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Low testosterone, also called male hypogonadism, is a condition in which the testicles do not produce enough testosterone. Testosterone is the main male sex hormone. It supports muscle mass, bone strength, red blood cell production, energy, mood, sex drive, and fertility. Testosterone levels also drop naturally with age, declining about 1% per year starting in the late 30s. When low levels appear alongside symptoms, providers diagnose male hypogonadism.
Signs and Symptoms
Symptoms of low testosterone vary by age and severity. Sexual symptoms are the most specific. These include low libido, loss of morning or spontaneous erections, and trouble attaining or maintaining an erection.
Other symptoms that strongly suggest hypogonadism include loss of armpit and pubic hair, shrinking testicles, hot flashes, and low sperm count. Additional signs include depressed mood, problems with concentration and memory, increased body fat, enlarged male breast tissue, reduced muscle strength and mass, and decreased endurance.
In boys, low testosterone before or during puberty produces different effects. These can include slowed growth in height, reduced development of pubic hair, limited growth of the penis and testicles, less voice deepening, and lower-than-normal strength and endurance.
Causes
Low testosterone has several possible causes. Any problem with the testicles, the hypothalamus, or the pituitary gland can lower testosterone. The hypothalamus and pituitary gland release hormones that control how much testosterone the testicles make. Providers divide the condition into two main types.
Primary hypogonadism is a problem with the testicles. Conditions present at birth include the absence of testicles, undescended testicles, Klinefelter’s syndrome, and Noonan syndrome. Acquired causes include testicle injury or removal, infection of the testicles, chemotherapy or radiation, certain tumors, iron overload, and alcohol use disorder.
Secondary hypogonadism is a problem with the hypothalamus or pituitary gland. Untreated low testosterone can lead to infertility, erectile dysfunction, and a decrease in lean muscle mass.
Treating Low Testosterone
Treatment begins with a thorough evaluation to identify any underlying cause. A provider performs a physical exam and reviews medical history, medications, and symptoms. Blood tests help confirm the diagnosis. A total testosterone test usually requires two morning samples. Luteinizing hormone and prolactin tests help locate a pituitary cause.
Nutritious food and regular physical activity are the first treatments. If symptoms continue or if they are severe, other treatment may follow. Testosterone replacement therapy comes in several forms. These include skin gels, injections, implanted pellets, nasal gel, and oral testosterone for specific conditions. Pituitary hormones can stimulate sperm production, and clomiphene citrate is an option for those who want to preserve fertility.
Some men cannot receive testosterone therapy. Contraindications include prostate cancer, breast cancer, an enlarged prostate, poorly managed high blood pressure, recent heart attack or stroke, and untreated sleep apnea. Premier Endocrinology notes that when hypogonadism stems from a pituitary tumor, treatment may involve a neurosurgeon. Ongoing therapy requires regular follow-up visits, often once or twice a year.
Find a Urologist
If you notice symptoms of low testosterone that affect your daily life, talk to a healthcare provider. A urologist or endocrinologist can assess your symptoms and order the right blood tests. Schedule an evaluation to learn what options are available to you.
