Male Hypogonadism (Low Testosterone in Men) – Causes, Symptoms and Treatments

Low T is a medical disorder in which the body does not create enough testosterone. Both men and women produce testosterone, but it is known as the "male hormone" since men constitute more of it.

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Testosterone is the primary androgen. During puberty, testosterone helps boys develop male characteristics such as body and facial hair, a deeper voice, and muscle strength. Men also need testosterone to produce sperm.

Testosterone levels typically decline with age, therefore elderly men have low blood testosterone levels. However, low testosterone at a younger age can indicate a disorder called male hypogonadism. It is a disorder in which your testicles produce insufficient amounts of testosterone, which can lead to serious issues including infertility. Let’s learn more.

Why is Testosterone important?

Testosterone is the primary male hormone responsible for governing sex differentiation, generating male sex features, spermatogenesis, and fertility. The effects of testosterone first manifest themselves in the fetus. Testosterone also promotes the maintenance and development of:

  • Reproductive organs and genitalia
  • Muscle mass
  • Adequate red blood cell count
  • Bone density
  • Feeling of well-being
  • Sexual and reproductive functions

Who does low testosterone affect?

Male hypogonadism is a medical disorder that affects people with testicles at any age, from birth to adulthood. Individuals with low testosterone are more likely to have been suffering from:

  • Obesity
  • Poorly managed Type 2 diabetes
  • Obstructive sleep apnea
  • Chronic medical issues, such as kidney failure or cirrhosis of the liver.
  • HIV/AIDS
  • Old age

What causes low testosterone levels?

Your hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to secrete luteinizing hormone. LH then travels to the gonads, where it stimulates testosterone production and release. However, there are various potential causes that interfere with this process and lead to low testosterone levels. The reasons causing male hypogonadism are divided into two types namely:

Primary Hypogonadism (Testicular Disorder)

Primary hypogonadism occurs when something is wrong with your testicles that prevents them from producing normal quantities of testosterone. The following conditions can impact your testicles:

  • The absence of testicles at birth
  • Undescended testicles
  • Underdevelopment of Leydig cells in your testicles
  • Klinefelter’s Syndrome
  • Noonan syndrome
  • Myotonic dystrophy
  • Testicular damage or removal
  • Inflammation of both or one of the testicles
  • Chemotherapy or radiation therapy for the testicles
  • Specific types of tumors
  • Anabolic Steroid Use

Secondary Hypogonadism (Pituitary-Hypothalamic Dysfunction)

Secondary hypogonadism is caused by conditions that disrupt the function of the hypothalamus and/or pituitary gland. Secondary hypogonadism can result from the following conditions:

  • Isolated Hypogonadotropic Hypogonadism
  • Kallmann Syndrome
  • Prader–Willi syndrome
  • Hypopituitarism
  • Hyperprolactinemia
  • Iron overload
  • Brain or head injury
  • Cushing’s Syndrome
  • Cirrhosis of the liver
  • Kidney failure
  • HIV/AIDS
  • Alcohol Use Disorder
  • Diabetes that is not effectively managed
  • Obesity
  • Obstructive Sleep Apnea
  • Certain medications 
  • LOH, which is common in aging

What are the signs of low testosterone?

Certain health issues, medications, or injuries can cause low testosterone (low-T). Testosterone levels also normally decrease with age. Low testosterone levels can have an impact on sexual drive, mood, muscle, and fat composition. The symptoms of low testosterone can vary greatly, particularly with age. Symptoms indicating low testosterone in adult males include:

  • Reduced sexual drive
  • Erectile Dysfunction
  • Loss of pubic and armpit hair
  • The testicles shrink
  • Hot flashes
  • Low or no sperm count (azoospermia)
  • Depressed mood
  • Problems with focus and memory
  • Increased body fat
  • Enlarged male breast tissue (gynecomastia).
  • Decrease in muscle strength and mass
  • Decreased endurance

How is low testosterone treated?

Hypogonadism affects the capacity to create regular quantities of testosterone due to an issue with the testicles or the pituitary gland, which regulates the testicles, as previously stated.

To treat low testosterone (male hypogonadism), doctors use testosterone replacement treatment, which may include testosterone skin gels, testosterone injections, testosterone patches, or testosterone tablets. 

If you’re considering taking testosterone externally, consult your doctor about the risks and advantages. Your doctor would most likely check the testosterone levels in your body at least twice before recommending testosterone therapy.

It is not advisable to treat normal aging with testosterone therapy. If you do not have a medical problem that is causing your testosterone levels to drop, your doctor may recommend natural testosterone boosters such as weight loss and muscle mass gain through resistance training.

How to get your partner pregnant with low testosterone?

Low testosterone levels are not necessarily the direct cause of infertility. Men with low testosterone levels can still generate healthy sperm because sperm production is mostly regulated by other hormones. However, low testosterone levels may lead to decreased sperm production. If you are experiencing reproductive problems, you can seek ART treatments such as IVF or ICSI to get your partner pregnant.

Assisted Reproductive Technology (ART): ART treatments comprise acquiring sperm through regular ejaculation, surgical extraction, or from donor individuals, depending on your personal condition and preferences. The sperm is then placed in the female vaginal canal or used for IVF or intracytoplasmic sperm injection, to help you in becoming a father.

Testosterone and Pregnancy

Testosterone is essential for optimal fetal development throughout pregnancy. It regulates the development of the male reproductive system. Testosterone levels in the womb may also influence the way your right and left brains work.

To keep the fetal brain healthy, testosterone levels must fall within a relatively limited range. High amounts of fetal testosterone may be associated with autism.

Testosterone in Females

Testosterone is the primary male hormone, but women also require it for proper physical function. Women produce significantly less testosterone than men, but, when a woman reaches menopause, her estrogen levels drop. This may increase the woman’s levels of male hormones, or androgens. Polycystic ovarian syndrome (PCOS) can also cause an increase in testosterone levels.

Excess testosterone in a woman’s circulation may cause the following symptoms:

  • Scalp hair loss and acne
  • Irregular or missing menstruation
  • Increased facial hair 
  • In women, low testosterone levels can also lead to fertility issues, as well as weak bones and libido loss.

Is it possible to prevent low testosterone?

Healthcare providers and medical experts are uncertain about how to avoid low testosterone due to genetic problems or damage to the testicles, hypothalamus, or pituitary gland. However, the following lifestyle choices may help maintain normal testosterone levels:

  • Eating a nutritious diet
  • Regular exercise
  • Weight control
  • Avoiding excessive use of alcohol and drugs

When should I see my doctor about low testosterone?

If you are using hormone replacement treatment, and have low testosterone symptoms, such as decreased sex drive and hot flashes, consult with a doctor. They will evaluate you and may request some blood tests. If your child has not reached puberty by the age of 14, consult their pediatrician.

FAQ’s

What happens if testosterone levels are too low?

Certain health issues, medications, or injuries can cause low testosterone (low-T). Testosterone levels also normally decrease with age. Low testosterone levels can have an impact on sexual drive, mood, and muscle and fat composition. Testosterone treatment may help relieve symptoms.

What are the signs of good testosterone levels?

The symptoms of normal testosterone levels are:
– Sex Drive
– Sperm production
– Muscle and bone growth
– Deepening voice and hair growth
– The growth and development of male sex organs.
– Pleasant mood

Does exercise increase testosterone levels?

Testosterone levels rise for short periods following exercise, ranging from 15 minutes to an hour depending on the person. Younger males have a larger post-exercise increase in testosterone levels.

When is the testosterone level high?

Testosterone levels change throughout the day. They are normally greater in the morning and decrease in the afternoon.

What causes low testosterone in young men?

For younger guys and adolescents, hypogonadism is typically caused by congenital or acquired disorders that interfere with testosterone production in the testis or signaling from the hypothalamic-pituitary-gonadal axis.

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