculine growth and development during puberty — or has an impaired ability to produce sperm or both.

You may be born with male hypogonadism, or it can develop later in life, often from injury or infection. The effects — and what you can do about them — depend on the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.

How common is male hypogonadism?

Male hypogonadism may occur in men at any age, but low testosterone levels are especially common in older males. More than 60% of men over age 65 have free testosterone levels below the normal values of men aged 30 to 35. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of male hypogonadism?

A lack of testosterone can cause a wide range of symptoms.

These depend on:

  • The age of onset
  • The degree of testosterone deficiency
  • How long the loss has been occurring

Adolescents and young adults who have not yet completed puberty appear younger than their chronological age.

They may also have small genitalia, a lack of facial hair, failure of the voice to deepen, and difficulty gaining muscle mass, even with exercise.

Puberty-onset hypogonadism can lead to:

Symptoms of adult-onset hypogonadism include:

  • Erectile dysfunction
  • Low sperm count
  • Depressed mood
  • Decreased libido
  • Lethargy
  • Sleep disturbances
  • Decreased muscle mass and strength
  • Loss of body hair (pubic, axillary, facial)
  • Osteoporosis and decreased bone mineral density
  • Increased body fat
  • Breast discomfort and enlargement
  • Hot flashes
  • Sweating
  • Poor concentration and decreased energy

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes male hypogonadism?

Hypogonadism in a male refers to a decrease in either or both of the two major functions of the testes: sperm production and testosterone production.

This can happen for a number of reasons.

In primary hypogonadism, the testicles do not respond to hormone stimulation. This can be due to a congenital disorder such as Klinefelter’s syndrome, or acquired as a result of radiation treatment, chemotherapy, mumps, tumors or trauma to the testes.

In secondary hypogonadism, a disease state interferes with either the hypothalamus or pituitary gland, the main glands that release hormones to stimulate the testes to produce testosterone.

Situations that can cause secondary hypogonadism include:

  • Malnutrition
  • Systemic illness
  • Stress
  • Medication side effects
  • Liver cirrhosis
  • Toxins (alcohol and heavy metals)
  • Morbid obesity.

Andropause is sometimes used to describe decreased testosterone due to the normal aging process. Testosterone levels in males increase until the age of 17 years. Then, starting at approximately 40 years of age, testosterone levels begin to decline at 1.2-2 percent per year.

Risk factors

What increases my risk for male hypogonadism?

There are many risk factors for male hypogonadism, such as:

  • Kallmann syndrome
  • Undescended testicles as an infant
  • Mumps infection affecting your testicles
  • Injury to your testicles
  • Testicular or pituitary tumors
  • HIV/AIDS
  • Klinefelter syndrome
  • Hemochromatosis
  • Previous chemotherapy or radiation therapy
  • Untreated sleep apnea

Hypogonadism can be inherited. If any of these risk factors are in your family health history, tell your doctor.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is male hypogonadism diagnosed?

Your doctor will conduct a physical exam during which he or she will note whether your sexual development, such as your pubic hair, muscle mass and size of your testes, is consistent with your age. Your doctor may test your blood level of testosterone if you have any of the signs or symptoms of hypogonadism.

Early detection in boys can help prevent problems from delayed puberty. Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions.

Doctors base a diagnosis of hypogonadism on symptoms and results of blood tests that measure testosterone levels. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day, before 10 a.m.

If tests confirm you have low testosterone, further testing can determine if a testicular disorder or a pituitary abnormality is the cause. Based on specific signs and symptoms, additional studies can pinpoint the cause. These studies may include:

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

Testosterone testing also plays an important role in managing hypogonadism. This helps your doctor determine the right dosage of medication, both initially and over time.

How is male hypogonadism treated?

Testosterone replacement therapy (TRT) is the recommended treatment for male hypogonadism.

It is normally given as a topical gel, transdermal patch, or by injection. Oral forms of testosterone are not used due to the high risk of side effects, such as upset stomach.

TRT can eliminate many, if not all, of the signs and symptoms of male hypogonadism.

Benefits include:

  • Increased libido
  • Mood improvement
  • Increased bone mineral density
  • Overall improved quality of life

However, there are a few risks associated with it.

It may lead to worsening of benign prostatic hyperplasia (BPH), acceleration of pre-existing prostate cancer, and worsening of both sleep apnea and congestive heart failure. TRT should not be started without first attending to these conditions.

All males who are using TRT require ongoing medical evaluation to determine adequate response to treatment. This will include regular blood tests and periodic digital rectal exams.

TRT is contraindicated in men with erythrocytosis, a condition involving a high volume percentage of red blood cells in the blood.

The response to TRT is individualized, and testosterone levels are not an indicator of who will respond to TRT and who will not. It is also worth noting that while it can relieve symptoms of hypogonadism, TRT does not restore fertility.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage male hypogonadism?

The following lifestyles and home remedies might help you cope with male hypogonadism:

  • Losing weight
  • Exercising
  • Managing stress
  • Getting adequate sleep
  • Avoiding alcohol
  • Giving up smoking.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: December 15, 2017 | Last Modified: December 15, 2017

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