What you need to know about male hypogonadism

Male hypogonadism, also known as testosterone deficiency, is a failure of the testes to produce the male sex hormone testosterone, sperm, or both.

It can be due to a testicular disorder or the result of a disease process involving the hypothalamus and pituitary gland.

Hypogonadism can affect many organ functions and it can have a negative impact on quality of life.

The signs and symptoms depend on when it starts, how severe the deficiency is, and whether or not there is a decrease in the major functions of the testes.

Fast facts on male hypogonadism

Here are some key points about male hypogonadism. More detail is in the main article.

• Hypogonadism may occur at any age, and the consequences differ, according to when it starts.
• If hypogonadism occurs before puberty, puberty does not progress. If it occurs after puberty, there may be infertility and sexual dysfunction.
• In adult men, symptoms begin within a few weeks of the onset of testosteronedeficiency.
• Hypogonadism may increase the risk for cardiovascular disease, type 2 diabetes, metabolic syndrome, premature death in older men, and Alzheimer's disease.

Symptoms

When hypogonadism develops in adulthood, erectile dysfunction can be a prominent symptom in males.

A lack of testosterone can cause a wide range of symptoms.

These depend on:

• the age of onset
• the degree of testosterone deficiency
• how long the loss has been occurring

Adolescents and young adults who have not yet completed puberty appear younger than their chronological age.

They may also have small genitalia, a lack of facial hair, failure of the voice to deepen, and difficulty gaining muscle mass, even with exercise.

Puberty-onset hypogonadism can lead to:

• impaired sexual development
• decreased testicular size
• enlarged breasts

Symptoms of adult-onset hypogonadism include:

• erectile dysfunction
• low sperm count
• depressed mood
• decreased libido
• lethargy
• sleep disturbances
• decreased muscle mass and strength
• loss of body hair (pubic, axillary, facial)
• osteoporosis and decreased bone mineral density
• increased body fat
• breast discomfort and enlargement
• hot flashes
• sweating
• poor concentration and decreased energy

Causes

Hypogonadism in a male refers to a decrease in either or both of the two major functions of the testes: sperm production and testosterone production.

This can happen for a number of reasons.

Primary male hypogonadism is caused by testicular dysfunction that can be congenital or develop later in life.

In primary hypogonadism, the testicles do not respond to hormone stimulation. This can be due to a congenital disorder such as Klinefelter's syndrome, or acquired as a result of radiation treatment, chemotherapy, mumps, tumors or trauma to the testes.

In secondary hypogonadism, a disease state interferes with either the hypothalamus or pituitary gland, the main glands that release hormones to stimulate the testes to produce testosterone.

Situations that can cause secondary hypogonadism include:

• malnutrition
• systemic illness
• stress
• medication side effects
• liver cirrhosis
• toxins (alcohol and heavy metals)
• morbid obesity.

Andropause is sometimes used to describe decreased testosterone due to the normal aging process. Testosterone levels in males increase until the age of 17 years. Then, starting at approximately 40 years of age, testosterone levels begin to decline at 1.2-2 percent per year.

Risk factors for hypogonadism include type 2 diabetes, obesity, renal failure, HIV, hypertension, chronic obstructive pulmonary disease (COPD) and taking glucocorticoid (steroids), opioid or antipsychotic medication therapy.

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Treatment

Testosterone replacement therapy can improve mood and overall quality of life in males with hypogonadism.

Testosterone replacement therapy (TRT) is the recommended treatment for male hypogonadism.

It is normally given as a topical gel, transdermal patch, or by injection. Oral forms of testosterone are not used due to the high risk of side effects, such as upset stomach.

TRT can eliminate many, if not all, of the signs and symptoms of male hypogonadism.

Benefits include:

• increased libido
• mood improvement
• increased bone mineral density
• overall improved quality of life

However, there are a few risks associated with it.

It may lead to worsening of benign prostatic hyperplasia (BPH), acceleration of pre-existing prostate cancer, and worsening of both sleep apnea and congestive heart failure. TRT should not be started without first attending to these conditions.

All males who are using TRT require ongoing medical evaluation to determine adequate response to treatment. This will include regular blood tests and periodic digital rectal exams.

TRT is contraindicated in men with erythrocytosis, a condition involving a high volume percentage of red blood cells in the blood.

The response to TRT is individualized, and testosterone levels are not an indicator of who will respond to TRT and who will not. It is also worth noting that while it can relieve symptoms of hypogonadism, TRT does not restore fertility.