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Also known as
Male hypogonadism, Testosterone deficiency syndrome, Androgen deficiency, Hypogonadotropic hypogonadism, Hypergonadotropic hypogonadism, Low testosterone, Gonadal deficiency, Testicular failure, Late-onset hypogonadism (LOH), Andropause
Definition
Hypogonadism is a clinical condition characterized by inadequate production of sex hormones by the gonads (testes in men, ovaries in women).1 In males, hypogonadism manifests as testosterone deficiency, resulting in decreased functional activity of the testes with reduced production of testosterone, sperm, or both.2 The condition can be classified as primary (originating from a problem in the gonads) or secondary (resulting from disorders in the hypothalamus or pituitary gland).3 Primary hypogonadism indicates testicular failure, while secondary hypogonadism indicates a problem in the hypothalamic-pituitary axis that signals the testes to produce testosterone.1 Hypogonadism can be congenital or acquired, and its effects depend on when it develops—during fetal development, puberty, or adulthood.1
Clinical Context
Hypogonadism requires clinical evaluation when patients present with symptoms of hormone deficiency.2 Symptoms highly suggestive of hypogonadism include decreased spontaneous erections, decreased nocturnal penile tumescence, decreased libido, and reduced testicular volume.2 In adult males, early signs include decreased sex drive, decreased energy, and depression.1 Over time, men may develop erectile dysfunction, infertility, decreased facial and body hair growth, decreased muscle mass, gynecomastia (development of breast tissue), and osteoporosis.1
Diagnosis typically involves measuring morning serum testosterone levels on two separate occasions, with levels below 300 ng/dL generally considered diagnostic when accompanied by clinical symptoms.2 Additional testing may include follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels to differentiate between primary and secondary hypogonadism.2
Treatment options depend on the cause and type of hypogonadism. Testosterone replacement therapy is the primary treatment for symptomatic hypogonadism and has been shown to improve libido, anemia, bone mineral density, lean body mass, depression, and erectile function.2 Alternative treatments like clomiphene citrate may be considered for men wishing to preserve fertility.2 Patients with hypogonadism should be monitored for potential complications including polycythemia, cardiovascular events, and prostate issues.3
Population screening is not recommended, but testing should be considered for patients with HIV, end-stage renal disease, type 2 diabetes, infertility, severe COPD, unexplained anemia, and osteoporosis.2 Other risk factors include post-chemotherapy testicular atrophy, post-testicular radiation therapy, chronic opioid use, pituitary dysfunction, and chronic steroid use.2