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Hypogonadism (Low testosterone)

Hypogonadism (Low testosterone)

Male hypogonadism means the testicles do not produce enough of the male sex hormone testosterone. When levels are low, men might have decreased sex drive, less muscle mass, erectile dysfunction, and fatigue. Testosterone is responsible for male reproductive and sexual functions. It affects puberty, fertility, muscle mass, body composition, bone strength, fat metabolism, sex drive, mood and mental processes.

Types of Hypogonadism:

Primary hypogonadism is caused by a problem in the testes. This type is most frequent and usually affects development in childhood and adolescence.
Secondary hypogonadism is caused by a problem in glands (pituitary gland, hypothalamus) that tell the testes to make testosterone. This type is more common among older men.


Hypogonadism can occur at any age. The symptoms will be different depending on your age when it develops. Common symptoms in adult men include:
  • Fatigue
  • Hot flushes
  • Low sex drive
  • Erectile dysfunction
  • Mood changes
  • Difficulty concentrating
  • Problem in sleeping
  • Loss of muscle mass
  • Decreased bone density
  • Enlarged breastsLoss of body hair
  • Infertility
  • Loss of body hair


Male hypogonadism is diagnosed based on:
  • Long-term discomfort from symptoms
  • Low testosterone levels in the blood
  • Size of the testes on clinical examination


In adults, the American Urological Association AUA recommends that Testosterone therapy (TT) be prescribed only to men who meet the clinical and laboratory definition of testosterone deficiency (Testosterone level of less than 300 ng/dL).
  • Health changes such as losing weight and getting more physical activity will likely raise your testosterone levels.
  • Your doctor will want to check your hemoglobin/hematocrit (Hgb/Hct) levels while you are on TT. This blood test will help check for thickening of the blood.
  • Blood thickening may cause blood clots. Your doctor may do Hgb/Hct levels two to six weeks after you start TT and every six to twelve months after that test.
  • If you are at risk for heart disease, your doctor will follow you more closely when you are on TT. It also is important to make health changes to decrease the chances for heart and blood vessel disease.
  • Your doctor will treat your Low-T level to raise it above 300ng/dl but the exact level may vary.
  • Your doctor will watch you for signs and symptoms of improvement. Any changes will likely appear within three to six months of treatment.
  • If your total testosterone blood level returns to normal and you still have symptoms, it is likely that there are other reasons for your symptoms. Your doctor may stop TT and try to find out what else might be the problem.
How Do I Take Testosterone? There are different ways to take testosterone. They are: transdermal (through the skin), injection, oral/buccal (by mouth), intranasal (through the nose), and by pellets under the skin. No method is better than another. While you are taking TT, your doctor will test your blood to determine testosterone levels. Here are some details about the five different methods:
  • Transdermal (Topical). There are topical gels, creams, liquids and patches. Topical medicines most often last for about four days. They absorb better if covered with an air- or water- tight dressing. Make sure that other people, especially women and children, do not touch the medicines.
  • Injection. There are short-acting and long-acting forms of testosterone injection. The short-acting medicine may be given under the skin or in the muscle. The long-acting one is usually given in the muscle. Injections are usually given either weekly, every two weeks, or monthly.
  • Oral/buccal (by mouth). The buccal dose comes in a patch that you place above your incisor (canine or “eyetooth”). The medication looks like a tablet but you should not chew or swallow it. The drug is released over 12 hours. This method has fewer harmful side effects on the liver than if the drug is swallowed, but it may cause headaches or cause irritation where you place it.
  • Intranasal. This form of testosterone comes in a gel. You pump the dose into each nostril, as directed. It is usually taken three times daily.
  • Pellets. Your doctor will place the testosterone pellets under the skin of your upper hip or buttocks. Your doctor will give a shot of local anesthesia to numb your skin, then make a small cut and place the pellets inside the fatty tissues underneath your skin. This medication dissolves slowly and is released over about 3-6 months, depending on the number of pellets.
You may want to choose how you take your testosterone based on what is best or most useful for you. Are There Side Effects of TT? There are some side effects of TT. Some side effects are mild while others are more serious. You should ask your doctor about these side effects and watch for them while you are taking TT. Some of the side effects are as follows:
  • For gels and liquids, there may be some redness at the skin site. With patches, you may have itching and a rash around the area. A very small number of patients report back pain.
  • For short-acting injections, you may have some reaction at the injection site. Some persons have had serious allergic reactions to the long-acting injection. Because of this, when you get the long-acting injection they will watch you closely for a while afterwards in the medical office.
  • For testosterone pellets, possible adverse effects include swelling, pain, bruising and, rarely, hematoma (clotted blood under the skin).
  • During TT, there is increased risk of erythrocytosis (abnormal raising of blood hemoglobin and hematocrit).
  • TT may interrupt normal sperm production. You should not have TT if you plan on having children soon. If you are being treated for Low-T your doctor may suggest added treatment for sperm production.
  • Topical testosterone, specifically gels, creams and liquids, may transfer to others. Women and children are most at risk of harmful effects from contact with them. You should take care to cover the area and wash your hands well after putting on the medication. Be careful not to let the site with the topical TT touch others because that could transfer the drug.
Here are some things you should know:
  • There is no evidence linking TT to prostate cancer.
  • There is no strong evidence linking TT to increase in vein clots.