What is male hypogonadism (low testosterone)?
Male hypogonadism is characterized by a level of testosterone and symptoms consistent with low testosterone.
Testosterone is an important sex hormone in men. It is produced by the testes and is responsible for maintaining sex drive (libido), sperm production, bone health, and characteristics such as facial, pubic, and body hair. The brain and pituitary gland control the production of testosterone by the testes.
What Causes Low Testosterone?
Causes of low testosterone include:
- Testicular injury or infection
- Anabolic steroid use
- Chemotherapy or radiation treatment for cancer
- Hormone disorders, such as high prolactin or pituitary tumors
- Chronic diseases, such as liver and kidney disease, type 2 diabetes, sleep disorders, HIV
- Some medications, including opioids
- Genetic conditions
Symptoms of Low Testosterone
Symptoms vary from person to person and may not necessarily be due to low testosterone. They can include:
- Low libido (decreased sex drive)
- Loss of spontaneous erections
- Erectile dysfunction
- Decrease sperm count
- Infertility
- Breast tenderness or enlargement
- Decrease in the size of testes
- Reduced muscle mass
- Reduced energy
Treatment of Low Testosterone
Prior to treatment, a thorough evaluation is performed to confirm low testosterone and to determine the cause. In some situations, such as a high prolactin level, treatment of the underlying cause will resolve the low testosterone without needing testosterone replacement therapy.
In situations where testosterone replacement therapy is recommended, the benefits and risks are reviewed and agreed upon prior to starting testosterone therapy. There are different types of testosterone therapy. Method of treatment depends on the patient’s preferences, cost, tolerance, and concern about fertility.
Typical treatment options for testosterone replacement therapy include:
- Injections: Self-administered every 1–2 weeks
- Gels: Applied to upper arm/shoulder. May transfer to others via skin contact — must wait to absorb completely into skin.
- Patches: Adhere to skin every day to back, abdomen, upper arm, thigh; rotate locations to lessen skin reaction.
You should not receive testosterone therapy if you have:
- Prostate or breast cancer (or suspected)
- Enlarged prostate causing difficulty with urination
- Elevated prostate specific antigen (PSA) levels
- High number of red blood cells
- Untreated sleep apnea (obstructed breathing during sleep)
- Planning to have children
- Heart attack or stroke within the last 6 months
- Blood clots
Possible risks of testosterone treatment include:
- Decreased sperm production
- A high red blood cell count
- Acne
- An increase in prostate size
- Sleep apnea—the occasional stopping of breathing during sleep (rarely)
Frequently Asked Questions about Low Testosterone
Does testosterone level decrease with age?
Testosterone naturally decreases by 1% each year after age 30.
Does it matter what time of day I have my testosterone level checked?
Yes. When evaluating testosterone levels accurately, it should be drawn fasting in the morning. Testosterone levels naturally change from hour to hour, with the highest level in the AM and lowest at night.
Should I wait to check my testosterone level if I am feeling sick or under the weather?
Yes. Illness can temporarily decrease testosterone level. Intense physical activity, poor nutrition, and certain medications can also temporarily decrease testosterone.
