Male Hypogonadism: Symptoms, Causes, Treatment

The problem may originate in the testes or in hormonal signalling from the brain and pituitary. Age-related hormonal changes do not automatically establish disease, and the label “male menopause” may obscure other causes of symptoms.

Related reading: Unexplained Infertility.

Symptoms can include reduced sexual desire, fewer spontaneous erections, infertility and changes in muscle mass or hair. Fatigue and mood changes are nonspecific. Delayed puberty in an adolescent needs its own assessment rather than automatic use of an adult treatment plan.

Causes include genetic conditions, testicular damage, certain cancer treatments and pituitary disorders. Obesity, severe illness, some medicines including opioids, and anabolic steroid use may also lower testosterone. Identifying the cause determines reversibility and treatment options.

Chronic illness, obesity, testicular or pituitary disorders and chemotherapy or radiotherapy can increase risk. Increasing age alone is not an indication for replacement. Fertility plans and contraindications must also be considered before prescribing.

Diagnosis combines symptoms and examination with low testosterone on two separate morning measurements, following laboratory and clinical instructions. Pituitary hormones help distinguish causes; prolactin testing or imaging may be indicated. Temporary illness and sampling time affect interpretation.

Address reversible causes where possible. Testosterone replacement may suit confirmed deficiency with symptoms after discussion of risks and monitoring. External testosterone suppresses sperm production and is not a fertility treatment. Those seeking pregnancy need specialist, cause-specific options rather than one universal substitute.

Persistent deficiency may affect bone strength, fertility and body composition. Hormone replacement also has risks requiring monitoring, including increased red blood cell levels. Follow-up evaluates response, testosterone and other tests selected for age, history and treatment type.

Not all congenital or acquired causes are preventable. Avoid non-prescribed anabolic steroids, support healthy sleep and weight, and review medicines with a clinician. Do not stop long-term treatment yourself or substitute testosterone-boosting supplements for assessment.