Male Hypogonadism

Male hypogonadism (also known as testosterone deficiency) is a medical condition characterized by the failure of the testes to produce sufficiently the sex hormone (known as testosterone), that plays the key role in masculine growth and development during puberty, or enough sperm cells, or both. Male hypogonadism can be genetic, as a result of the testicular disorder, due to an injury or infection, or due to problems with the hypothalamus and pituitary gland. Male hypogonadism affects the functioning of many organs and can have a high negative impact on the quality of life. The signs and symptoms of hypogonadism depend on the onset, the severity, and the impact it has on the major functions of the testes. The overall effects of male hypogonadism and its treatment depend on the underlying cause and at what stage in life it occurs. Testosterone replacement therapy is the choice of treatment. Types of male hypogonadism causes There are two major types of male hypogonadism. Namely, primary hypogonadism and secondary hypogonadism.
  • In primary hypogonadism, also known as a primary testicular failure, the testicles fail to respond to hormone stimulation for production. While they receive the messages, they aren’t able to make production. This may be congenital (such as Klinefelter’s syndrome) or acquired due to exposure to radiation (for treatment or otherwise), tumors, chemotherapy, mumps, or trauma to the testes.
  • In secondary hypogonadism, also known as central hypogonadism, a disease process inhibits either the hypothalamus or pituitary gland, which are the main glands that secrete the hormones that stimulate the testes to produce testosterone.
Hypogonadism diagnosis The first step to diagnosing male hypogonadism is to take a detailed medical history and carrying out a physical examination.  To further a hypogonadism diagnosis, the following may also be requested 
  • Hormonal analysis.
  • Semen analysis.
  • Pituitary imaging: CT scans or MRIs can be requested to check for tumors in the pituitary gland.
  • Genetic studies.
  • Testicular biopsy.
Male hypogonadism treatment Testosterone replacement therapy is the most widely used male hypogonadism treatment. This male hypogonadism treatment can be applied via several routes such as through,
    • Injection.
    • Transdermal patch.
    • Topical gel.
    • Lozenge.
    • Implantable pellets.
    • Nasal cavity.
  • Gum and cheek (buccal cavity).
For puberty-related male hypogonadism treatment, an injection of a gonadotropin-releasing hormone may be given to trigger puberty. This also boosts sperm production. In hypogonadism due to tumor on the pituitary gland, the choice of male hypogonadism treatment may include:
  • Radiation.
  • Medication.
  • Surgery.


There are several signs and symptoms of hypogonadism in men. Irrespective of age and stage of life the following are the signs and symptoms of hypogonadism.

  • Loss of bodily hair.
  • Muscle loss.
  • An abnormal breast growth.
  • Condensed growth of penis and testicles.
  • Erectile dysfunction.
  • Osteoporosis.
  • Low or absence of sex drive.
  • Infertility.
  • Fatigue.
  • Hot flashes.
  • Difficulty in concentrating.
  • Low sperm count.
  • Depression.
  • Decreased libido.
  • Lethargy.
  • Sleep disturbances.


This is based on the type of hypogonadism.

Primary hypogonadism can be caused by

  • Hemochromatosis: Too much of iron in the blood can cause the testicles to fail or the pituitary gland to dysfunction, thereby affecting testosterone production.
  • Injury to the testicles. 
  • Cancer treatment: with chemotherapy or radiation therapy can interfere with testosterone and sperm production.
  • Autoimmune disorders, for instance Addison’s disease and hypo-parathyroidism
  • Genetic disorders, for instance Turner and Klinefelter syndrome.
  • Severe infections, such as mumps orchitis (mumps infection involving the testicles).
  • Liver and kidney diseases.
  • Undescended testes.
  • Surgery on your sexual organs.

Secondary hypogonadism may be due to 

  • Genetic disorders, such as Kallmann’s syndrome (an abnormal hypothalamic development).
  • Infections, such as HIV/AIDS.
  • Pituitary disorders.
  • Inflammatory diseases – For instance tuberculosis, sarcoidosis, and histiocytosis.
  • Obesity.
  • Rapid weight loss.
  • Nutritional deficiencies.
  • Use of steroids or opioids.
  • Brain surgery.
  • Radiation exposure.
  • Appearance of tumour in or near your pituitary gland.
  • Systemic illness.
  • Stress.
  • Medication side effects.
  • Liver cirrhosis.
  • Toxins (for instance alcohol and heavy metals).
  • Normal aging.


. When to see a doctor about male hypogonadism

When you notice any of the symptoms of male hypogonadism mentioned above. It is advisable to take immediate actions to find out the cause and ensure prompt treatment.

What are home remedies to hypogonadism?

Some couple of changes to lifestyle may help boost and maintain normal testosterone levels. These include:

  • Losing weight and keeping physically fit.
  • Exercising regularly.
  • Stress management.
  • Getting adequate and sufficient sleep
  • Quit alcohol consumption and smoking.

What is the long term outlook of primary hypogonadism?

Male hypogonadism is a chronic condition and may require a lifelong treatment. This can only be otherwise if it’s caused by a treatable condition. Cessation of hypogonadism treatment may cause the sex hormone level to drop.

Can male hypogonadism be inherited?

While there are genetic causes of male hypogonadism, such as Klinefelter’s syndrome and Kallmann’s syndrome, male hypogonadism does neither run in families nor can be transferred from parents to offspring. These genetic conditions occur sporadically. 

How common is male hypogonadism?

The levels of testosterone starts to fall in men after the age of 40. This makes the male hypogonadism to be more common in ageing men. It has been established that 8.4% of men between the ages of 50–79 are deficient in testosterone. Male hypogonadism has also been linked with type 2 diabetes and roughly around 17% of men with type 2 diabetes have been estimated to have low level of testosterone.

What are the risk factors of male hypogonadism?

Some of the risk factors for hypogonadism include

  • Previously undergone chemotherapy or radiation therapy.
  • Aging.
  • Obesity.
  • Malnutrition.

What are the complications associated with male hypogonadism?

There are a host of complications associated with male hypogonadism. However, these differ based on onset, whether during foetal development, puberty or adulthood.

These complications include:

  • Strange genitalia.
  • Inflated male breasts (known as gynecomastia).
  • Infertility.
  • Erectile dysfunction.
  • Osteoporosis.
  • Poor self-image or inferiority complex.