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A. Male hypogonadism means the testicles do not produce enough of the male sex hormone testosterone. When levels are low, men might have decreased sex drive, less muscle mass, erectile dysfunction, and fatigue.
Hypogonadism has a negative effect on organ function and quality of life. Testosterone is responsible for male reproductive and sexual functions. It affects puberty, fertility, muscle mass, body composition, bone strength, fat metabolism, sex drive, mood and mental processes .
Testosterone is an androgen. Production of androgens decreases slightly with age. Low levels are more common in men who are obese and have multiple health conditions.
A. Primary hypogonadism is caused by a problem in the testicles.
Secondary hypogonadism is caused by a problem in glands (pituitary) that tell the testicles to make testosterone.
A. Testosterone is produced mainly in the testicles and also by the adrenal glands. Women have testosterone, but in much smaller amounts than men.
In the brain, the hypothalamus and pituitary gland help the testicles produce testosterone. They produce hormones that prompt action in the testicles. In response, the testicles produce sperm and testosterone.
Role of testosterone in various organs:
Brain: Affects sex drive, mood, and mental processes (cognition)
Skin: Affects male pattern body and facial hair, balding, and oil production
Larynx: Deepens voice and prompts formation of Adam’s apple
Organ: Stimulates production of erythropoietin, which causes red blood cells to form
Male sexual organs: Affect penile and prostate growth and function and production of sperm
Muscle: Increases strength and muscle mass
Liver: Affects production of proteins
Fat: Decreases fat mass
Bone marrow: Stimulates production of stem cells
Bone: Accelerates growth, increases bone strength, and maintains bone density
A. Hypogonadism can develop at any age but affects young children, adolescent boys, and men differently. It has little impact on young children and may well go away over time.
In contrast, low hormone levels at puberty can affect a boy’s sexual development.
Adolescent boys with hypogonadism typically have undeveloped muscles and genitals, a high-pitched voice, and little or no body hair.
Breasts may form, and arms and legs may become out of proportion to a small torso as they continue to grow.
In most cases, a delay in development is normal and will correct itself, although the wait may be emotionally and socially difficult.
A. Check for hypogonadism if a boy:
A. The symptoms will be different depending on your age when it develops.
Common symptoms in adult men include:
Older men with low hormone levels may have low sexual desire and activity, erectile dysfunction, and hot flushes. In men with normal testosterone levels, these symptoms can be caused by other conditions.
A. Male hypogonadism is diagnosed based on:
Your doctor might refer you to a hormone specialist (endocrinologist) if hypogonadism is suspected.
Physical and clinical symptoms suggestive of low testosterone:
Physical examination: A physical exam will look at your body hair, male pattern hair loss, body mass index, the waist-hip ratio, muscle mass, presence of gynaecomastia, testicular size, examination of the penis and digital rectal examination of the prostate.
Your doctor will make sure they are consistent with your age. Your doctor might also take a medical history to assess your general health.
For an adult patient, the doctor could also ask about your sexual life.
Blood test: If you have symptoms of hypogonadism, your doctor will take blood to test your testosterone level. Blood should be drawn in the morning before breakfast. This test should be done at least two separate times.
Additional tests: If both tests confirm you have low testosterone, further testing can determine whether the cause is testicular (primary hypogonadism) or pituitary (secondary type).
A. Other conditions can cause the same symptoms as hypogonadism. Additional Blood tests will assess levels of:
Imaging: MRI or CT scan may be used to check for tumours in the pituitary gland
Genetic testing: Some types of hypogonadism are caused by problems in the way the genes developed. These tests can check for genetic causes of low hormone levels.
A. Losing weight, adjusting your diet, stopping smoking, and increasing exercise can improve your quality of life with hypogonadism.
These changes can also help increase muscle strength and improve diabetes control and sexuality.
Hormone replacement therapy is the main treatment for both types of hypogonadism.
Tumours found in the pituitary gland may require surgery, medication, radiation, or replacement of other hormones.
Hormone replacement therapy: The goal of hormone replacement is to improve quality of life, sense of well-being, sexual function, muscle strength, and bone mineral density.
Replacement of the hormone testosterone aims to restore levels in men diagnosed with low testosterone caused by problems in the testicles (primary hypogonadism).
Pituitary hormones may be replaced if low levels are caused by a problem in the pituitary gland (secondary hypogonadism).
These hormones can stimulate genital development in boys.
They can increase sperm production and restore fertility in men.
A. Main indications for testosterone treatment are:
Contra-indications against testosterone treatment:
Risks of testosterone treatment:
In addition to side effects, hormone replacement carries some risks related to natural changes in hormone levels. Testosterone replacement can cause both cancerous and non-cancerous prostate tumours, enlarged breasts, infertility, and blood clots in the veins.
Do not use testosterone replacement therapy if you have:
A. Different types of testosterone replacement are absorbed into the body differently and have different side effects.
Consider starting therapy with a type that can be stopped easily (short-acting treatment) if side effects are a problem.
A. Regular medical monitoring is recommended during treatment.
Your doctor will schedule visits with you to assess whether treatment is working, address possible side effects, and check treatment safety.
Your testosterone will be tested over time to help determine the right dosage for therapy.
Follow-up may include blood tests, examination of your prostate and your heart, and bone density scans.
With treatment, your symptoms will go away gradually. For example, your sex drive might improve first, then your mood might improve, and then erectile function might return.