Hypogonadism Testosterone Deficiency

Male hypogonadism is a deficiency of testosterone in men. About 5 percent to 6 percent of men experience male hypogonadism, and the condition becomes more common as a man ages.

Hypogonadism may be congenital or may be acquired as the result of aging, disease, drugs or other factors. Symptoms include low sperm count, decreased libido, erectile dysfunction, fatigue, sleep disturbances and depression.

In primary hypogonadism, the testes fail to make testosterone because of infection or injury to the testes. Common causes of testicular dysfunction include cancer treatment, excessive alcohol consumption, Klinefelter syndrome, mumps orchitis and autoimmune disorders.

In secondary hypogonadism, which is more common, the hypothalamus or the pituitary gland fails to produce enough hormones. These hormones are needed to trigger the testes to produce testosterone. Secondary hypogonadism can be caused by Kallmann syndrome, pituitary or hypothalamic tumors or disorders, obesity, diabetes and Prader-Willi syndrome.

Diagnosing Male Hypogonadism

Following a complete medical history and physical, tests will be done to measure the man's testosterone level. Because testosterone levels naturally fall off during the day, a testosterone blood test is done between 7:00 am and 10:00 am.

If the test shows a low testosterone level, additional tests may be ordered to check for a pituitary gland disorder. A blood test to check serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin levels can help determine the cause. If needed, specialized testing may be performed in the Endocrine Diagnostic Unit, based at Froedtert Hospital.

Other tests may be used to measure sperm count, check for testicle or gland tumors, or identify a genetic (congenital) cause. 

Hypogonadism Treatment

For men with primary hypogonadism, treatment typically involves lifelong testosterone replacement therapy. Options for replacement therapy include:

  • Testosterone gel applied on the skin
  • Buccal mucosal patch, which is placed inside the mouth
  • Transdermal testosterone patch, which sticks to the skin
  • Testosterone injections into the muscles

Too much testosterone can place a man at a higher risk for blood clots. As with any hormonal therapy, it’s important to monitor patients as treatment progresses. Men receiving hormone replacement therapy are seen for blood tests and a prostate exam at one, three and six months after beginning treatment. They continue to be seen every six months.

Secondary hypogonadism is treated by addressing the root cause - a disorder with the hypothalamus or pituitary gland

Treatment may also be needed for conditions related to hypogonadism, including:

  • Erectile dysfunction (ED) therapy
  • Bone loss treatment, if bone loss has been diagnosed
  • Gynecomastia treatment, if desired, which may involve breast reduction surgery

Fertility treatment

Infertility related to secondary hypogonadism may respond to hormonal replacement therapy. Infertility related to primary hypogonadism, however, does not respond to hormonal therapy. In these cases, a man and his partner can be referred to the Reproductive Medicine Center for help conceiving a child.