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What is hypogonadism?
Hypogonadism is a medical condition characterized by the body's inadequate production of testosterone, which is crucial for male health. This condition affects approximately 6% of middle-aged men, with prevalence increasing with age. Men in their seventies produce about 35% less testosterone compared to their younger counterparts.1
Symptoms of hypogonadism
Men with hypogonadism may experience:2,3
- Reduced Libido: A significant decrease in sexual interest.
- Erectile Dysfunction: Difficulty achieving or maintaining an erection.
- Fatigue: Persistent, severe tiredness.
- Decreased Muscle Mass: Noticeable loss of muscle strength and mass.
- Increased Body Fat: Particularly around the abdomen and hips.
- Reduced Facial and Body Hair: Less hair growth in typical male areas.
- Infertility: Reduced sperm production affecting fertility.
- Mood Changes: Depression, anxiety, or irritability.
- Osteoporosis: Increased risk of bone density loss and fractures.
- Anemia: Often unrecognized, contributing further to fatigue and weakness.
Diagnosis of hypogonadism
Diagnosis involves: 4
- Clinical assessment of symptoms.
- Blood tests to confirm low testosterone levels are recommended to be repeated for accuracy. Further diagnostic testing may explore specific causes of the condition.1
Causes of hypogonadism
- Primary hypogonadism stems from problems within the testes and can be caused by: 3
- Genetic conditions such as Klinefelter syndrome and Down syndrome.
- Mumps-related orchitis or other severe infections of the testes.
- COVID-19 infections can affect the ability of the testis to produce testosterone, at least temporarily.
- Chronic illnesses like chronic kidney disease, chronic obstructive pulmonary disease, or HIV infection.
- Cancer treatments such as chemotherapy or radiation.
- Physical injury to the testicles.
- Secondary hypogonadism originates from issues in the pituitary gland or hypothalamus and can be caused by: 3
- Genetic conditions such as Kallmann syndrome.
- Pituitary dysfunction due to tumors, surgery, trauma, infection, or infiltrative diseases.
- Inflammatory diseases affecting the hypothalamic-pituitary axis.
- Certain medications, especially those that are opiate-based.
- Functional hypogonadism: This is a term recently adopted to refer to lifestyle or age-related decline in testosterone, affecting the hypothalamic-pituitary-gonadal axis. Typical causes include:
- Ageing
- Obesity
- Type 2 diabetes
- Excessive stress
- Chronic inflammation
Treatment of hypogonadism
Treatment aims at the underlying cause where possible. If ineffective, testosterone replacement therapy (TRT) can be considered, administered through long- and short-acting injections of testosterone esters or various preparations of testosterone gels. However, TRT is contraindicated in men desiring paternity and in those with untreated prostate carcinoma due to potential risks.
Prognosis of hypogonadism
The prognosis depends on the underlying cause, age at diagnosis, and effectiveness of treatment. Proper management can lead to a significant improvement in quality of life.
Questions to ask your doctor about hypogonadism
How could anemia be influencing my symptoms of hypogonadism?
Should I undergo multiple tests to confirm low testosterone levels?
What are the causes of my hypogonadism, and is it reversible?
What are the specific contraindications for TRT in my case?
What are the best TRT alternatives considering my desire for children?
What are the safety considerations before starting TRT?
How should I discuss my condition with my family?
Support & resources for hypogonadism
It is important to consult healthcare providers and patient advocacy groups specialising in hormonal health for additional information and support.
