Taking the mystery out of male hypogonadism

An increasingly common condition seen in men is male hypogonadism.  Male hypogonadism is when the testicles are not making normal levels of the male sex hormone, testosterone.   Some men may be born with it or later in their life.  The prevalence rate is estimated to be as high as 38.7% in men age 45 and older. It also is commonly seen – up to 30-50% – in men with obesity or type 2 diabetes.  

During a man’s lifetime, there are stages of hormonal development. For instance, puberty in boys triggers the pituitary gland to release luteinizing hormone (LH). LH stimulates the testicles to produce testosterone.   A primary function of testosterone is to develop male characteristics such as deepening of the voice, body and pubic hair growth, increased height, and enlarged penis, prostate, and testicles in adolescent boys.  Another hormone, called follicle-stimulating hormone (FSH), works with LH to stimulate the production of sperm in the testicles.

Signs of male hypogonadism

There can be a variety of symptoms and signs signaling male hypogonadism.  The following signs can suggest low testosterone or androgen deficiency in adult men:

  • Reduced libido or sexual interest
  • Decreased number of spontaneous night-time and morning erections
  • Incomplete sexual development
  • Reduced growth of facial hair
  • Fatigue and loss of energy
  • Very small or shrinking testes
  • Breast enlargement 
  • Reduced muscle mass and strength
  • Mild depression
  • Reduced sperm production causing infertility
  • Osteoporosis

The symptoms listed above are what bring a man into his doctor’s office seeking treatment for these signs. However, because many of these symptoms also commonly occur in various conditions (obesity, diabetes, metabolic syndrome), diagnosing hypogonadism can be challenging.  

Confirming male hypogonadism

The definitive method of diagnosing male hypogonadism is through an early morning blood test gauging testosterone levels and if they fall into a normal range.  Usually, more than one morning blood test will be needed to obtain an accurate testosterone level.  Depending on the laboratory conducting the test, the normal range may vary, but it is generally considered to be 300 up to 1,000 ng/dl.  If the blood tests show low testosterone levels, then pituitary gland functioning measuring both LH and FSH levels will need to be also done.  


Causes of male hypogonadism

There can be several reasons why a man has male hypogonadism.  One is what is called primary hypogonadism.  This means there is a problem with the testes not working properly; here are possible reasons why:

  • Men with Klinefelter’s syndrome
  • The testes are underdeveloped
  • The testes are undescended, meaning they are located in the body instead of in the scrotum 
  • Damage from an infection, disease, or injury to the testes 
  • Removal of the testes surgically
  • Men who’ve had radiation or chemotherapy to the testes

If the endocrine glands are not stimulating the testes, telling them to produce hormones, then secondary hypogonadism can be caused by the following: 

  • Men using medication such as opiates and replacement hormones
  • Using radiation to treat cancer
  • Any harm or damage to the pituitary or hypothalamus glands
  • Men with hemochromatosis or excess iron in the blood 
  • Men with genetic conditions such as Kallmann syndrome and Prader-Willi syndrome

Treating male hypogonadism

Men with consistently low testosterone levels and signs and symptoms of androgen deficiency, most likely need treatment with testosterone replacement therapy.  Testosterone replacement therapy is used to increase testosterone levels by improving or maintaining a man’s masculinity, enhancing mood and energy, muscle strength, reducimg bone loss, and improving sex drive.  

Men who should not be treated with testosterone replacement therapy include the following:

  • Men with active or a history of prostate cancer
  • Untreated sleep apnea
  • Men with uncontrolled severe heart failure 
  • Men with severe enlargement of the prostate causing difficulty in urinating.

Here are different methods used to replace testosterone:

  • Direct injection of testosterone into the muscle – usually every 2 weeks
  • Application of a patch(es) to the skin once a day
  • Application of a Gel or solution preparations applied once daily
  • Application twice a day to the gums of Buccal tablets
  • Implanting pellets under the skin

For men able to use testosterone replacement therapy, how it is given depends on patient preference, tolerance, cost, and what their medical insurance will pay for.  In addition, each can have different side effects, from injections being uncomfortable, skin patches causing redness and rashes, or gels transferring testosterone to others who come into contact with the man’s skin where the medication is applied. 

All men using testosterone replacement therapy require regular monitoring by their physician for the duration of the treatment.  


Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.  Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911. 

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