Male Hypogonadism: What to Know About Low Testosterone Levels

November 25, 2024

4 mins

Rex MD also offers a selection of treatment options like injections and other medications with It’s not uncommon for men over the age of 75 to have testosterone levels that are below normal. Low testosterone levels in young men may be a sign of an underlying health condition affecting the reproductive system.

Your gonads are the primary reproductive organs in the body. In men, gonads is another term for the testes. Testosterone is produced in the testes. Hypogonadism interrupts the production of sex hormones in the body. 

In women, hypogonadism can lead to early menopause. Both women and men may experience weaker bones from hypogonadism. 

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What is Male Hypogonadism?

Hypogonadism — also referred to as gonadal deficiency — occurs when reproductive organs don’t produce enough sex hormones. There are two types of hypogonadism — primary and secondary (central). Both types can lead to poor function of sex organs and an underproduction of sex hormones.

In men, primary hypogonadism (hypergonadotropic hypogonadism) causes complications in the testes. Men with certain autoimmune disorders have an increased risk of hypogonadism. 

Secondary hypogonadism (hypogonadotropic hypogonadism) is typically caused by damage to the pituitary gland or hypothalamus. The pituitary gland and hypothalamus are parts of the brain that are essential in hormone regulation.

What Causes Male Hypogonadism?

Hypogonadism is often the result of problems with the pituitary gland or hypothalamus. The brain communicates with the reproductive system to regulate hormones in the body.

Causes of primary hypogonadism 

Primary hypogonadism is also commonly referred to as testicular failure. It can happen even when other sex hormones like luteinizing hormones (LH) and follicle-stimulating hormones (FSH) are high.

This type of hypogonadism can happen over time naturally as men get older, but there are also specific health conditions and experiences that can cause low testosterone levels:

• Klinefelter syndrome: Genetic disorders common in men that affect common sex hormones. In severe cases, it can lead to infertility.

• Autoimmune disorders: Health conditions like rheumatoid arthritis and lupus can cause inflammation in the gonads (testes).

• Orchitis: A type of infection from viral infections or STIs that causes inflammation in one or both testicles.

• Hemochromatosis: An overproduction of iron in the body can affect the functionality of the testes.

Causes of secondary hypogonadism 

Damage to the pituitary gland or hypothalamus in the brain leads to secondary hypogonadism. The male body depends on stimulation from the pituitary gland to know when to produce testosterone.

When chemical signals fail to effectively travel from the brain to the reproductive organs, it may be because of the following:

• Surgery: Brain surgery can cause changes to the hypothalamus that lead to hypogonadism.

• Trauma: Neurological trauma can affect how the hypothalamus and the pituitary gland in the brain function.

• Genetics: Male congenital hypogonadotropic hypogonadism (CHH) is a group of genetic disorders that can reduce testosterone production.

• Weight changes: Sudden weight gain and weight loss can cause a drop in testosterone that can lead to erectile dysfunction.

• Radiation: When radiation is applied to the pelvic region, it can lead to low testosterone levels as cells are treated.

• Obesity: Severe obesity can cause erectile dysfunction from low testosterone levels in the body.

What are the Symptoms of Male Hypogonadism?

Kallmann syndrome is a type of secondary hypogonadism that causes delayed puberty in boys. For example, males with Kallman syndrome may take longer to grow facial hair. An underproduction of testosterone in men can sometimes cause fatigue.

Growth problems from hypogonadism can cause muscle loss and slow the overall growth of muscles. Other symptoms include breast enlargement and low libido.

While rare, central hypogonadism can be a sign of a brain tumor. Craniopharyngioma is the most common tumor in children, while prolactinoma adenomas is the most common brain tumor in adults.

Headaches, vision loss, and hypothyroidism — an underactive thyroid condition  — are all symptoms that may occur with all types of hypogonadism.

What risk factors are associated with male hypogonadism?

Severe hypogonadism can lead to autoimmune damage to the gonads. Hypogonadism can weaken muscles and increase the risk of osteoporosis (a disease that weakens bones). Most people with osteoporosis do not experience any symptoms in its early stages.

Does male hypogonadism cause erectile dysfunction?

Hypogonadism can cause infertility and erectile dysfunction (ED) in men. Hypogonadism causes complications in smooth muscle and erectile tissue function that lead to ED. Low testosterone levels are not the only potential cause of erectile dysfunction, but increasing levels can help some men successfully reach and maintain orgasms.

How is Male Hypogonadism Diagnosed?

If a healthcare provider suspects that you may have hypogonadism there are several tests to check testosterone levels and the presence of other sex hormones. 

A routine blood test can show any potential changes in iron levels. Other tests include genetic tests and imaging tests like an MRI, CT scan, or sonogram. MRIs and CT scans can let a healthcare provider know if you have pituitary disease or secondary hypogonadism.

During the diagnostic process, they may also perform tests to check:

• Testosterone levels

• Sperm count

• Thyroid function

• Iron levels

• Prolactin levels

Treatments for Male Hypogonadism

A healthcare provider can provide you with the best options for treatment based on the cause. Testosterone replacement therapy (TRT) is typically the first method of treatment for hypogonadism. However, some causes of hypogonadism can be addressed before needing TRT.

Lifestyle factors like severe obesity, high-stress levels, and substance abuse increase your risk of male hypogonadism. A healthcare provider may also prescribe medications to treat chronic health conditions that contribute to male hypogonadism.

Testosterone replacement therapy (TRT)

If you are already showing symptoms of male hypogonadism, a healthcare provider may suggest testosterone replacement therapy to increase testosterone levels.

Treatment options are as follows:

Injections: Testosterone injections be self-administered or from a healthcare provider at a clinic every 10 weeks or as instructed.

Gels: Gels are applied on the arm, shoulder, inner thigh, or armpit. Be careful to wait until it is completely absorbed into the skin before putting on clothing or coming into skin-to-skin contact with others. Nasal gels are applied to the nostrils three times a day.

Patches: You place a testosterone patch on the back, abdomen, upper arm, or thigh. Some men may experience skin rashes or redness.

Implants: Pellets are implemented under the skin surgically every three to six months. Be sure to discuss potential side effects with a healthcare provider.

Tablets: Buccal tablets are applied to the gums twice daily before absorbing into the bloodstream.

Risks of testosterone replacement therapy (TRT)

Testosterone therapy is meant to be a short-term treatment option for male hypogonadism. A healthcare provider may recommend alternate modes of treatment for men with:

• A family history of prostate cancer

• An enlarged prostate

• A history of blood clots

• Heart attack or strokes in the last six months

African-American men over the age of 45 have a high risk of prostate cancer. Be sure to thoroughly discuss your health history with a healthcare provider before choosing a treatment option.

Medications to Treat Male Hypogonadism

Medications for male hypogonadism increase testosterone levels and may also improve fertility outcomes in men. 

Clomiphene: A selective estrogen receptor modulator (SERM) that blocks the effects of estrogen. The branded version of this medication is called Clomid. It’s also a relatively affordable option for treating conditions associated with low testosterone levels in men.

Aromatase inhibitors: This medication works well in men with severe obesity or who develop hypogonadism later in life.

GnRH therapy: Gonadotropin-releasing hormones can improve sperm quality in men with hypogonadism. Testosterone levels may also increase in men.

Some men may benefit more from surgery and radiation therapy to regulate the pituitary gland. This is most commonly a treatment option for men with secondary hypogonadism.  

Self-care remedies for hypogonadism

Keeping a consistent exercise routine and following a healthy diet can help prevent hypogonadism. If caused by a genetic mutation, hypogonadism may not be preventable for most men. If your family has a history of hypogonadism, speak with a healthcare provider about options for reducing your risk.

When health concerns interfere with family planning, it can be a taxing experience to go through with a partner. A key aspect of preventing male hypogonadism is reducing high-stress levels. Reach out to a healthcare provider about options for mental health support while dealing with the mental toll of treatment.

How Can Rex MD Help

The Rex MD TestoRx program offers access to quality care from a team of licensed clinicians. If interested, get started by answering some questions about your symptoms and medical history. A licensed healthcare provider can then order lab work to help determine your eligibility for treatment. 

Personalized testosterone therapy, when clinically appropriate. Then, you’ll be able to schedule a virtual call with the Rex MD care team to discuss which treatment option is best for you, if any.