It's a condition that often lurks in the shadows, underdiagnosed despite its potential to significantly affect men's health and quality of life. While it's generally associated with men over the age of 50, it's not uncommon among men in their 40s, making it a concern that spans across age groups. The triggers of hypogonadism are manifold. Central obesity, other co-morbidities such as diabetes, and overall poor health can contribute to its onset. Certain populations, including patients with type 2 diabetes, metabolic syndrome, obesity, cardiovascular disease, chronic obstructive pulmonary disease, renal disease, and cancer, exhibit a high prevalence of hypogonadism, highlighting the interconnectivity of these conditions. The symptoms of hypogonadism form a triad of sexual symptoms - low libido, reduced spontaneous erections, and erectile dysfunction. These symptoms are typically associated with a decrease in serum testosterone levels. However, its impact extends beyond sexual health, with other symptoms such as fatigue, reduced motivation, low mood, and diminished concentration also being commonly reported.


Addressing hypogonadism requires a strategic and experienced approach. It's a treatable condition in the majority of cases, but the path to effective treatment depends heavily on the clinician's expertise and understanding of the condition. In the face of hypogonadism, we're not just treating a condition - we're addressing a complex health issue that can profoundly affect a man's life on multiple fronts.


At what age does testosterone start to decline?

A man’s ability to produce testosterone starts to decline at about 40 years of age, and levels continue to drop 1 – 3% a year thereafter. It is important to note that just because the levels are dropping after 40 doesn’t necessarily mean that all men are candidates for therapy. There must be certain symptoms present.

What are the causes of hypogonadism?

  • Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes are present in addition to one Y chromosome.
  • Undescended testicles. Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum. Sometimes one or both of the testicles aren’t descended at birth.
  • Mumps orchitis. A mumps infection involving the testicles that occurs during adolescence or adulthood can damage the testicles, affecting the function of the testicles and testosterone production.
  • Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
  • Injury to the testicles. Because they’re outside the abdomen, the testicles are prone to injury. Damage to both testicles can cause hypogonadism. Damage to one testicle might not impair total testosterone production.
  • Cancer treatment. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production. The effects of both treatments often are temporary, but permanent infertility may occur.
  • Kallmann’s syndrome. This is an abnormal development of the area of the brain that controls the secretion of pituitary hormones (hypothalamus). This abnormality can also affect the ability to smell (anosmia) and cause red-green colorblindness.
  • Pituitary disorders. An abnormality in the pituitary gland can impair the release of hormones from the pituitary gland to the testicles, affecting normal testosterone production.Also, treatment for a brain tumour, such as surgery or radiation therapy, can affect the pituitary gland and cause hypogonadism.
  • Inflammatory disease. Certain inflammatory diseases, such as sarcoidosis, histiocytosis and tuberculosis, involve the hypothalamus and pituitary gland and can affect testosterone production.
  • HIV/AIDS. HIV/AIDS can cause low levels of testosterone by affecting the hypothalamus, the pituitary and the testes.
  • Medications. The use of certain drugs, such as opiate pain medications and some hormones, can affect testosterone production.
  • Obesity. Being significantly overweight at any age might be linked to hypogonadism.
  • Ageing. As men age, there’s a slow, progressive decrease in testosterone production. The rate varies greatly.

What are signs of low testosterone in males?

  • Reduced sex drive.
  • Reduced erectile function.
  • Loss of body hair.
  • Less beard growth.
  • Loss of lean muscle mass.
  • Feeling very tired all the time
  • Obesity
  • Symptoms of depression.
  • Lack of motivation
  • Difficulty in focusing
  • Poor memory
  • Difficulty with finding words to say

When should you see a doctor?

If you’re experiencing physical symptoms like sudden weight gain or decrease in your sex drive or sexual performance and other mental and emotional symptoms, you should talk to a doctor about testing your testosterone levels.

Does hypogonadism go away?

Unless a treatable condition causes it, hypogonadism is chronic and may require lifelong treatment. Your levels of sex hormones may decrease if you stop hormone therapy. Most cases of hypogonadism respond well to appropriate medical treatment, though.

Can you produce sperm with hypogonadism?

Low testosterone does not always directly cause infertility. Men with low testosterone can still produce healthy sperm because sperm production is mainly stimulated by other hormones. However, low levels of testosterone may result in decreased production of sperm.

Can you live a normal life with hypogonadism?

If your testosterone levels fall below the norm, negative consequences may adversely impact your health, preventing you from going about your day-to-day life as you’re used to. Low testosterone can significantly lower your sex drive and virility.

What happens if low testosterone goes untreated?

Untreated testosterone deficiency will greatly increase your risk for developing heart disease, osteoporosis, and other age-related diseases.

Can exercise cure hypogonadism?

Hormone replacement therapy with testosterone is often the conventional treatment for hypogonadism. Natural ways to boost these hormones include diet, exercise, and stress reduction, though this may improve symptoms of hypogonadism in mild cases only.

How do you treat hypogonadism in men?

Adult men. Male hypogonadism usually is treated with testosterone replacement to return testosterone levels to normal. Testosterone can help counter the signs and symptoms of male hypogonadism, such as decreased sexual desire, decreased energy, decreased facial and body hair, and loss of muscle mass and bone density.

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