Everything to Know About Male Hypogonadism

Male hypogonadism, commonly known as low testosterone in men, occurs when the testicles fail to produce sufficient testosterone. This condition can stem from various factors, such as testicular issues, pituitary gland disorders, or hypothalamic dysfunction. Fortunately, it can be effectively managed through testosterone replacement therapy.

What is Male Hypogonadism?

Low testosterone, also called male hypogonadism, is a condition where the testicles (male sex organs) don’t produce enough testosterone, the main male sex hormone. These hormones are made by specialized cells called Leydig cells within the testicles.

Low testosterone in men can cause various symptoms, and these can differ depending on your age. It’s natural for testosterone levels to decrease as men age (including cisgender men, non-binary individuals assigned male at birth, and transgender women not on hormone therapy).

Other Names:

There are several other terms for low testosterone and male hypogonadism, including:

  • Testosterone deficiency syndrome
  • Testosterone deficiency
  • Primary hypogonadism (when the testicles themselves aren’t producing enough testosterone)
  • Secondary hypogonadism (when the problem lies elsewhere in the body, like the pituitary gland)
  • Specific terms based on hormone levels (hypergonadotropic and hypogonadotropic hypogonadism)

What does testosterone do?

Testosterone, the primary male sex hormone, plays a vital role in male development and function. It’s responsible for:

  • Building the body: Testosterone fuels muscle growth and bone density.
  • Fueling reproduction: It’s essential for sperm production and healthy sex organs.
  • Creating a man: Testosterone helps develop male physical characteristics like facial hair and a deeper voice.
  • Keeping you going: It can influence red blood cell production and contribute to a sense of well-being.

Production and Control

The body carefully regulates testosterone levels, which are naturally higher in men than in women. These levels peak in the morning and decrease throughout the day.

The brain (hypothalamus and pituitary gland) acts as a control center for testosterone production. It sends signals to the testicles to produce testosterone, which in turn helps with sperm production (stimulated by another hormone, FSH). Problems in any of these areas can lead to low testosterone in men.

What is a low testosterone level?

There’s no single, universally agreed-upon definition for “low testosterone.” The American Urology Association (AUA) uses a blood test threshold of less than 300 nanograms per deciliter (ng/dL) for adults. However, some experts believe a level below 250 ng/dL might be indicative of low testosterone in men.

It’s important to note that testosterone levels naturally decline with age. Additionally, doctors consider symptoms alongside blood test results when diagnosing low testosterone.

Who can be affected by low testosterone?

Low testosterone in men, also known as male hypogonadism, can develop at any stage of life, from birth to adulthood, in anyone with testicles. However, certain factors increase the likelihood of experiencing it, such as:

  • Age: Testosterone levels naturally decline as men get older.
  • Medical conditions: Obesity, poorly controlled type 2 diabetes, obstructive sleep apnea, chronic kidney disease, and liver cirrhosis can all contribute to low testosterone.
  • HIV/AIDS: The virus itself and some HIV medications can affect testosterone production.

If you’re concerned about low testosterone in men, it’s always best to consult a healthcare professional for diagnosis and treatment.

How common is low testosterone?

Estimating the exact prevalence of low testosterone is tricky. Different studies use varying definitions of what constitutes “low” levels.

However, available data suggests that around 2% of people assigned male at birth (AMAB) might experience low testosterone in men. This percentage increases with age, with some studies suggesting over 8% of AMAB individuals between 50 and 79 years old potentially having low testosterone.

Symptoms of Low Testosterone

Low testosterone in men can cause a wide range of symptoms, and these can vary depending on your age. Here’s a breakdown:

  • Adults: Reduced sex drive, erectile dysfunction, decreased body hair, shrinking testicles, hot flashes, infertility, mood swings, memory problems, increased body fat, breast tissue enlargement, muscle weakness, and fatigue.
  • Children: Slowed growth, delayed puberty development, less voice deepening, lower strength, and endurance.

Causes of Low Testosterone

There are two main categories of low testosterone, each with different causes:

  • Primary Hypogonadism (Testicle Problem): This happens when the testicles themselves aren’t producing enough testosterone. Causes include congenital conditions (present at birth) like undescended testicles, Klinefelter’s syndrome, or acquired conditions like injuries, infections, or certain medications.
  • Secondary Hypogonadism (Pituitary/Hypothalamus Dysfunction): This occurs when the pituitary gland or hypothalamus (areas of the brain) aren’t sending the right signals to the testicles. This can be due to congenital conditions or acquired ones like head injuries, tumors, or certain medications.

Aging and Other Risk Factors

Testosterone levels naturally decline with age. Additionally, certain factors like obesity, type 2 diabetes, sleep apnea, and chronic health conditions can increase the risk of low testosterone in men.

It’s important to remember that symptoms can vary and testosterone levels naturally fluctuate. If you’re concerned about low testosterone in men, a healthcare professional can perform a blood test to determine your levels and discuss treatment options if needed.

Diagnosis and Tests

If you’re experiencing symptoms that might point to low testosterone in men, a healthcare professional will likely take a two-pronged approach to diagnosis:

  • Physical Exam and History: They’ll perform a physical exam and ask detailed questions about your medical history, medications, lifestyle habits (like smoking), and current symptoms.
  • Blood Tests:  Several blood tests can provide valuable information:
    • Total Testosterone Level: This is the main test, usually requiring two-morning samples (between 8 AM and 10 AM) to capture peak testosterone levels. Illness can affect results, so mention any recent sickness to your doctor.
    • Luteinizing Hormone (LH) Test: This helps pinpoint the source of low testosterone. Low LH might indicate an issue with the pituitary gland.
    • Prolactin Test: High prolactin levels can signal pituitary problems or tumors.

By combining the information from the physical exam, medical history, and blood tests, your doctor can diagnose low testosterone and determine the underlying cause.

How is low testosterone treated?

If you’re diagnosed with low testosterone, treatment is available through testosterone replacement therapy (TRT). TRT comes in various forms, each with its own pros and cons that your doctor will discuss with you:

  • Gels: Applied daily to clean, dry skin, gels are a popular TRT option. However, it’s crucial to avoid skin-to-skin contact with others after application.
  • Injections: These can be administered by you or a healthcare professional, with frequencies ranging from weekly to every 10 weeks. Subcutaneous injection options are also available.
  • Patches: Worn daily on the skin, patches require rotation to prevent skin irritation.
  • Pellets: Implanted under the skin by a specialist, these pellets provide long-lasting testosterone delivery every few months.
  • Buccal Tablets: These sticky tablets dissolve on your gums twice daily for quick absorption.
  • Nasal Gel: Applied directly to the nostrils three times a day, this option offers another route for testosterone delivery.
  • Oral Testosterone: In specific cases, like Klinefelter syndrome, an oral form of testosterone might be prescribed.

Important Considerations for TRT

Testosterone replacement therapy isn’t suitable for everyone. Here are some conditions that may preclude you from receiving TRT:

  • Prostate Cancer or Unexplained Prostate Lump: A prostate screening is mandatory before starting TRT.
  • Breast Cancer
  • Uncontrolled Heart Failure
  • Untreated Obstructive Sleep Apnea

It’s important to discuss all your health concerns with your doctor to determine the most appropriate course of treatment for you.

What are the side effects of testosterone replacement therapy?

Testosterone replacement therapy (TRT) is generally safe, but it’s not without potential side effects. It’s important to be aware of these and discuss them with your doctor:

  • Skin Issues: Acne or oily skin can occur. Topical applications might irritate the application site.
  • Urinary Symptoms: Prostate stimulation can lead to difficulty urinating.
  • Breast Changes: Enlargement or tenderness in breast tissue is a potential side effect.
  • Sleep Apnea: Existing sleep apnea may worsen with TRT.
  • Reduced Fertility: Sperm count can decrease, impacting fertility. This is a crucial consideration for younger men who desire biological children.

Monitoring Blood Work:

TRT can also affect certain blood values:

  • Prostate-Specific Antigen (PSA): Levels may increase. It’s important to note that an increase in PSA doesn’t necessarily indicate prostate cancer. Regular monitoring is crucial.
  • Red Blood Cell Count: This may rise with TRT.
  • Sperm Count: A decrease is possible, affecting fertility.

Can low testosterone be prevented?

While there’s no guaranteed way to prevent low testosterone in men caused by genetics or organ damage, certain lifestyle choices can support healthy testosterone levels:

  • Maintain a Balanced Diet: Eating a nutritious diet rich in fruits, vegetables, and whole grains provides your body with the essential building blocks for hormone production.
  • Stay Active: Regular exercise, including strength training, can help optimize testosterone levels.
  • Manage Weight: Obesity is linked to lower testosterone. Maintaining a healthy weight can be beneficial.
  • Limit Alcohol and Drugs: Excessive alcohol and drug use can negatively impact testosterone production. Moderation or abstinence is key.

By incorporating these healthy habits into your routine, you can create an environment that supports optimal testosterone function.

Final Note

While low testosterone symptoms in men can be associated with aging, it’s important not to dismiss bothersome symptoms as inevitable. If you’re experiencing issues that affect your quality of life, seeking professional help is key. A healthcare provider can diagnose low testosterone in men and discuss treatment options if necessary. Taking charge of your health can lead to a significant improvement in your well-being.

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