Male Hypogonadism

What is male hypogonadism?

Male hypogonadism is a condition in which the testes (the male sex organs) do not produce enough testosterone, sperm, or both.

Male hypogonadism is also known as testosterone deficiency.

What causes male hypogonadism?

There are two main types of male hypogonadism, primary and secondary.

Primary hypogonadism (primary testicular failure)

This originates from a problem in the testes. Common causes include:

• Cancer treatment: Chemotherapy or radiation therapy may cause temporary or permanent decreases in testosterone or sperm production
• Klinefelter syndrome: Two or more X chromosomes are present in addition to one Y chromosome (a normal male has one X and one Y chromosome). The extra X chromosomes cause abnormal development of the testes
• Hemochromatosis: This condition causes too much iron in the blood which can affect the testicles or pituitary gland, decreasing testosterone production
• Injury to the testicles: Damage to one or both testicles can potentially affect testosterone production
• Mumps infection. Sometimes mumps can affect the testicles (this is called mumps orchitis), damaging them and affecting testosterone production.
• Undescended testicles: During fetal development, the testicles develop inside the abdomen and then move down into the scrotum at birth. If one or both testicles don’t descend, and the testes don’t descend naturally or aren’t corrected surgically during early childhood, then this can lead to reduced production of testosterone.

Secondary hypogonadism (secondary testicular failure)

The production of testosterone is under the control of the hypothalamus and the pituitary gland. Common causes of secondary hypogonadism include:

• Aging (testosterone production slowly decreases with age)
• Excessive alcohol
• Heavy metal toxins
• HIV/AIDs
• Inflammatory conditions such as sarcoidosis and tuberculosis
• Kallmann’s syndrome: A brain condition where the area of the brain that controls the secretion of pituitary hormones develops abnormally. Symptoms may also include red/green color blindness and an inability to smell
• Liver cirrhosis
• Malnutrition
• Medications that affect testosterone production, such as hormones
• Obesity
• Pituitary disorders or chemotherapy or radiation treatment that affects the pituitary gland.

What are the symptoms of male hypogonadism?

Symptoms reflect the lack of testosterone and can vary depending on the age at which the testosterone deficiency occurred, how deficient he is, and how long he has been deficient in testosterone.

Hypogonadism can begin in the womb. Symptoms vary depending on how much testosterone was present at specific times during fetal development but a child who is genetically male may be born with:

• Female genitals
• Genitals that are ambiguous (neither clearly male nor female)
• Underdeveloped genitals.

If the testosterone deficiency occurs during childhood but before puberty, then symptoms in adolescents or young adults may include:

• Appearing younger than their chronological age
• Lack of facial hair
• Small genitalia
• Failure of the voice to deepen
• Difficulty gaining muscle mass even with exercise.

If the testosterone deficiency occurs around puberty, then symptoms may include:

• Enlarged breasts
• Excessive growth of the arms and legs compared to the trunk
• Impaired emotional and physical sexual development
• Small testicles.

Symptoms of male hypogonadism in adults include:

• Decreased muscle mass and strength
• Decreased sex drive
• Depression
• Development of breast tissue (gynecomastia)
• Erectile dysfunction
• Hot flashes
• Infertility
• Loss of body, facial, and pubic hair
• Loss of bone density and osteoporosis
• Poor concentration
• Sleep disturbances
• Sweating
• Tiredness
• Weight increase.

How is male hypogonadism diagnosed?

If you or your boy have symptoms of male hypogonadism, see your doctor.

Your doctor may conduct some tests, such as hormone testing, semen analysis, genetic studies, and imaging studies to try and establish a cause.

How is male hypogonadism treated?

Treatment varies depending on the age of the male and the degree of testosterone deficiency and may include:

• Testosterone replacement therapy (available as capsules, gels, injection, patch, nasal spray, or implantable pellets)
• Lifestyle changes, such as losing weight, exercising, avoiding alcohol, and stopping smoking