Hypogonadism

Have you noticed a drop in your sex drive or energy? Maybe you’re losing muscle strength or having trouble with fertility. These changes can be frustrating, especially when you don’t know what’s causing them.

One possible cause is hypogonadism, a condition that affects how your body makes sex hormones. In men, it often leads to low testosterone and can affect sperm production.

At Diabetes & Glandular Disease Clinic in San Antonio, TX, we diagnose and treat hormone disorders, including male hypogonadism.

Hypogonadism happens when the testes don’t make enough testosterone, don’t produce sperm normally, or both.

Testosterone plays an important role in men’s health. It affects sex drive, erections, muscle strength, bone health, and sperm production. It also supports the changes boys go through during puberty.

Women can have hypogonadism, too, when their ovaries don’t make enough reproductive hormones. But it’s more often recognized and treated as a low testosterone condition in men.

Your testes make testosterone, but they rely on signals from your brain to tell them how much to produce.

Two parts of your brain control these signals:

• Hypothalamus: Sends a message to your pituitary gland to start the process
• Pituitary gland: Releases LH to signal testosterone production and FSH to support sperm production

Hypogonadism can develop when these signals don’t work, or your testes can’t respond to them.

Doctors divide male hypogonadism into two main types.

Primary Hypogonadism

Primary hypogonadism means the problem starts in your testes. Your brain sends signals telling them to make testosterone, but they can’t respond as they should.

Possible causes include:

• Injury to the testes
• Certain infections that damage the testes
• Chemotherapy or radiation treatment
• Genetic conditions, such as Klinefelter syndrome

With primary hypogonadism, blood tests often show low testosterone along with high LH levels. FSH may also be high, especially when sperm production is affected.

Secondary Hypogonadism

Secondary hypogonadism, also called hypogonadotropic hypogonadism, happens when your hypothalamus or pituitary gland doesn’t send enough signals to your testes.

Possible causes include:

• Pituitary gland disorders
• Certain medications, including opioids
• Obesity
• Chronic or serious illness
• Poor nutrition or very low body weight
• Genetic conditions

With secondary hypogonadism, testosterone is low, but LH and FSH levels are low or lower than expected.

Some causes can improve with treatment, while others may require long-term care.

Symptoms depend on your age, how low your testosterone is, and how long you’ve had the condition.

In adult men, symptoms may include:

• Less interest in sex
• Fewer morning erections
• Trouble getting or keeping an erection
• Loss of muscle mass or strength
• Low energy
• Less facial or body hair
• Weak bones
• Fertility problems

These symptoms don’t always mean you have hypogonadism. Other health problems, medications and poor sleep can cause similar changes.

Boys with hypogonadism may start puberty later than expected or stop developing normally.

Signs include delayed growth of the testes, less facial hair, slower muscle development, and a voice that doesn’t deepen as expected.

Finding out whether you have hypogonadism involves more than checking your testosterone level. Your doctor also needs to understand why your body isn’t making enough of the hormone.

Your doctor will ask about your symptoms, review your health history, and perform a physical exam.

Doctors often use a testosterone level below 300 ng/dL as a guide when checking for testosterone deficiency.

Because levels change throughout the day, your doctor will usually order blood tests on two separate mornings. A single low reading isn’t enough to confirm hypogonadism.

Your doctor will look at your symptoms and test results to decide what to check next.

Once low testosterone is confirmed, your doctor may check other hormones to find out where the problem starts.

Tests may include:

• LH and FSH: Help show whether the problem starts in your testes or the hormone signals from your brain
• Prolactin: Checks for a hormone imbalance that may affect testosterone production
• Free testosterone: Gives more information about testosterone levels in certain cases
• Thyroid tests: Check for thyroid problems that may cause similar symptoms
• Iron tests: Look for excess iron that can affect hormone production

Your doctor may also recommend an MRI if a pituitary gland problem is suspected.

If fertility is a concern, a semen analysis can check your sperm count and quality.

Your treatment depends on the type of hypogonadism you have, what’s causing it and whether you want to have children.

Sometimes, treating another health problem or changing a medication can help your body make more testosterone.

Some men need testosterone replacement therapy (TRT). It can raise testosterone levels and improve certain symptoms, but it doesn’t correct every cause of hypogonadism.

TRT is available as injections, gels, patches, oral medications, and pellets placed under the skin.

What If You Want to Have Children?

Fertility is an important part of your treatment plan.

Testosterone replacement can lower sperm production, making it harder to have children. If you’re planning a family, your doctor may recommend other treatments that support your body’s testosterone production while preserving sperm production.

Will You Need Ongoing Care?

Some causes of hypogonadism improve with treatment, while others require long-term hormone care.

If you start testosterone therapy, your doctor will monitor your testosterone levels and red blood cell count. Depending on your age and health history, prostate monitoring may also be needed.

If you’ve noticed lasting changes in your sex drive, erections, muscle strength or fertility, a hormone evaluation can help you find out why.

At Diabetes & Glandular Disease Clinic in San Antonio, TX, we evaluate male hypogonadism, identify hormone imbalances and recommend treatment based on your health and goals.

Schedule an appointment with Diabetes & Glandular Disease Clinic to get answers about your symptoms and explore your treatment options.

1. Is Hypogonadism the Same as Low Testosterone?

Not exactly. Low testosterone is a common feature of male hypogonadism, but the condition can also affect sperm production and fertility.

2. Can Hypogonadism Be Reversed?

Sometimes. If the cause is a medication, obesity or another treatable health problem, testosterone levels may improve when that issue is addressed. Other causes, such as certain genetic conditions or permanent testicular damage, may require long-term treatment.

3. Can Hypogonadism Cause Infertility?

Yes. Hypogonadism can interfere with sperm production and make it harder to have children. Treatment depends on the cause and whether you want to preserve your fertility.