Male hypogonadism, also referred to as low testosterone, is a disorder in which the testicles fail to produce enough testosterone. Low Testosterone is to discuss today. This may be the consequence of a number of conditions or traumas to the hypothalamus, pituitary, or testicles. The best treatment for this illness is testosterone replacement therapy.
Low testosterone, or male hypogonadism, is characterized by insufficient production of the male sex hormone by the testicles, specifically by the Leydig cells. This condition affects individuals assigned male at birth (AMAB), including cisgender men, non-binary people AMAB, and transgender women not undergoing feminizing hormone therapy. Testosterone levels naturally decline with age in adults AMAB, leading to different symptoms at different stages of life.
Alternative names for low testosterone and male hypogonadism include:
- Testosterone deficiency syndrome
- Testosterone deficiency
- Primary hypogonadism
- Secondary hypogonadism
- Hypergonadotropic hypogonadism
- Hypogonadotropic hypogonadism
Testosterone Function?
Testosterone is the primary androgen, crucial for developing male characteristics and essential for sperm production (spermatogenesis). Its levels are naturally much higher in individuals assigned male at birth (AMAB) compared to those assigned female at birth (AFAB).
In AMAB individuals, testosterone plays a key role in:
- Developing and maintaining sex organs and genitalia
- Building and preserving muscle mass
- Preserving sufficient quantities of red blood cells
- Ensuring bone density
- Supporting a sense of well-being
- Regulating sexual and reproductive functions
The body typically regulates testosterone levels closely, with the highest concentrations occurring in the morning and gradually decreasing throughout the day.
The hypothalamus and pituitary gland manage the production and release of testosterone from the testicles. Gonadotropin-releasing hormone (GnRH) is released by the hypothalamus, and this causes the pituitary gland to release luteinizing hormone (LH). LH travels to the gonads (testicles or ovaries), stimulating testosterone production and release. The pituitary gland also releases follicle-stimulating hormone (FSH), which is essential for sperm production.
Any dysfunction in the testicles, hypothalamus, or pituitary gland can lead to low testosterone (male hypogonadism).
Low testosterone level?
For adults, low blood testosterone is defined by the American Urology Association (AUA) as fewer than 300 nanograms per deciliter (ng/dL).
In contrast, some scientists and medical professionals believe that concentrations less than 250 ng/dL are low. In diagnosing low testosterone, providers also examine symptoms.
Low testosterone (male hypogonadism) affect?
People with testicles can develop male hypogonadism at any stage of life, from infancy to adulthood.
People who:
• Are older are more likely to suffer from low testosterone.
• Be overweight.
• Don’t adequately control your Type 2 diabetes.
• Suffer from obstructive sleep apnea.
• Experience long-term health issues, including as liver cirrhosis or kidney failure.
• Are infected with HIV/AIDS.
Is low testosterone common?
Because different studies define low testosterone differently, it is challenging for researchers to determine how widespread low testosterone is.
According to data, 2% of AMAB individuals may have low testosterone. According to estimates from other studies, low testosterone affects over 8% of AMAB individuals between the ages of 50 and 79.
Symptoms and Causes
Symptoms of low testosterone?
Low testosterone symptoms might differ greatly, especially depending on age.
In adults assigned male at birth, the following symptoms strongly reflect low testosterone levels:
• Decreased sex drive.
• Problems with erection.
• Loss of pubic and underarm hair.
• Testicles gets smaller.
• Warm flashes.
• A low or absent sperm count, or azoospermia, which results in infertility in males.
• Mood swings are another sign of low testosterone in adults AMAB.
• Challenges pertaining to focus and recall.
• A rise in body fat.
• Gynecomastia, or male enlargement of the breast tissue.
• A decrease in muscular mass and strength.
• A reduction in endurance.
Low testosterone level in children
For children assigned male at birth, low testosterone levels before or throughout puberty can cause:
- Slowed height growth, however arms and legs may continue to expand excessively in comparison to the rest of the body.
• A decrease in pubic hair growth.• They have lessened the growth of their testicles and penis; their voice has not deepened; and their strength and endurance are below average.
Low testosterone Causes?
Low testosterone can have a number of reasons. Male hypogonadism comes in two flavors:
• Primary hypogonadism, or testicular disease.
• Secondary hypogonadism, or malfunctioning pituitary and hypothalamus.
The causes of congenital (occurring at birth) and acquired (occurring later in childhood or age) hypogonadism are also separated.
Causes of male hypogonadism ( Low Testosterone )
Primary hypogonadism occurs when the testicles are unable to produce normal levels of testosterone. This condition, also known as hypergonadotropic hypogonadism, triggers the pituitary gland to release more luteinizing hormone (LH) and follicle-stimulating hormone (FSH), collectively known as gonadotropins, in response to low testosterone levels. Under normal circumstances, these elevated hormone levels would stimulate the testicles to produce more testosterone and sperm. However, if the testicles are damaged (commonly from chemotherapy) or absent, they cannot respond to the increased gonadotropins, resulting in low or absent testosterone and sperm production.
In some cases of primary hypogonadism, testosterone levels may be within the normal range while gonadotropin levels are elevated. A specialist can determine if treatment is necessary, even if testosterone levels appear normal.
The following congenital disorders have the potential to cause primary hypogonadism:
- Absence of testicles at birth (anorchia)
- Undescended testicles (cryptorchidism)
- Leydig cell hypoplasia (underdevelopment of Leydig cells in the testicles)
- Klinefelter’s syndrome (a genetic condition where individuals AMAB have an extra X chromosome: XXY instead of XY)
- Noonan syndrome (a rare genetic disorder that can cause delayed puberty, undescended testicles, or infertility)
- Myotonic dystrophy (part of a group of inherited disorders known as muscular dystrophies)
Acquired conditions that can cause primary hypogonadism include:
- Testicle injury or removal
- Orchitis (inflammation of one or both testicles), often due to bacterial infections like sexually transmitted infections or viral infections like mumps
- Chemotherapy or radiation therapy affecting the testicles
- Certain types of tumors
- Anabolic steroid use
Causes of secondary male hypogonadism ( Low Testosterone )
Secondary hypogonadism, also known as hypogonadotropic hypogonadism, occurs when conditions affecting the hypothalamus or pituitary gland lead to low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These decreased hormone levels result in reduced testosterone and sperm production.
Congenital conditions that can cause secondary hypogonadism include:
- Isolated hypogonadotropic hypogonadism (a condition present from birth causing low levels of gonadotropin-releasing hormone)
- Kallmann syndrome (a rare genetic disorder leading to the loss of nerve cells in the hypothalamus that produce gonadotropin-releasing hormone, and often also results in a lack of smell)
- Prader-Willi syndrome (a rare genetic disorder affecting multiple systems, including hypothalamic function)
Following acquired disorders have the potential to cause secondary hypogonadism:
- Hypopituitarism (which may arise from adenomas, infiltrative diseases, infections, injuries, radiation therapy, or surgeries affecting the pituitary gland)
- Hyperprolactinemia
- Iron overload (hemochromatosis)
- Brain or head injuries
- Cushing’s syndrome
- Liver cirrhosis
- Kidney failure
- HIV/AIDS
- Alcohol use disorder
- Poorly managed diabetes
- Obesity
- Obstructive sleep apnea
- Late-onset hypogonadism (LOH) is a form of secondary hypogonadism that occurs with aging. As individuals age, the function of the hypothalamus, pituitary gland, and Leydig cells deteriorates, leading to decreased testosterone and/or sperm production.
LOH and low testosterone are more prevalent in people AMAB with Type 2 diabetes, overweight, and/or obesity. One study found that 30% of overweight individuals AMAB had low testosterone levels, compared to 6% of those with normal weight. Another study showed that 25% of individuals AMAB with Type 2 diabetes had low testosterone levels, compared to 13% of those without diabetes.
Diagnosis and Tests
How to diagnosed low testosterone ?
If you exhibit signs and symptoms of low testosterone, a healthcare provider will conduct a physical examination. They will inquire about your medical history, current and past medications, smoking habits, and any symptoms you are experiencing. Blood tests might be ordered as part of the evaluation.
To diagnose low testosterone, the provider will take into account your specific symptoms, the results of your physical exam, and any relevant blood test results.
Tests to diagnose low testosterone?
The following tests can help confirm low testosterone levels and identify the underlying cause:
- Total testosterone level blood test: Typically, this test requires collecting two blood samples between 8 a.m. and 10 a.m., when testosterone levels are at their peak. Inform your provider if you are or have recently been ill, as acute illness can result in falsely low testosterone readings.
- Luteinizing hormone (LH) blood test: This test can help determine if the low testosterone is due to an issue with the pituitary gland.
- Prolactin blood test: Elevated prolactin levels can indicate problems with the pituitary gland or the presence of tumors.
Management and Treatment
Treatment of Low testosterone?
Healthcare providers manage low testosterone (male hypogonadism) with testosterone replacement therapy (TRT), which is available in several forms:
- Testosterone skin gels: Applied daily to clean, dry skin as directed. It’s crucial to avoid transferring the gel to others through skin contact. These gels are among the most commonly used treatments in the U.S.
- Intramuscular testosterone injections: Administered into a muscle either by you or a healthcare provider every 1 to 2 weeks. Long-acting testosterone injections can be given every 10 weeks, with subcutaneous injection options also available.
- Testosterone patches: Applied daily to the skin as directed, with locations rotated to prevent skin reactions.
- Testosterone pellets: Implanted under the skin by a specialist every three to six months, providing consistent and long-term testosterone levels.
- Buccal testosterone tablets: Sticky pills applied to the gums twice a day, allowing testosterone to quickly absorb into the bloodstream.
- Testosterone nasal gel: Applied into each nostril three times a day.
- Oral testosterone: A pill form called undecanoate, suitable for individuals with low testosterone due to conditions like Klinefelter syndrome or pituitary gland damage.
Certain medical conditions may prevent you from receiving testosterone replacement therapy, including:
- Prostate cancer
- An unexplored lump on the prostate (prostate screening is mandatory before starting TRT)
- Breast cancer
- Uncontrolled heart failure
- Untreated obstructive sleep apnea
Side effects of testosterone replacement therapy?
The side effects of testosterone replacement therapy can include:
- Acne or oily skin
- Mild fluid retention that results in ankle edema
- Prostate stimulation, leading to urinary issues like difficulty urinating
- Breast enlargement or tenderness
- Worsening of sleep apnea
- Shrinking of the testicles
- Skin irritation (with topical testosterone treatments)
Potential laboratory abnormalities with testosterone replacement therapy include:
- Increased prostate-specific antigen (PSA)
- Elevated red blood cell count
- Reduced sperm count, potentially causing infertility, which is particularly significant for younger individuals wanting to have biological children
Prevention
Can low testosterone be prevented?
Healthcare providers and researchers currently lack methods to prevent low testosterone caused by genetic conditions or damage to the testicles, hypothalamus, or pituitary gland. However, certain lifestyle habits may help maintain normal testosterone levels:
- Following a healthy diet
- Regular exercise
- Managing weight
- Avoiding excessive alcohol and drug use
Expectations if I have low testosterone (male hypogonadism)?
There isn’t a permanent solution for low testosterone, but ongoing hormone replacement therapy can significantly improve sex drive, alleviate symptoms of depression, and boost energy levels in many individuals assigned male at birth (AMAB) with low testosterone. This treatment may also enhance muscle mass and bone density.
People AMAB with testosterone deficiency have a notably higher mortality rate compared to those with normal testosterone levels. However, it remains uncertain if normalizing testosterone levels through replacement therapy reduces this increased mortality. The primary goal of treatment is symptom relief rather than achieving specific testosterone levels.
For children AMAB with congenital hypogonadism, testosterone replacement therapy often helps prevent complications associated with delayed puberty.