Male Hypogonadism

Diagnosis

Finding male hypogonadism in childhood can help prevent complications related to delayed puberty. Early diagnosis and treatment in adults may help protect against conditions such as osteoporosis and reduced muscle mass.

A member of the healthcare team begins with a physical examination and an assessment of sexual development. This includes evaluating pubic hair growth, muscle mass and the size of the testes to see whether development is typical for the person’s age.

Blood tests are used to measure testosterone levels. Testosterone is usually highest in the morning, so blood samples are typically taken between 8 and 10 a.m. Testing may be repeated on more than one day to confirm results.

If testosterone levels are low, further testing may be needed to determine the underlying cause. These tests may include:

• Pituitary hormone testing

• Semen analysis

• Imaging of the pituitary gland

• Genetic studies

These evaluations help distinguish between primary hypogonadism, which begins in the testes, and secondary hypogonadism, which involves the brain and pituitary gland.

Treatment

Treatment for male hypogonadism depends on age, cause and individual goals, such as symptom relief or fertility.

Treatment for Adults

Testosterone replacement therapy can raise testosterone levels and relieve symptoms such as low sex drive, low energy, loss of muscle mass, reduced body and facial hair, and decreased bone density.

In older adults with age-related low testosterone, the benefits of testosterone replacement are less certain. People receiving testosterone therapy need regular medical checkups and blood tests several times during the first year and yearly after that. This monitoring helps evaluate effectiveness and detect side effects early.

Types of Testosterone Replacement Therapy

Several forms of testosterone replacement are available. The choice often depends on convenience, cost, availability and insurance coverage.

Oral testosterone is rarely used because it can cause liver problems and does not maintain stable testosterone levels. One oral form, testosterone undecanoate, is absorbed through the lymph system and may reduce liver risk, but it is not used for age-related hypogonadism.

Other forms include:

• Gels applied to the skin, usually on the upper arms, shoulders or thighs. These require time to absorb and care to avoid transferring medication to others through skin contact

• Injections given into a muscle or under the skin, which may be administered at home or in a medical setting

• Long-acting injections that must be given by a healthcare professional and carry a risk of serious side effects

• Skin patches worn overnight on the arm or torso, which may cause skin irritation

• Gum-and-cheek applications that release testosterone through the lining of the mouth and may irritate the gums

• Nasal gel applied several times a day, which reduces the risk of skin-to-skin transfer

• Pellets implanted under the skin every few months through a minor surgical procedure

Testosterone therapy carries potential risks, including:

• Increased red blood cell count

• Acne

• Breast enlargement

• Sleep disturbances

• Prostate growth

• Reduced sperm production

These risks are often linked to doses that are too high and may improve when the dose is adjusted. Regular follow-up with a healthcare professional is essential.

Treatment of Infertility Due to Hypogonadism

If hypogonadism is caused by a pituitary disorder, pituitary hormones may be used to stimulate sperm production and restore fertility. Treatment may involve medication, surgery, radiation or replacement of other hormones if a tumor is present.

In primary hypogonadism, sperm production often cannot be restored. However, assisted reproductive technologies may help couples achieve pregnancy.

Treatment for Boys

Treatment for delayed puberty in boys depends on the underlying cause. Short-term testosterone therapy, usually given as injections over three to six months, may help start puberty. This treatment can increase muscle mass, promote growth of facial and pubic hair, and support penis growth. Testosterone therapy for boys is given only when bone maturity is appropriate.