Male Hypogonadism โ Diagnosis and Treatment
Adults with testosterone deficiency, or male hypogonadism, often experience reduced sexual desire and low energy. They may also notice loss of facial and body hair.
Muscle mass and bone strength can decline, which affects daily activities and bone health. For older adults, age-related testosterone decline is common.
Diagnosis
Diagnosing male hypogonadism starts with a thorough review of symptoms, medical history, and a physical exam. Doctors look for signs like:
- Decreased libido or sexual function
- Fatigue or low energy
- Reduced muscle or bone mass
- Infertility
- Mood changes or depression
Blood Tests
The primary test involves measuring total testosterone levels in the morning (between 7 a.m. and 10 a.m.), when levels are highest. If levels are low, doctors often repeat the test and may also check:
- Free testosterone
- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
- Prolactin, thyroid, or iron levels to rule out other causes
- Semen analysis if fertility is a concern
These tests help determine whether the hypogonadism is primary (testicular origin) or secondary (pituitary or hypothalamic origin).
Treatment
Doctors can use several methods to give testosterone therapy. Each method has benefits and drawbacks.
The best option depends on your health, how your body absorbs medicine, your lifestyle, and insurance coverage.
Method | How You Use It | Main Benefits | Possible Issues |
---|---|---|---|
Gels | Apply to the skin daily | Easy use, steady absorption | Skin irritation, risk of passing hormone to others |
Shots | Inject into muscle or under the skin | Can self-administer, longer effect | Levels may fluctuate, may cause discomfort |
Patch | Stick to skin, change daily | Steady hormone release | May cause skin problems |
Gum/Cheek | Place in mouth several times a day | No skin contact, direct absorption | Gum irritation |
Nasal Gel | Pump into nostrils three times a day | Lower contact risk for others | Frequent dosing needed |
Pellet Implants | Doctor places under skin every 3โ6 months | Low maintenance after placement | Needs minor procedure |
Oral (undecanoate) | Take by mouth as a capsule | No skin or needles, lymph absorption | Not for age-related hypogonadism, less common |
The U.S. Food and Drug Administration (FDA) approves only certain forms for specific conditions. Oral testosterone undecanoate uses the lymph system for absorption and is less likely to harm the liver than older oral drugs.
Doctors do not recommend oral testosterone undecanoate for older adults with age-related hypogonadism.
Possible side effects:
- Too many red blood cells (polycythemia)
- Acne
- Worsened sleep apnea
- Gynecomastia
- Lower sperm production (may affect fertility)
- Prostate growth
Most side effects depend on the dose. Healthcare professionals can adjust the regimen or dose to reduce problems.
Restoring Fertility When Hypogonadism Causes Infertility
Low testosterone or hypogonadism can cause male infertility. The treatment depends on the cause.
If the pituitary gland causes the problem, doctors use hormones like luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to help the testicles make sperm. Sometimes, pituitary tumors require surgery, radiation, or other medicines to correct hormone imbalances.
For men with primary hypogonadism, such as Klinefelter syndrome or testicular damage, sperm production is often very difficult or impossible. Standard testosterone replacement does not restore fertility.
Assisted reproductive technologies, such as in vitro fertilization (IVF) or sperm retrieval techniques, may help some couples achieve pregnancy.
Steps for Promoting Puberty in Young Males
When boys experience delayed puberty because of hypogonadism, the health team might recommend short-term testosterone shots.
This treatment usually lasts three to six months and helps start physical changes like muscle growth, body hair, beard hair, and an increase in penis size.
Doctors only consider this therapy after they check that the bones are mature enough. This step lowers the risk of growth-related problems.
Boys with rare genetic syndromes, such as Kallmann syndrome or Prader-Willi syndrome, need careful evaluation. Doctors may design a hormone therapy plan just for them.
Points to keep in mind for treating pubertal delay:
- Short-Duration Therapy: Doctors use this to start puberty, not for long-term maintenance.
- Physical Effects: Boys may see more muscle mass, body hair, and sexual development.
- Monitoring: The health team schedules regular bone and hormone tests to track progress.