Table of ContentsView All
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Table of Contents
Common Symptoms
Causes
Diagnosis
Treatment
Natural Therapies
Managing Complications
Female Hypogonadism
In adult males, signs oflow testosteroneinclude fatigue, irritability, low sex drive, erectile dysfunction, depression, abnormal breast growth, and hot flashes. Low T in boys can cause delayed puberty. In both instances, testosterone replacement therapy is the primary form of treatment.
This article describes the symptoms and causes of male hypogonadism, including how low testosterone is diagnosed and treated in adults and children. It also offers tips on how to manage low testosterone with lifestyle changes and natural remedies.
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A Note on Gender and Sex TerminologyMale hypogonadism affects people born with testes and a penis, who are typically assigned male at birth.Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
A Note on Gender and Sex Terminology
Male hypogonadism affects people born with testes and a penis, who are typically assigned male at birth.Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Male hypogonadism affects people born with testes and a penis, who are typically assigned male at birth.
Verywell Health acknowledges thatsex and genderare related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Male Hypogonadism Symptoms
Throughout the life of a male, testosterone plays a crucial role in sexual and physical development and function.During puberty, it contributes to growth spurts along with secondary sexual characteristics such as facial hair, increased muscle mass, and the deepening of the voice.
Thereafter, the production of testosterone is essential tolibido(sex drive) and the ability to achieve and maintainerections. Testosterone also enhances moods, promotes energy levels, and enhances cognitive skills like memory, reasoning, and alertness.
A drop in normal testosterone, referred to as hypogonadism, can affect all these functions and more.
Physical symptomsof male hypogonadism include:
Psychological symptoms of male hypogonadism include:
Sexual symptoms of male hypogonadism include:
What Are the Signs of Hypogonadism?
Signs of Low Testosterone Based on Age
Because the function of testosterone differs during the stages of life, the impact of hypogonadism can vary based on whether it occurs before, during, or after puberty.
Puberty-Onset Hypogonadism
Signs of hypogonadism at birth are exceptionally rare, affecting 1 of every 5,000 to 10,000 newborn males. Most cases are only recognized during puberty when the lack of testosterone affects sexual and physical development, resulting in delayed puberty.
Signs of puberty-onset hypogonadism include:
If left untreated, puberty-onset hypogonadism may lead to permanent short stature,microorchidism(small testicles), and impaired fertility in some males.
Adult-Onset Hypogonadism
In principle, your testicles should continue to function and produce testosterone from puberty through old age. Though testosterone levels will naturally decline as you age, there will not be the steep decline seen withestrogenlevels in females during menopause.
In addition to the common signs and symptoms of hypogonadism, persistently low testosterone levels can lead to longer-term complications like:
What Is Compensated Hypogonadism?
What Causes Low Testosterone?
The production of testosterone involves a complex interaction between thegonads(testicles in males andovariesin females), which produce testosterone, and theendocrine system(including the hypothalamus and pituitary gland), which tells the testicles when to produce testosterone.
In males, hypogonadism occurs either because the testicles are not functioning normally or because the hypothalamus and/or pituitary gland are not functioning normally.
Primary Hypogonadism
Congenital causes of primary hypogonadism include:
Acquired causes of primary hypogonadism include:
Secondary Hypogonadism
Congenital causes of secondary hypogonadism include:
Acquired causes of secondary hypogonadism include:
How Male Hypogonadism Is Diagnosed
Male hypogonadism is diagnosed based on low testosterone blood levels and the appearance of symptoms. The process is not always straightforward and may require the input of a hormone specialist known as anendocrinologistto interpret the results.
Physical Exam
The diagnosis of male hypogonadism typically starts with a physical exam and a review of your medical and family histories. This may include a gloved examination of yourscrotum, testicles, penis, and breasts.
Some healthcare providers will use a questionnaire called the Androgen Deficiency in Aging Males (ADAM) test to assess the likelihood of hypogonadism based on the following 10 questions (with each “yes” scored as 1 and each “no " scored as 0):
While higher scores provide stronger evidence of male hypogonadism, the ADAM test has its limitations and may not be as reliable in males under 50.
Lab Testing
The most important tool for the diagnosis of hypogonadism is theserum testosterone test. This test measures the amount of testosterone in units of nanograms per deciliter of blood (ng/dL). In adult males, the normal range is between 300 and 1,000 ng/dL.
For male children, serum testosterone values would need to be adjusted based on their age.
When taken together:
Based on the findings, other tests may be ordered. These may include asemen analysisandtesticular ultrasoundto investigate causes of primary hypogonadism, oriron saturation testsandpituitary function teststo investigate causes of secondary hypogonadism.
Screening Recommendations
Testosterone testing should be considered for adult males with the following conditions and symptoms, even without other signs of hypogonadism:
How Male Hypogonadism Is Treated: Testosterone Replacement Therapy
Testosterone replacement therapy (TRT) is the primary form of treatment for male hypogonadism. TRT is used to normalize testosterone levels with the aim of:
TRT is available in different forms, including oral tablets, intramuscular injections, implantable pellets, transdermal patches, topical gels, intranasal gels, and under-the-tongue dissolvable films or tablets.
In cases of testicular damage, TRT is the only form of treatment. With congenital disorders or certain chronic diseases, lifelong TRT may be needed. Boys with delayed puberty are typically treated with monthly intramuscular injections for anywhere from three to 12 months.
Depending on the underlying cause, male hypogonadism can sometimes be cured. In other cases, low T may require lifelong management.
Risks and Complications
TRT is not recommended for people withheart failureas it can worsen the condition. TRT is also avoided in men with untreatedprostate or breast canceras testosterone may stimulate the growth of a tumor.
If a male with low testosterone is trying to raise testosterone and maintain or improve fertility, then fertility-sparing regimens are recommended. Generally, these are with off-label use of drugs such as clomiphene citrate or human chorionic gonadotropin (HCG).
How Infertility Is Treated
If you have impaired fertility due to secondary hypogonadism, TRT would not be used given that that underlying problem is not the testicles but rather the hypothalamus or pituitary gland.
Lifestyle Changes and Natural Remedies for Low Testosterone
Although testosterone production will naturally decline with age, testosterone replacement therapy is not always the right solution. Many experts recommend making key lifestyle changes to correct problems that contribute to low testosterone as you get older.
Here are seven lifestyle changes that may help reduce or reverse the risk of hypogonadism:
Natural Treatments for Low Testosterone
Managing Male Hypogonadism
If you have been diagnosed with male hypogonadism, you may need ongoing care from an endocrinologist to manage the condition. This includes males with congenital causes or who are at risk of osteoporosis, prostate cancer, or heart disease.
Among the considerations:
Male vs. Female Hypogonadism
Prior to menopause, testosterone levels are 3 times higher than estrogen (although only a fraction of what is seen in males).During and after menopause, testosterone levels can plummet, leading to many of the same sexual, physical, and psychological symptoms seen in males.
Although some experts recommend TRT along withestrogen-replacement therapyforperimenopausalandpostmenopausalfemales, testosterone is not approved for such use in the United States. Even so, testosterone is sometimes prescribed off-label to treat female hypogonadism, albeit with close medical supervision.
Possible risks of TRT in females includeendometrial bleedingand masculinizing effects (such asincreased facial and body hairandmale-pattern baldness). There is also evidence that TRT may increase the risk ofhormone-sensitive breast cancersand heart disease. The risk appears to be dose-dependent, meaning that it increases in tandem with higher doses.
Summary
Male hypogonadism is abnormally low testosterone levels in males. Symptoms include fatigue, lack of concentration, low energy, muscle weakness, irritability, depression, low sex drive, erectile dysfunction, and infertility. Hypogonadism in male children can lead to delayed puberty and stunted growth.
Male hypogonadism may be due to the failure of the testicles to produce testosterone (primary hypogonadism) or the failure of the hypothalamus or pituitary gland to regulate the production of testosterone (secondary hypogonadism).
Hypogonadism is diagnosed based on symptoms and a testosterone blood test. Testosterone replacement therapy is the primary form of treatment. Infertile males with secondary hypogonadism may benefit from fertility drugs called gonadotropins.
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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