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Male Hypogonadism | Endocrinology | Dartmouth-Hitchcock

Alternative names: Gonadal Deficiency, Testosterone Deficiency

What is male hypogonadism? What are the signs of male hypogonadism? What causes male hypogonadism? How does my doctor tell if I have male hypogonadism? How is male hypogonadism treated?

Male hypogonadism is caused by a man’s testes failing to produce normal levels of the male sex hormone, testosterone. Some men are born with hypogonadism, while others may develop the condition later in life.

There are two kinds of male hypogonadism:

Male hypogonadism at puberty can slow a boy’s growth, and affect the development of normal male sexual characteristics. He may not undergo the normal changes a boy has during puberty, such as a deepening voice, body and facial hair, and increased muscle mass.

Male hypogonadism in adults can cause:

Primary hypogonadism, in which the testes do not work properly, can be caused by many conditions, including:

Secondary hypogonadism, in which the endocrine glands do not stimulate the testes to produce hormones, can be caused by:

Your doctor may check for low levels of testosterone (male sex hormone) by performing a blood test. He or she may also use blood tests to check the levels of the pituitary hormones (FSH and LH) that stimulate the testes to produce their hormones.

Other laboratory tests can help your doctor tell if hypogonadism is being caused by a problem with the testes, or with the pituitary gland. Such tests include:

If male hypogonadism is caused by a pituitary or other tumor, treatment is aimed at removing the tumor, or reducing its effects. This can include medication, surgery, and/or radiation therapy.

Male hormone replacement therapy has been used successfully for years to treat male hypogonadism. This involves a man taking testosterone by injection, transdermal system (patch), or gel.

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Male Hypogonadism | Endocrinology | Dartmouth-Hitchcock

Low Testosterone (Male Hypogonadism) | Cleveland Clinic

What is low testosterone (male hypogonadism)?

Low testosterone (male hypogonadism) is a condition in which the testes (testicles, the male reproductive glands) do not produce enough testosterone (a male sex hormone).

In men, testosterone helps maintain and develop:

Low testosterone affects almost 40% of men aged 45 and older. It is difficult to define normal testosterone levels, because levels vary throughout the day and are affected by body mass index (BMI), nutrition, alcohol consumption, certain medications, age and illness.

As a man ages, the amount of testosterone in his body gradually drops. This natural decline starts after age 30 and continues (about 1% per year) throughout his life.

There are many other potential causes of low testosterone, including the following:

Symptoms of low testosterone depend on the age of person, and include the following:

Other changes that occur with low testosterone include:

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Low Testosterone (Male Hypogonadism) | Cleveland Clinic

Hypogonadism? | Go Ask Alice!

Dear Just Wondering,

Hypogonadism and hypergonadism are syndromes that result from abnormal levels of testosterone and estrogen. They affect the reproductive systems in both sexes, permanantly causing the testes and ovaries to not function properly. Hypogonadism acts by lowering the production and quality of testosterone and sperm in men and estrogen and eggs in women. This imbalance in the body’s chemistry can result in a lowered sex drive in both men and women. Hypogonadism can also cause infertility.

Hypogonadism can appear either before or after puberty. If it occurs before puberty, the symptoms can include:

Hypogonadism after puberty can cause:

Treatment of hypogonadism usually comes through hormone replacement therapy. In men, testosterone is replaced, and in women, estradiol (a precursor to estrogen) and progesterone. While this therapy has improved the chances of many couples trying to have children, it does not help everybody.

On the other end of the spectrum is hypergonadism. As you most likely guessed, those with hypergonadism have higher levels of testosterone and estrogen in their systems. While this may sound great for the dating scene, the extra hormones are not as fun as they may seem.

Hypergonadism is rarer than hypogondism. But, like hypogonadism it can appear either before or after puberty.

Hypergonadism occuring before puberty actually prods puberty into action. After puberty those diagnosed exhibit the same affects as the prepubescent. Hypergonadism causes the same changes in both men and women, including:

Like hypogonadism, hormonal treatments are needed to correct hypergonadism. But since there are higher levels of estrogen and testosterone coursing through the body, a delicately balanced hormonal cocktail is needed. Treating hypergonadism is much more difficult because it is tougher to lower an excess of hormones than it is to add them to the body.

The latest research points towards many different sources as the cause of hypogonadism and hypergonadism in both males and females including:

It appears that the best course of action for treating both hypogonadism and hypergonadism is hormonal therapy. An endocrinologist, a medical provider specializing in the body’s hormones, can make certain that hormonal balance is achieved in the safest possible way.

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Hypogonadism? | Go Ask Alice!

Endo Pharmaceuticals | Hypogonadism

Male hypogonadism (or Low-T) is a condition in which the body doesn’t produce enough testosterone the hormone that plays a key role in masculine growth and development during puberty or has an impaired ability to produce sperm or both.

You may be born with male hypogonadism, or it can develop later in life from injury or infection. The effects and what you can do about them depend on the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.

Doctors base a diagnosis of hypogonadism on symptoms and results of blood tests that measure testosterone levels. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day, near 8 a.m.

If tests confirm you have low testosterone, further testing can determine if a testicular disorder or a pituitary abnormality is the cause. Based on specific signs and symptoms, additional studies can pinpoint the cause.

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Endo Pharmaceuticals | Hypogonadism

Hypogonadism disease: Malacards – Research Articles, Drugs …

Drugs for Hypogonadism (from DrugBank, HMDB, Dgidb, PharmGKB, IUPHAR, NovoSeek, BitterDB): (show top 50) (show all 199) # Name Status Phase Clinical Trials Cas Number PubChem Id 1 Methyltestosterone Approved Phase 4,Phase 3,Phase 2,Phase 1,Early Phase 1 58-18-4 6010



































17-beta-Hydroxy-delta(sup 4)-androsten-3-one


































AA 2500





Andro 100

Andro L.A. 200


Androderm (TN)



Androgel (TN)

Android 10

Android 25

Android 5



Andronate 100

Andronate 200


Andropository 200






Andryl 200


beta testosterone

Beta Testosterone


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Hypogonadism disease: Malacards – Research Articles, Drugs …

Male hypogonadism – You and Your Hormones

Alternative names for male hypogonadism

Testosterone deficiency syndrome; testosterone deficiency; primary hypogonadism; secondary hypogonadism; hypergonadotrophic hypogonadism; hypogonadotrophic hypogonadism

Male hypogonadism describes a state of low levels of the male hormone testosterone in men. Testosterone is produced in the testes and is important for the formation of male characteristics such as deepening of the voice, development of facial and pubic hair, and growth of the penis and testes during puberty. Gonadotrophin-releasing hormone, made in the hypothalamus, stimulates the pituitary gland to produce luteinising hormone and follicle stimulating hormone (gonadotrophins). The gonadotrophins then act on the testes causing them to produce testosterone.Low levels of testosterone can occur due to disease of the testes or from conditions affecting the hypothalamus or pituitary gland. Men can be affected at any age and present with different symptoms depending on the timing of the disease in relation to the start of puberty. In some cases, it can be difficult to tell if there is a true deficiency of testosterone, particularly when the levels are in the borderline range.

Male hypogonadism can be divided into two groups.Classical hypogonadism is where the low levels of testosterone are caused by an underlying specific medical condition, for example Klinefelter’s syndrome, Kallmanns syndrome or a pituitary tumour.Late-onset hypogonadism is where the decline in testosterone levels is linked to general ageing and/or age-related diseases, particularly obesity and type 2 diabetes.It is estimated that late-onset hypogonadism only affects about 2% of men over the age of 40.

There are two types of classical male hypogonadism primary and secondary.Primary hypogonadism occurs when the low level of testosterone is due to conditions affecting the testes.Primary hypogonadism is also referred to as hypergonadotrophic hypogonadism, whereby the pituitary produces too much luteinising hormone (LH) and follicle stimulating hormone (FSH) (gonadotrophins) to try and stimulate the testes to produce more testosterone. However, as the testes are impaired or missing, they are not able to respond to the increased levels of gonadotrophins and little or no testosterone is produced. In some patients with primary hypogonadism, testosterone levels may be within the normal range, but the increased LH and FSH indicates that the pituitary gland is trying to compensate for a deficiency and treatment may still be needed.

Examples of conditions affecting the testes, which lead to primary gonadal failure, include:

Secondary hypogonadism results from conditions affecting the function of the hypothalamus and/or pituitary gland.It is also known as hypogonadotrophic hypogonadism due to low levels of LH and FSH resulting in decreased testosterone production.Secondary hypogonadism often occurs as part of a wider syndrome of hypopituitarism.Examples of causes can include:

The signs and symptoms depend on the stage at which the patient presents with hypogonadism in relation to sexual maturity.If testosterone deficiency occurs before or during puberty, signs and symptoms are likely to include:

Around the time of puberty, boys with too little testosterone may also have less than normal strength and endurance, and their arms and legs may continue to grow out of proportion with the rest of their body.

In men who have already reached sexual maturity, symptoms are likely to include:

As some of these symptoms (e.g. tiredness, mood changes) can have multiple causes, diagnosis of male hypogonadism may sometimes get missed initially.

Male hypogonadism is more common in ageing men. The levels of testosterone in men start to fall after the age of 40. It has been estimated that 8.4% of men aged 5079 years have testosterone deficiency.Male hypogonadism is also linked with type 2 diabetes: approximately 17% of men with type 2 diabetes are estimated to have low testosterone levels.

Male hypogonadism does not run in families.There are genetic causes of hypogonadism, which include Klinefelters syndrome and Kallmanns syndrome; however, these conditions occur sporadically, they are not inherited from the parents.

A detailed medical history should be taken.In particular, it is important to find out if virilisation (development of normal male characteristics) was complete at birth, whether the testes descended and to see if the patient went through puberty at the same time as his peers. The patient should be thoroughly examined and the presence and size of the testes recorded, and whether they are correctly positioned in the scrotum.

Many of the symptoms of male hypogonadism are non-specific and can be caused by a range of conditions. Therefore, when diagnosing hypogonadism, it is important that biochemical tests are performed to assess the levels of testosterone in the blood to confirm diagnosis. Blood tests will be carried out to measure testosterone levels.The blood sample should be collected preferably at 9 a.m. (this is because levels of testosterone change throughout the day) and in the fasting state (because eating can lower testosterone leves). The blood test can can be carried out as an outpatient appointment. If the result of the first test shows a low level of testosterone, the test should be repeated after two or three weeks to confirm the result. Other hormones are also tested along with the second blood sample. These hormones include luteinising hormone, follicle stimulating hormone and prolactin (produced by the pituitary gland).The results of these blood tests will help distinguish between primary (low testosterone and high gonadotrophins) and secondary (low testosterone and normal or low gonadotrophins) hypogonadism.Testosterone is carried around the blood stream by a protein called Sex Hormone Binding Globulin (SHBG). SHBG is often checked at the same time as testosterone as it makes it easier to interpret whether there is a true deficiency. In patients with obesity and type 2 diabetes, SHBG is often low which can make the testosterone level appear lower than it really is.

Depending on the findings of the above tests, other investigations may be carried out. These include: a bone densitometry test to assess the impact of testosterone deficiency on bone; semen analysis; genetic studies; and an ultrasound of the testes to check for nodules or growths.

Treatment of classical hypogonadism involves replacement of testosterone with the aim of raising the level of testosterone in the blood to normal levels.Exact treatment will vary between patients and be tailored to their individual needs.Different preparations of testosterone are available:

All these are outpatient treatments. All of these options should be discussed with a medical professional and the most appropriate treatment option chosen.During treatment with testosterone replacement, regular blood tests should be carried out to monitor testosterone levels and if necessary, the dose adjusted to ensure levels return to the normal range.Tablet forms of testosterone taken by mouth are not recommended due to a link with liver damage, and because it is more difficult to monitor replacement.

Testosterone should not be given if the patient has prostate cancer, because it might make the tumour grow quicker. Before starting treatment with testosterone, a blood test to measure a hormone produced by the prostate called PSA (prostate-specific antigen) is carried out (PSA levels are elevated in prostate cancer).The prostate may also be examined (via the back passage) to rule out prostate cancer.

For patients who have been diagnosed with late-onset hypogonadism, there is currently not enough evidence for us to know whether treatment with testosterone is safe and effective over the long term.While there are some short-term studies that indicate it may benefit these patients over a short period of time, there is a need for longer-term clinical trials in this area, following a large number of patients, to assess the long-term impact of testosterone treatment on patients with late-onset hypogonadism. Areas that particularly require focus are assessing the effects of treatment on the likelihood of developing cardiovascular disease, prostate cancer and secondary polycythaemia (a condition in which there are increased numbers of red blood cells in the blood, which may predispose to increased blood clots).

If patients have any concerns about their health, they should contact their GP in the first instance.

There can be mild side-effects of testosterone replacement depending on the form used: injectable forms can cause pain and bruising at site of injection; the gel form can cause skin irritation.

Treatment with testosterone can cause an increase in red blood cells (known as polycythaemia), which increases the risk of thrombosis.Regular blood tests should be carried out during treatment to check for an increase in red blood cells.Enlargement of the prostate is another serious side-effect that should be monitored.Prostate examination and a blood test for PSA should be performed every three months for the first year and then annually in men over the age of 40 years after starting treatment.If patients have any concerns about these possible side-effects, they should discuss them with their doctor.

Symptoms of male hypogonadism, such as lack of sex drive, inadequate erections (erectile dysfunction) and infertility, can lead to low self-esteem and cause depression. Professional counselling is available to help deal with these side-effects; patients should talk to their doctor for more information.Patients generally see an improvement in their sex drive and self-esteem following testosterone replacement therapy. Erectile dusfunction is a common symptom in patients without hypogonadism and may need treatment in addition to testosterone.

Male hypogonadism has been linked with an increased risk of developing heart disease (low testosterone can cause an increase in cholesterol levels). Studies have shown that testosterone levels can be lower in men with type 2 diabetes and in men with excess body weight. However, it is not clear whether this is an association or a direct cause and effect. Lifestyle changes to reduce weight and increase exercise can raise testosterone levels in men with diabetes.

Testosterone levels in men decline naturally as they age.In the media, this is sometimes referred to as the male menopause (andropause) although this is not a generally accepted medical term.Low testosterone levels can also cause difficulty with concentration, memory loss and sleep difficulties.Current research suggests that this effect occurs in only a small group of ageing men.However, there is a lot of research in progress to find out more about the effects of testosterone in older men and also whether the use of testosterone replacement therapy would have any benefits.

Last reviewed: Mar 2018

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Male hypogonadism – You and Your Hormones

Hypogonadism (Low Testosterone) | Men’s Health Resource Center

Hypogonadism (hi-po-go-na-dizm) also known as low testosterone (Low T),occurs when the body does not produce enough male sex hormones (androgen deficiency), specifically testosterone, and it can result in sexual impotence, infertility, loss of muscle mass and strength, reduction in bone density, mood changes and fat accumulation. It can develop from a testicular disorder at any age or it can result from disease, injury or drug abuse.

There are two basic types of male hypogonadism, which both result in decreases in sperm and testosterone production.

Primary hypogonadism is low testosterone due to a dysfunction or defect in the testes.

Secondary hypogonadism is low testosterone due to a dysfunction or defect in the pituitary gland or hypothalamus (the parts of the brain that signal the testicles to produce testosterone).

What is Testosterone?

Testosterone is the most important sex hormone in the male body. It is needed for masculine growth and development during puberty, and the development of male characteristics such as body and facial hair, muscle growth, strength and a deep voice. Normal levels of testosterone also influence the production of sperm, promote sexual function and sex drive. The brain and the testicles work together to keep testosterone levels within a normal range. When levels of testosterone are below normal, the brain signals the testicles to make more. When testosterone levels are too high, the brain signals for the testicles to make less.


The ability to produce testosterone declines as men age, resulting in a condition called hypogonadismor Low Testosterone (Low T). This loss of testosterone may lead to uncomfortable and distressing symptoms. Researchers estimate that hypogonadism affects from 2-6 million men in the United States with only 5% receiving treatment.*

Low T may affect a mans interest in sex, his ability to perform sexually and it can result in sexual impotence, infertility, loss of muscle mass and strength, reduction in bone density, mood changes and fat accumulation. Causes of Low T vary, and some men are born with the condition, while others develop it later in life. Low T is characterized by low levels of testosterone and presents such symptoms such as decreased sexual desire, erectile dysfunction, decreased energy and depression.

Its normal for a mans sex drive to slowly decline from its peak in his teens and 20s, but libido and sex drive vary widely among men and also for an individual over time. It is affected by stress, sleep, general health and opportunities for sex. Men may not recognize a problem until a partner considers it an issue or the man recognizes he cannot function sexually.

In Puberty:Hypogonadism may delay puberty or inhibit development. You may notice the following symptoms:

In Adulthood:Hypogonadismmay alter physical characteristics, cause health problems or impair reproductive function. You may notice the following symptoms.

Some men may also experience the following signs and symptoms:


GET SCREENEDYou may want to ask your healthcare provider to check you for low testosterone levels if you experience symptoms associated with Low T. A primary care provider checks testosterone levels with a blood test to determine if you have Low T and determine if testosterone therapy is right for you. You might also ask your healthcare provider about a referral to an endocrinologist or urologist who specializes in treating Low T.

In order to get the best treatment, its important that you become a proactive partner in your healthcare. Here are some questions you can ask your healthcare provider about Low Testosterone.

If you do experience symptoms of Low Testosterone and are diagnosed by a healthcare provider, the good news is that the condition very often is treatable.

There are several FDA-approved testosterone replacement therapies, including:

Gels and SolutionsTestosterone gels and solutions are applied directly to the skin and are absorbed into the body. These generally require daily application.

PatchesPatches allow testosterone to be absorbed by the skin. Patches are applied daily, typically to the back, abdomen, upper arm or thigh.

InjectionsTestosterone injections, usually in the upper buttock, are typically given every 1-2 weeks. However, there are some long-acting injections that can be administered every 10 weeks.

Buccal TabletIn your mouth, the tablet is applied to the gum, where testosterone is absorbed over a 12-hour period. They are taken twice daily.

PelletsPellets are implanted under the skin near the hip during a surgical procedure by a healthcare provider.

REMEMBER:Regular checkups and age-appropriate screening, including low testosterone, can improve your health and extend your life.

Testosterone therapy should not be used in men with carcinoma of the breast or known or suspected carcinoma of the prostate. Geriatric patients treated with androgens may be at an increased risk for the development ofprostatic hyperplasiaand prostatic carcinoma.

To learn more about Hypogonadism visit the following pages

MedscapeCleveland ClinicMedline PlusWhat Men Should Know About Testosterone

The following professional and patient care organizations are available as resources for further information about low Testosterone and testosterone replacement therapy:

American Academy of Family Healthcare providers (AAFP)11400 Tomahawk Creek ParkwayLeawood, KS

American Osteopathic Association (AOA)142 E. Ontario St.Chicago, IL

American Association of Clinical Endocrinologists (AACE)1000 Riverside Avenue, Suite 205Jacksonville, FL

American Society for Reproductive Medicine1209 Montgomery HighwayBirmingham, AL

American Urologic Association (AUA)1000 Corporate BoulevardLinthicum, MD

The Endocrine Society8401 Connecticut Avenue, Suite 900Chevy Chase, MD

The Hormone Foundation8401 Connecticut Avenue, Suite 900Chevy Chase, MD

Sexual Medicine Society of North America, Inc.1111 North Plaza Drive, Suite 550Schaumburg, IL

Hypogonadism (Low Testosterone) | Men’s Health Resource Center

Late-onset hypogonadism – Wikipedia

Late-onset hypogonadism is a rare condition in older men, characterized by measurably low testosterone levels and clinical symptoms mostly of a sexual nature, including decreased desire for sex, fewer spontaneous erections, and erectile dysfunction.[1] It is the result of a gradual drop in testosterone; a steady decline in testosterone levels of about 1% per year can happen and is well documented in both men and women.[2][3]

Late-onset hypogonadism is an endocrine condition as well as a result of aging.[1]

The terms “male menopause” and “andropause” are used in the popular media and are misleading, as they imply a sudden change in hormone levels similar to what women experience in menopause.[4]

As of 2016, the International Society for the Study of the Aging Male defines late-onset hypogonadism as a series of symptoms in older adults related to testosterone deficiency that combines features of both primary and secondary hypogonadism; the European Male Aging Study (a prospective study of ~3000 men)[5] defined the condition by the presence of at least three sexual symptoms (e.g. reduced libido, reduced spontaneous erections, and erectile dysfunction) and total testosterone concentrations less than 11 nmol/l (3.2ng/ml) and free testosterone concentrations less than 220 pmol/l (64 pg/ml).[1]

Some men present with the symptoms, but with normal testosterone levels, and some men with low testosterone levels have no symptoms; the reasons for this are not known.[1][6]

Some men in their late 40s and early 50s develop depression, loss of libido, erectile dysfunction, and other physical and emotional symptoms such as irritability, loss of muscle mass and reduced ability to exercise, weight gain, lack of energy, difficulty sleeping, or poor concentration; many of these symptoms may arise from a midlife crisis or as the results of a long-term unhealthy lifestyle (smoking, excess drinking, overeating, lack of exercise) and may be best addressed by lifestyle changes, therapy, or antidepressants.[4]

If a person has symptoms of late-onset hypogonadism, testosterone is measured by taking blood in the morning on at least two days; while immunoassays are commonly used, mass spectrometry is more accurate and is becoming more widely available.[6] The meaning of the measurement is different depending on many factors that affect how testosterone is made and how it is carried in the blood. Increased concentrations of proteins that bind testosterone in blood occur if the person is older, has hyperthyroidism or liver disease, or is taking anticonvulsant drugs (which are increasingly used for depression and various neuropathies), and decreased concentrations of proteins that bind testosterone occur if the person is obese, has diabetes, has hypothyroidism, has liver disease, or is taking glucocorticoids or androgens, or progestins.[6] If levels are low, conditions that cause primary and secondary hypogonadism need to be ruled out.[6][7][8]

Due to difficulty and expense of testing, and the ambiguity of the results, screening is not recommended.[1][6] While some clinical instruments (standard surveys) had been developed as of 2016, their specificity was too low to be useful clinically.[1]

Testosterone levels can and are well-documented to decline with aging at about 1% per year in both men and women after a certain age; the causes are not well understood.[1][2][3][9][10]

The significance of a decrease in testosterone levels is debated and its treatment with replacement is controversial. The Food and Drug Administration (FDA) stated in 2015 that neither the benefits nor the safety of testosterone have been established in older men with low testosterone levels.[11] Testosterone replacement therapy should only be started if low levels have been confirmed;[7] in the US, this confirmation is not done about 25% of the time, as of 2015.[8] Testosterone levels should also be monitored during therapy.[7]

Adverse effects of testosterone supplementation may include increased cardiovascular (CV) events (including strokes and heart attacks) and deaths, especially in men over 65 and men with pre-existing heart conditions.[1] The potential for CV risks from testosterone therapy led the FDA to issue a requirement in 2015 that testosterone pharmaceutical labels include warning information about the possibility of an increased risk of heart attacks and stroke.[1][11] However, the data are mixed, so the European Medicines Agency, the American Association of Clinical Endocrinologists, and the American College of Endocrinology have stated that no consistent evidence shows that testosterone therapy either increases or decreases cardiovascular risk.[1]

Other significant adverse effects of testosterone supplementation include acceleration of pre-existing prostate cancer growth; increased hematocrit, which can require venipuncture to treat; and, exacerbation of sleep apnea.[1]

Adverse effects may also include minor side effects such as acne and oily skin, as well as significant hair loss and/or thinning of the hair, which may be prevented with 5-alpha reductase inhibitors ordinarily used for the treatment of benign prostatic hyperplasia, such as finasteride or dutasteride.[12]

Exogenous testosterone may also cause suppression of spermatogenesis, leading to, in some cases, infertility.[1]

As of 2015, the evidence is inconclusive as to whether testosterone replacement therapy can help with erectile dysfunction in men with late-onset hypogonadism.[8] It appears that testosterone replacement therapy may benefit men with symptoms of frailty who have late-onset hypogonadism.[8]

The epidemiology is not clear; 20% of men in their 60s and 30% of men in their 70s have low testosterone;[2][8] around 5% of men between 70 and 79 have both low testosterone and the symptoms, so are diagnosed with late-onset hypogonadism.[2] The National Health Service describes it as rare.[4]

The impact of low levels of testosterone has been previously reported. In 1944, Heller and Myers identified symptoms of what they labeled the “male climacteric” including loss of libido and potency, nervousness, depression, impaired memory, the inability to concentrate, fatigue, insomnia, hot flushes, and sweating. Heller and Myers found that their subjects had lower than normal levels of testosterone, and that symptoms decreased dramatically when patients were given replacement doses of testosterone.[13][14]

Popular interest in the concept of “andropause” was fueled by the 1998 book Male Menopause, written by Jed Diamond, a lay person.[15] According to Diamond’s view, andropause is a change of life in middle-aged men, which has hormonal, physical, psychological, interpersonal, social, sexual, and spiritual aspects. Diamond claims that this change occurs in all men, may occur as early as age 45 to 50 and more dramatically after the age of 70 in some men, and that women’s and men’s experiences are somewhat similar phenomena.[16][17] The language of “andropause” and its supposed parallels with menopause have been rejected by the medical community.[4][18]

Thomas Perls and David J. Handelsman, in a 2015 editorial in the Journal of the American Geriatrics Society, say that between the ill-defined nature of the diagnosis and the pressure and advertising from drug companies selling testosterone and human growth hormone, as well as dietary supplement companies selling all kinds of “boosters” for aging men, the condition is overdiagnosed and overtreated.[19] Perls and Handelsman note that in the US, “sales of testosterone increased from $324 million in 2002 to $2 billion in 2012, and the number of testosterone doses prescribed climbed from 100 million in 2007 to half a billion in 2012, not including the additional contributions from compounding pharmacies, Internet, and direct-to-patient clinic sales.”[19]

As of 2016, research was necessary to find better ways to measure testosterone and to be better able to understand the measurements in any given person, and to understand why some people with low testosterone do not present with symptoms and some with seemingly adequate levels do present with symptoms.[1] Research was also necessary to better understand the cardiovascular risks of testosterone replacement therapy in older men.[1]

A relationship between late-onset hypogonadism and risk of Alzheimer’s disease and some small clinical studies have been conducted to prevent Alzheimer’s disease in men with late-onset hypogonadism; as of 2009, results were inconclusive.[20]

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Late-onset hypogonadism – Wikipedia

Hypogonadism Treatment & Management: Approach Considerations …

In prepubertal patients with hypogonadism, treatment is directed at initiating pubertal development at the appropriate age. Age of therapy initiation takes into account the patient’s psychosocial needs, current growth, and growth potential. Treatment entails hormonal replacement therapy with sex steroids, ie,estrogen for females and testosterone for males.

Introduction of sex steroids in such cases startswith the use ofsmall, escalating doses over a period of a couple of years. In females, introduction of puberty can begin with administration of small doses of estrogen given either orally or transdermally. One traditional regimen uses conjugated estrogen startingat doses as low as 0.15 mg daily and titrating upwards in 6-12 month intervals to typically 0.625 mg daily, at which point menses can be induced with the introduction of a progestin. Alternatively, transdermal 17-estradiol (0.08 to 0.12 mcg estradiol/kg) can be used.

In boys, introduction of puberty is achieved with the use of testosterone, administered intramuscularly or transdermally (in the form of a patch or gel). A typical regimen involves testosterone enanthate injections 50 mg monthly, titrating up to 200-250 mg every 2 weeks, which is a typical adult replacement dose. Adult testosterone dose can be adjusted to maintain serum testosterone concentrations in the normal adult range.

Therapy with sexsteroid replacement ensures development of secondary sexual characteristics and maintenance of normal sexual function. In patients with hypergonadotropic hypogonadism, fertility is not possible. However, patients with hypogonadotropic hypogonadism have fertilitypotential,although therapy with sex steroids does not confer fertility or stimulate testicular growth in men.An alternative for men with hypogonadotropic hypogonadism has been treatment with pulsatile LHRH or hCG, either of which can stimulate testicular growth and spermatogenesis.

Because such treatment is more complex than testosterone replacement, and because treatment with testosterone does not interfere with later therapy to induce fertility, most male patients with hypogonadotropic hypogonadism prefer to initiate and maintain virilization with testosterone.At a time when fertility is desired, it may be induced with either pulsatile LHRH or (more commonly) with a schedule of injections of hCG and FSH. Similarly, fertility can be achieved in females with pulsatile LHRH or exogenous gonadotropin. Such therapy results in ovulation in 95% of women.

A phase III, multicenter, open-label, single-arm trial by Nieschlag et al indicated that corifollitropin-alfa therapy combined with hCG treatment can significantly increase testicular volume and induce spermatogenesis in adult males with hypogonadotropic hypogonadism whose azoospermia could not be cured by hCG treatment alone. Patients in the study who remained azoospermic, though with normalized testosterone levels, after 16 weeks of hCG treatment underwent 52 weeks of twice-weekly hCG therapy along with every-other-week corifollitropin-alfa treatment (150 g). Mean testicular volume in these patients rose from 8.6 mL to 17.8 mL, while spermatogenesis was induced in more than 75% of subjects. [10]

The use of oral testosterone preparations, such as 17-alkylated androgens (eg, methyltestosterone), is discouraged because of liver toxicity. However, oral testosterone undecanoate is available in some countriesand is now approved in the United States. Intramuscular testosterone is available as testosterone enanthate or cypionate. Transdermal testosterone can be administered either in the form of a patch or gel. A nasal testosterone replacement therapy has been approved by the US Food and Drug Administration (FDA) for adult males with conditions such as primary hypogonadism (congenital or acquired) and hypogonadotropic hypogonadism (congenital or acquired) resulting from a deficiency or absence of endogenous testosterone. [11] The recommended dosage is 33 mg/day in three divided doses. The drug has not been approved for males younger than 18 years.

For older men with testosterone deficiency, a review by the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) found that the evidence concerning the risk of serious cardiovascular side effects from the use of testosterone in men with hypogonadism was inconsistent. [12, 13] The PRAC determined that the benefits of testosterone outweigh its risks but stressed that testosterone-containing medicines should be used only when lack of testosterone has been confirmed by signs and symptoms, as well as by laboratory tests. However,a literature review by Albert and Morley indicated that testosterone supplementation in males aged 65 years or older may increase the risk of cardiovascular events, particularly during the first year of treatment, althoughintramuscular testosterone seemed to carry less risk than other forms. [14]

On the other hand,a study by Traish et al suggested that long-term testosterone therapy in men with hypogonadism significantly reduces cardiovascular diseaserelated mortality. Patients in the studys testosterone-treated group (n=360) underwent therapy for up to 10 years, with median follow-up being 7 years. The investigators found no cardiovascular eventrelated deaths in the treated patients, compared with 19 such deaths in the group that received no testosterone therapy (n=296). According to the study, mortality in the testosterone-treated patients was reduced by an estimated 66-92%. [15]

A literature review by Corona et al indicated that testosterone replacement therapy is safe for age- or comorbidity-related (functional) male hypogonadism, not just for the organic variety. The investigators reported that the safety of testosterone replacement therapy in functional cases, with regard to cardiovascular and venous thromboembolism risk, as well as prostate concerns, is high enough to allow for the treatment. [16]

The latest Endocrine Society clinical practice guidelines suggest testosterone therapy for men receiving high doses of glucocorticoids who also have low testosterone levels, to promote bone health. The guidelines also suggest such therapy in human immunodeficiency virus (HIV)infected men with low testosterone levels, to maintain lean bone mass and muscle strength.

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Hypogonadism Treatment & Management: Approach Considerations …

Hypogonadism: Practice Essentials, Background, Pathophysiology

Morbidity for men and women with hypogonadism includes infertility and an increased risk of osteoporosis; there is no increase in mortality.

Hypogonadotropic hypogonadism (see the image below) is one of several types of hypogonadism.


Considerations in the evaluation of males with hypogonadism include the following:

For postpubertal males, the rate of beard growth, libido and sexual function, muscle strength, and energy levels

Possible causes of acquired testicular failure (eg, mumps orchitis, trauma, radiation exposure of the head or testes, and chemotherapy)

Drugs that may interrupt testicular function -Including agents that interfere with testosterone synthesis, such as spironolactone andcyproterone.Agents such as cortisol,marijuana, heroin, and methadone may interfere with gonadotropin secretion.

Considerations in the evaluation of females with hypogonadism include the following:

Signs associated with Turner syndrome (eg, lymphedema, cardiac or renal congenital anomalies, and short growth pattern)

Age of menarche

Physical examination

Considerations in the physical examination of males with hypogonadism include the following:

Evaluation of the testes: This is the most important feature of the physical examination; determine whether both testes are palpable, their position in the scrotum, and their consistency; testes size can be quantitated by comparison with testicular models (orchidometer), or their length and width may be measured

Examination of the genitalia for hypospadias

Examination of the scrotum to see if it is completely fused

Evaluation of the extent of virilization

Staging of puberty: Use the Tanner criteria for genitalia, pubic hair, and axillary hair

Examination for signs of Klinefelter syndrome (eg, tall stature, especially if the legs are disproportionately long, gynecomastia, small or soft testes, and a eunuchoid body habitus)

Considerations in the physical examination of females with hypogonadism include the following:

Examination of the genitalia is important

Determination of the extent of androgenization: May be adrenal or ovarian in origin and is demonstrated in pubic and axillary hair

Determination of the extent of estrogenization: As evidenced by breast development and maturation of the vaginal mucosa

Examination for signs of Turner syndrome (eg, short stature, webbing of the neck [such as pterygium colli], a highly arched palate, short fourth metacarpals, widely spaced nipples, or multiple pigmented nevi)

See Clinical Presentation for more detail.

The following studies may be indicated in males with hypogonadism:

Follicle-stimulating hormone (FSH) levels

Luteinizing hormone (LH) levels

Prolactin levels

Testosterone levels

Thyroid function

Seminal fluid examination


Testicular biopsy

For males after puberty, the Guidelines of the Endocrine Society [2] require that the diagnosis of hypogonadism be based on symptoms and signs of hypogonadism plus the presence of a low testosterone level measured on at least 2 occasions.

The following studies may be indicated in females with hypogonadism:

Additional tests in the evaluation of patients with hypogonadism include the following:

Adrenocorticotropic hormone (ACTH) stimulation testing: In patients in whom a form of congenital adrenal hyperplasia is suspected, adrenal steroid synthesis is best evaluated by performing a cosyntropin (ACTH 1-24) stimulation test

Luteinizing-hormone releasing hormone (LHRH) stimulation testing: To distinguish between true hypogonadotropic hypogonadism and constitutional delay in growth and maturation

Testicular tissue testing: If the testes are not palpable and if it is not certain whether any testicular tissue is present, administering human chorionic gonadotropin (hCG) and measuring testosterone response may be helpful

See Workup for more detail.

Hormonal replacement

The simplest and most successful treatment for males and females with either hypergonadotropic or hypogonadotropic hypogonadism is replacement of sex steroids, but the therapy does not confer fertility or, in men, stimulate testicular growth.

When fertility is desired, an alternative therapy for men with hypogonadotropic hypogonadism is administration of pulsatile LHRH or injections of hCG and FSH. (In patients with hypergonadotropic hypogonadism, fertility is not possible.)

In a 6-year European study of men being treated for hypogonadism, long-term transdermal testosterone treatment did not increase prostate-specific antigen (PSA) levels or influence prostate cancer risk. [3, 4]

Investigators used data from a 5-year, open-label extension of a 1-year trial of a transdermal testosterone patch (Testopatch) in men with hypogonadism. Study subjects wore two 60 cm2 patches, each of which delivered 2.4 mg of testosterone per day. More than 90% of patients had PSA concentrations below 2 ng/mL during the 6-year study, and no prostate cancer was found in patients over the course of the trial.

See Treatment and Medication for more detail.

Read more:
Hypogonadism: Practice Essentials, Background, Pathophysiology

Hypogonadism – UCSF Medical Center

Hypogonadism is a condition that causes decreased function of the gonads, which are the testis in males and the ovaries in females, and the production of hormones that play a role in sexual development during puberty. You may be born with the condition or it can develop later in life from injury or infection. Some types of hypogonadism can be treated with hormone replacement therapy.

There are two forms of the condition primary hypogonadism resulting from problems of the testis or ovary and central hypogonadism caused by problems with the pituitary or hypothalamic glands. Central hypogonadism leads to decreased levels of luteinizing hormone (LH) and follicle stimulating hormones (FSH), released by the pituitary gland.

The condition may have genetic, menopausal autoimmune and viral causes or may develop after cancer treatments such as radiation and chemotherapy.

Fasting, weight loss, eating disorders such as anorexia nervosa, and bulimia, and stressful conditions can cause the condition.

In children before puberty, hypogonadism causes no symptoms. In adolescents, it can delay or prevent exual development.

Adult women with the condition may stop menstruating or develop infertility, loss of libido, vaginal dryness and hot flashes. Prolonged periods of hypogonadism can cause osteoporosis.

Men with the condition may experience loss of libido, erectile dysfunction and infertility.

To diagnose hypogonadism, tests may be performed to check hormone levels estogren in females and testosterone in males. In addition, levels of luteinizing hormone (LH) and follicle stimulating hormones (FSH) will be tested. LH and FSH are pituitary hormones that are stimulated by the gonads.

Other tests may measure thyroid hormones, sperm count and prolactin, a hormone released by the pituitary gland that stimulates breast development and milk production Tests also may be performed to test for anemia and possible genetic causes of symptoms.

For women, your doctor may request a sonogram of your ovaries.

If pituitary disease is suspected, a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan may be performed to examine the the pituitary gland.

Hormone replacement therapy has proven to be effective treatment for hypogonadism in men and pre-menopausal women.

Estrogen may be administered in the form of a patch or pill. Testosterone can be given by a patch, a product soaked in by the gums, a gel or by injection.

For women who have not had their uterus removed, a combination of estrogen and progesterone is often recommended to decrease the chance of developing endometrial cancer. Low-dose testosterone may be added for women with hypogonadism who have a low sex drive.

Other hormones may be prescribed to restore fertility in men and women.

Reviewed by health care specialists at UCSF Medical Center.

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Hypogonadism – UCSF Medical Center

Diminished Androgen and Estrogen Receptors and Aromatase …

Aims: One third of males with type 2 diabetes have hypogonadism, characterized by low total and free testosterone concentrations. We hypothesized that this condition is associated with a compensatory increase in the expression of androgen receptors (AR) and that testosterone replacement reverses these changes. We also measured estrogen receptor and aromatase expression.

Materials and Methods: This is a randomized double-blind placebo controlled trial. 32 hypogonadal and 32 eugonadal men with type 2 diabetes were recruited. Hypogonadal men were randomized to receive intramuscular testosterone or saline every 2 weeks for 22 weeks. We measured AR, ER and aromatase expression in peripheral blood mononuclear cells (MNC) and adipose tissue in hypogonadal and eugonadal males with type 2 diabetes at baseline and after 22 weeks of treatment in those with hypogonadism.

Results: The mRNA expression of AR, ER and aromatase in adipose tissue from hypogonadal men was significantly lower as compared to eugonadal men and it increased significantly to levels comparable to those in eugonadal patients with type 2 diabetes following testosterone treatment. AR mRNA expression was also significantly lower in MNC from hypogonadal patients compared to eugonadal T2DM patients. Testosterone administration in hypogonadal patients also restored AR mRNA and nuclear extract protein levels from MNC to that in eugonadal patients.

Conclusions: We conclude that, contrary to our hypothesis, the expression of AR, ER and aromatase is significantly diminished in hypogonadal men as compared to eugonadal men with type 2 diabetes. Following testosterone replacement, there is a reversal of these deficits.

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Diminished Androgen and Estrogen Receptors and Aromatase …

Healthier Andropause Build to Balance

To the men out there, this post is for you! Im sure youre well aware that testosterone is critical for your health and vitality. But are you aware of its decline during the aging process, and that you can start doing something about it today with healthy diet and lifestyle practices?

Andropause, sometimes referred to as Male Menopause or Hypogonadism, is the decline of testosterone production in aging men (starting around 50s). Testosterone is a male sex hormone that is important for sexual and reproductive development. The hormone influences sex drive, sperm production, fat distribution, red cell production, maintenance of muscle strength and mass, and the prevention of osteoporosis in men. When its production starts to decline, primarily due to aging, men can experience unfavorable symptoms (many similar to menopause):

Aging is an inevitable part of life, and a top contributing factor for andropause. SHBG (sex hormone binding globulin) increases with age, which binds with testosterone rendering it unavailable. A healthy diet and lifestyle can help slow the aging process and the onset of andropause. Here is what to focus on:

Bottom line keep that male vitality going strong today and every day by adopting a healthy diet and lifestyle.


Bauman, E. NC202.2 Mens & Womens Health Lecture 2 (PowerPoint Handout). Retrieved from Bauman College:

Rettner, R. (June 2017). What is Testosterone? Live Science. Retrieved from

The Truth About Alcohol, Fat Loss, and Testosterone. (Oct. 2016). from

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Healthier Andropause Build to Balance

Attention, Men: Doing This Every Day Could Lower Your …

Got a headache? Take an ibuprofen. Sore muscles? Pop a painkiller. But if you take a daily dose of ibuprofen, we have some bad news: All of those pills can add up. They might increase your risk ofheart attacksandcausemuscle weakness, for starters. Now, new research shows that ibuprofen can damage fertility, too.

According to a new study published in Proceedings of the National Academy of Sciences, men who take this popular pain reliever over a long period of time might be more likely to develop a condition called compensated hypogonadism, which could reduce their fertility. Find out the other daily habits that may be harming your fertility.

For the study, 31 men between the ages of 18 and 35 took 600 milligrams (three tablets) a day of ibuprofen for six weeks. Other volunteers received a placebo drug. Then, a team of researchers from Denmark and France monitored the participants for two weeks.

By the end of the study, all of the volunteers showed higher levels of luteinizing hormones, which prevented certain cells in their testicles from producing testosterone. The researchers also found that participants’ pituitary glands were producing more of another hormone that encouraged their bodies to produce more testosterone.

While the combination of these two responses kept the participants’ overall testosterone levels constant, the changes still overworked their bodies, causing compensated hypogonadism. This condition can cause a temporary reduction in the production of sperm cells in men, reducing their fertility.

But hold upyou might not want to toss those painkillers just yet. It’s likely that the average ibuprofen user won’t experience any negative side effects to their fertility; on the other hand, regularly using the drug for long periods of time could be cause for concern, researchers say. Still, it cant hurt to cut back on the pills in the meantime, regardless of your normal doseat least until further studies are done.

Concerned about your baby-making ability? Heres what men can do to boost their fertility.

[Source: MedicalXpress]

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Attention, Men: Doing This Every Day Could Lower Your …

Lilly pulls Axiron from Korean market | Righting Injustice

Eli Lilly & Co. has taken its topical testosterone replacement therapy Axiron off the market in Korea after gaining the blessing of the countrys Ministry of Food and Drug Safety. The company said that it made the decision to withdraw the treatment from the market in Korea due to several factors including low male menopause awareness and the existence of substitutable medicines.

Axiron was developed by Australian pharmaceutical company Acrux and marketed by U.S.-based Lilly. It was approved by the U.S. Food and Drug Administration (FDA) in 2010 for the treatment of hypogonadism, a condition in which men do not produce enough of the male hormone due to injury, disease or defect. Axiron was approved by Koreas Ministry of Food and Drug Safety in November 2013, and hit the market there in 2014.

Lilly pulled Axiron from the U.S. as well as other countries, including Australia, last year, citing multiple commercial manufacturers supplying the U.S. market.

Not only was Eli Lilly & Co. facing growing competition from generic Axiron in the U.S., the company is also facing a slew of lawsuits as part of a multidistrict litigation naming several makers of testosterone replacement therapies for not warning the drug could incease the risk of heart attacks, strokes, blood clots and death. Two cases against AbbVie Inc., over its AndroGel testosterone treatment have been tried resulting in verdicts totaling nearly $300 million.

Lilly was to face its first two bellwether trials in the multidictrict litigation this month and in March, but announced it had reached a global settlement in all the cases. The judge overseeing the cases canceled the trial dates involving Axiron.

Sources:Korea Bio MedRighting Injustice

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Lilly pulls Axiron from Korean market | Righting Injustice

Hypogonadism | Cleveland Clinic

What is hypogonadism?

Hypogonadism is a condition in which the testicles are not working the way they should.

In an adult, the testicles have two main functions: to make testosterone (the male hormone) and sperm. These activities are controlled by a part of the brain called the pituitary. The pituitary sends signals (called gonadotropins) to the testicles that, under normal conditions, cause the testicles to produce sperm and testosterone.

The pituitary signals can change based on the feedback signals that the brain receives from the testicle. Hypogonadism can therefore be divided into two main categories:

These categories are important because they may influence the way that hypogonadism is treated, and play a role in the results.

Testicular failure occurs when the brain is signaling the testicle to make testosterone and sperm, but the testicles are not responding correctly. As a result, the brain increases the amount of the gonadotropins signals, which causes a higher-than-normal level of these signals in the blood. For this reason, this condition is also referred to as hypergonadotropic hypogonadism. This is the most common category of hypogonadism.

Secondary hypogonadism (also called hypogonadotropic hypogonadism) occurs when the brain fails to signal the testicles properly. In men who have secondary hypogonadism, the testosterone levels may be very low, and sperm are usually missing from the semen. Some boys are born with this condition. In most cases, it is discovered when a boy fails to go through puberty.

Causes of primary hypogonadism include:

Causes of secondary hypogonadism include:

Low testosterone: Hypogonadism may be diagnosed when a man has symptoms of low testosterone, including low energy, fatigue, and a lower sexual drive.

Patients with secondary hypogonadism are usually diagnosed during their teen years because they have not started puberty. These patients may not develop the body type, muscle build, or hair pattern seen in adult males. Some men will also have a poor sense of smell.

Infertility: Hypogonadism may be diagnosed when a man has a problem with fertility (cannot father a child) and is found to have no sperm or only a very low number of sperm in the semen.

Continued here:
Hypogonadism | Cleveland Clinic

Primary Hypogonadism VS Secondary Hypogonadism …

Most men who require hormone replacement therapy with testosterone have some form of testicular injury or primary hypogonadism. In other words, the problem is all in their balls. Those of us who have secondary hypogonadism often have perfectly functioning testes, but the problem lies elsewhere in whats known as the Hypothalamus Pituitary Testicular Axis (HPTA), which is responsible for keeping our male hormones in proper balance.

The problem with secondary hypogonadism, is that the treatment actually CAUSES primary hypogonadism by introducing exogenous (external) testosterone into the system. To understand that, first lets go over some basics

Hypothalamus:Among other things, this part of your brain sends GnRH (gonadotropin releasing hormone) down to instruct the pituitary gland to create more LH and FSH.

Pituitary Gland:Among other things (like growth hormone), this gland at the base of your brain secretes LH (luteinizing hormone) and FSH (follicle stimulating hormone), which travel down to the testes / gonads to instruct them to create more testosterone.

Testes / Gonads:Endocrinologists might get upset that I use these terms interchangeably. Oh well, screw em. You get the point. Your balls get the message from your pituitary gland to make more testosterone.

The Axis:The important thing to remember about the hypothalamus pituitary testicular axis (HPTA), also sometimes called thehypothalamic-pituitary-gonadal axis (HPG), is that it does not run only in one direction. The body tries to reach homeostasis a healthy balance of these hormones and the entire system can fall out of whack once you start introducing any of these hormones from outside sources. Which brings me to

The Problem With Taking Testosterone to Treat Secondary Hypogonadism:First of all, lets be clear I take testosterone to treat my secondary hypogonadism. Thats because there is currently no choice. Why cure something when you can have a customer for life? Why treat my bodys inability to create enough GnRH when that would require research money and you already have a product that fixes my symptoms ?

Digression aside, the problem with introducing an external source of testosterone is that eventually your gonads see that they are no longer needed. They pack their bags, or rather pack INTO their bags, and practically disappear over time. Now guess what? Not only do I have secondary hypogonadism, which might have been made even worse, but I now have a classic case of primary hypogonadism to deal with if I the medical community should ever find a treatment for secondary hypogonadism.

Heres an idea Why dont pharmaceutical companies make GnRH and market that to the endocrinologists so they can treat the source of my problem? Am I being naive here? Is there more to it than my not-medically-trained mind understands?

All gripes aside, I do feel great. Sure Ill be tied to this drug like a prisoner for the rest of my life, but I feel ten years younger. Im happy, confident, strong, lean, sharp, motivated, and a lot more fun in the bedroom. And Ive yet to see any CONVINCING studies about the long-term health dangers of testosterone replacement in hypogonadal men. Heart disease? Prostate cancer? Show me the studies? These are often-quoted side-effects, but all I hear are doctors deducing them because, for instance, taking away a mans testosterone seems to help with pre-existing conditions of prostate cancer. But that is not a cause-and-effect relationship. Just because removing testosterone helps treat or minimizes the recurrence of prostate cancer, doesnt mean it causes prostate cancer. Does it? OK, ok, thats anothe post entirely

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Primary Hypogonadism VS Secondary Hypogonadism …

Hypogonadism | Children’s Hospital of Philadelphia

Hypogonadism is a condition in which the bodys sex glands make little or no sex hormone. The sex glands are the testes in males and the ovaries in females. During puberty, sex hormones help control the development of breasts, testicles and pubic hair. They are also key for menstruation and sperm production.

Depending on when it begins, hypogonadism may affect the development of sex organs, interfere with puberty or cause infertility and sexual dysfunction.

Children with hypogonadism do not progress through puberty. Girls dont menstruate or develop breasts. Their overall growth is slowed.

Boys with hypogonadism have slowed muscle and genital development. Their arms and legs are long in relation to their torso. Body hair is sparse and their voice does not deepen.

Hypogonadism that appears after puberty will stop a womans menstrual cycle and may cause hot flashes. Men with hypogonadism have a decreased sex drive, muscle loss and breast development.

If the cause is a brain tumor, symptoms may include headaches or vision loss and a milky discharge from the breasts.

The two types of hypogonadism are called primary and central. In primary hypogonadism, the testes or ovaries dont function properly. In central hypogonadism, the hypothalamus and pituitary gland dont function properly. These areas of the brain signal the testes or ovaries to produce sex hormones. This form of hypogonadism can cause infertility.

The most common cause of primary hypogonadism is Klinefelter syndrome in boys and Turner syndrome in girls. One in 2,500 to 10,000 babies are born with Turner syndrome and 1 in 500 to 1,000 are born with Klinefelter syndrome.

Other causes of primary hypogonadism are:

Causes of central hypogonadism include:

Central hypogonadism affects boys and girls equally.

Diagnosis begins with a physical examination to check your childs progress through puberty. Your childs doctor will order blood tests to check the levels of testosterone or estrogen and the puberty hormones, such as LH (lutenizing hormone) and FSH (follicle-stimulating hormone).

Your childs doctor may also order imaging tests, such as an MRI or CT scan to check for tumors in the pituitary gland, and an ultrasound to look for ovarian cysts or other disorders of the ovaries.

Many forms of hypogonadism are treatable with hormone replacement therapy. Girls and women will take estrogen and progesterone are used for girls and women. Boys and men will take testosterone.

If hypogonadism is caused by a tumor on the pituitary gland, treatment may include radiation, medication or surgery to shrink or remove the tumor.

With ongoing hormone replacement therapy, men and women with hypogonadism are able to live a normal life.

The rest is here:
Hypogonadism | Children’s Hospital of Philadelphia

Male hypogonadism – Diagnosis and treatment – Mayo Clinic


Your doctor will conduct a physical exam during which he or she will note whether your sexual development, such as your pubic hair, muscle mass and size of your testes, is consistent with your age. Your doctor may test your blood level of testosterone if you have any of the signs or symptoms of hypogonadism.

Early detection in boys can help prevent problems from delayed puberty. Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions.

Doctors base a diagnosis of hypogonadism on symptoms and results of blood tests that measure testosterone levels. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day, before 10 a.m.

If tests confirm you have low testosterone, further testing can determine if a testicular disorder or a pituitary abnormality is the cause. Based on specific signs and symptoms, additional studies can pinpoint the cause. These studies may include:

Testosterone testing also plays an important role in managing hypogonadism. This helps your doctor determine the right dosage of medication, both initially and over time.

Treatment for male hypogonadism depends on the cause and whether you’re concerned about fertility.

Hormone replacement. For hypogonadism caused by testicular failure, doctors use male hormone replacement therapy (testosterone replacement therapy, or TRT). TRT can restore muscle strength and prevent bone loss. In addition, men receiving TRT may experience an increase in energy, sex drive, erectile function and sense of well-being.

If a pituitary problem is the cause, pituitary hormones may stimulate sperm production and restore fertility. Testosterone replacement therapy can be used if fertility isn’t an issue. A pituitary tumor may require surgical removal, medication, radiation or the replacement of other hormones.

In boys, testosterone replacement therapy (TRT) can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis. Pituitary hormones may be used to stimulate testicle growth. An initial low dose of testosterone with gradual increases may help to avoid adverse effects and more closely mimic the slow increase in testosterone that occurs during puberty.

Several testosterone delivery methods exist. Choosing a specific therapy depends on your preference of a particular delivery system, the side effects and the cost. Methods include:

Injection. Testosterone injections (testosterone cypionate, testosterone enanthate) are safe and effective. Injections are given in a muscle. Your symptoms might fluctuate between doses depending on the frequency of injections.

You or a family member can learn to give TRT injections at home. If you’re uncomfortable giving yourself injections, a nurse or doctor can give the injections.

Testosterone undecanoate (Aveed), an injection recently approved by the Food and Drug Administration, is injected less frequently but must be administered by a health care provider and can have serious side effects.

Gel. There are several gel preparations available with different ways of applying them. Depending on the brand, you either rub testosterone gel into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo), apply with an applicator under each armpit (Axiron) or pump on your front and inner thigh (Fortesta).

As the gel dries, your body absorbs testosterone through your skin. Gel application of testosterone replacement therapy appears to cause fewer skin reactions than patches do. Don’t shower or bathe for several hours after a gel application, to be sure it gets absorbed.

A potential side effect of the gel is the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry or cover the area after an application.

Oral testosterone isn’t recommended for long-term hormone replacement because it might cause liver problems.

Testosterone therapy carries various risks, including contributing to sleep apnea, stimulating noncancerous growth of the prostate, enlarging breasts, limiting sperm production, stimulating growth of existing prostate cancer and blood clots forming in the veins. Recent research also suggests testosterone therapy might increase your risk of a heart attack.

Reduce stress. Talk with your doctor about how you can reduce the anxiety and stress that often accompany these conditions. Many men benefit from psychological or family counseling.

Support groups can help people with hypogonadism and related conditions cope with similar situations and challenges. Helping your family understand the diagnosis of hypogonadism also is important.

Although you’re likely to start by seeing your family doctor or general practitioner, you may need to consult a doctor who specializes in the hormone-producing glands (endocrinologist). If your primary care doctor suspects you have male hypogonadism, he or she may refer you to an endocrinologist. Or, you can ask for a referral.

Here’s some information to help you get ready for your appointment and know what to expect from your doctor.

Preparing a list of questions for your doctor will help you make the most of your time together. For male hypogonadism, some basic questions to ask your doctor include:

Don’t hesitate to ask other questions you have.

Your doctor is likely to ask you a number of questions, such as:

Sept. 29, 2016

See more here:
Male hypogonadism – Diagnosis and treatment – Mayo Clinic

Hypogonadism Causes & Information | Cleveland Clinic

What is hypogonadism?

Hypogonadism is a condition in which the testicles are not working the way they should.

In an adult, the testicles have two main functions: to make testosterone (the male hormone) and sperm. These activities are controlled by a part of the brain called the pituitary. The pituitary sends signals (called gonadotropins) to the testicles that, under normal conditions, cause the testicles to produce sperm and testosterone.

The pituitary signals can change based on the feedback signals that the brain receives from the testicle. Hypogonadism can therefore be divided into two main categories:

These categories are important because they may influence the way that hypogonadism is treated, and play a role in the results.

Testicular failure occurs when the brain is signaling the testicle to make testosterone and sperm, but the testicles are not responding correctly. As a result, the brain increases the amount of the gonadotropins signals, which causes a higher-than-normal level of these signals in the blood. For this reason, this condition is also referred to as hypergonadotropic hypogonadism. This is the most common category of hypogonadism.

Secondary hypogonadism (also called hypogonadotropic hypogonadism) occurs when the brain fails to signal the testicles properly. In men who have secondary hypogonadism, the testosterone levels may be very low, and sperm are usually missing from the semen. Some boys are born with this condition. In most cases, it is discovered when a boy fails to go through puberty.

Causes of primary hypogonadism include:

Causes of secondary hypogonadism include:

Low testosterone: Hypogonadism may be diagnosed when a man has symptoms of low testosterone, including low energy, fatigue, and a lower sexual drive.

Patients with secondary hypogonadism are usually diagnosed during their teen years because they have not started puberty. These patients may not develop the body type, muscle build, or hair pattern seen in adult males. Some men will also have a poor sense of smell.

Infertility: Hypogonadism may be diagnosed when a man has a problem with fertility (cannot father a child) and is found to have no sperm or only a very low number of sperm in the semen.

More here:
Hypogonadism Causes & Information | Cleveland Clinic

Low Testosterone | Hormone Health Network

What is the role of testosterone in mens health?

Testosterone is the most important sex hormone that men have. It is responsible for the typical male characteristics, such as facial, pubic, and body hair as well as muscle. This hormone also helps maintain sex drive, sperm production, and bone health. The brain and pituitary gland (a small gland at the base of the brain) control the production of testosterone by the testes.

In the short term, low testosterone (also called hypogonadism) can cause:

Over time, low testosterone may cause a man to lose body hair, muscle bulk, and strength and to gain body fat. Chronic (long-term) low testosterone may also cause weak bones (osteoporosis), mood changes, less energy, and smaller testes. Signs and symptoms (what you see and feel) vary from person to person.

Low testosterone can result from:

Low testosterone is common in older men. In many cases, the cause is not known.

During a physical exam, your doctor will examine your body hair, size of your breasts and penis, and the size and consistency of the testes and scrotum. Your doctor may check for loss of side vision, which could indicate a pituitary tumor, a rare cause of low testosterone.

Your doctor will also use blood tests to see if your total testosterone level is low. The normal range is generally 300 to 1,000 ng/dL, but this depends on the lab that conducts the test. To get a diagnosis of low testosterone, you may need more than one early morning (710 AM) blood test and, sometimes, tests of pituitary gland hormones.

If you have symptoms of low testosterone, your doctor may suggest that you talk with an endocrinologist. This expert in hormones can help find the cause. Be open with your doctor about your medical history, all prescription and nonprescription drugs you are now taking, sexual problems, and any major changes in your life.

Testosterone replacement therapy can improve sexual interest, erections, mood and energy, body hair growth, bone density, and muscle mass. There are several ways to replace testosterone:

The best method will depend on your preference and tolerance, and the cost.

There are risks with long-term use of testosterone. The most serious possible risk is prostate cancer. African American men, men over 40 years of age who have close relatives with prostate cancer, and all men over 50 years of age need monitoring for prostate cancer during testosterone treatment. Men with known or suspected prostate cancer, or with breast cancer, should not receive testosterone treatment.

Other possible risks of testosterone treatment include:

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Low Testosterone | Hormone Health Network

Induction of fertility in men with secondary hypogonadism


Sperm production cannot be stimulated in men who are infertile as a result of primary hypogonadism due to damage to the seminiferous tubules. On the other hand, sperm production can usually be stimulated to a level sufficient to restore fertility in men who are infertile as a result of secondary hypogonadism, ie, due to damage to the pituitary or hypothalamus. Men who have pituitary disease can be treated with gonadotropins, while those with hypothalamic disease can be treated with gonadotropins or gonadotropin-releasing hormone (GnRH). (See “Causes of secondary hypogonadism in males”.)


Which patients are likely to respond?The diagnosis of secondary hypogonadism must be firmly established before therapy is begun, since only patients whose infertility is due to this disorder will respond. We recommend treatment with gonadotropins for most men who have secondary hypogonadism due to either hypothalamic or pituitary disease who wish to become fertile (see “Clinical features and diagnosis of male hypogonadism”). Gonadotropin treatment will not increase the sperm count in men who have idiopathic oligospermia, in which a subnormal sperm count is associated with a normal serum testosterone concentration [1].

Several factors enhance the likelihood that the sperm count will be increased, and increased sooner after gonadotropin administration:

Development of hypogonadism after puberty rather than before. In one study, as an example, all six men whose hypogonadism occurred postpubertally experienced an increase in total sperm count from less than one million to above 40 million per ejaculate when treated with human chorionic gonadotropin (hCG) (see ‘Initial treatment: hCG’ below). In comparison, only one of eight men whose hypogonadism occurred prepubertally (but without cryptorchidism) had a similar response [2].

Partial hypogonadism, rather than complete, as judged by testes that are not as small [3-6], and serum concentrations of follicle-stimulating hormone (FSH), inhibin B, and testosterone that are not as low [7].

Literature review current through:Oct 2017.|This topic last updated:Dec 16, 2015.

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Induction of fertility in men with secondary hypogonadism

Hypogonadism, Male | ARUPConsult Lab Test Selection

Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM, Task Force, Endocrine Society. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010; 95(6): 2536-59. PubMed

Choosing Wisely. An initiative of the ABIM Foundation. [Accessed: Sep 2017]

Dean JD, McMahon CG, Guay AT, Morgentaler A, Althof SE, Becher EF, Bivalacqua TJ, Burnett AL, Buvat J, Meliegy AE, Hellstrom WJ, Jannini EA, Maggi M, McCullough A, Torres LO, Zitzmann M. The International Society for Sexual Medicine’s Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. J Sex Med. 2015; 12(8): 1660-86. PubMed

Dohle G, Arver S, Bettocchi C, et al. Guidelines on male hypogonadism. European Association of Urology. Arnhem (the Netherlands) [Accessed: Jun 2017]

Kushnir MM, Blamires T, Rockwood AL, Roberts WL, Yue B, Erdogan E, Bunker AM, Meikle W. Liquid chromatography-tandem mass spectrometry assay for androstenedione, dehydroepiandrosterone, and testosterone with pediatric and adult reference intervals. Clin Chem. 2010; 56(7): 1138-47. PubMed

Morales A, Bebb RA, Manjoo P, Assimakopoulos P, Axler J, Collier C, Elliott S, Goldenberg L, Gottesman I, Grober ED, Guyatt GH, Holmes DT, Lee JC, Canadian Mens Health Foundation Multidisciplinary Guidelines Task Force on Testosterone Deficiency. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. CMAJ. 2015; 187(18): 1369-77. PubMed

Paduch DA, Brannigan RE, Fuchs EF, Kim ED, Marmar JL, Sandlow JI. The laboratory diagnosis of testosterone deficiency. Urology. 2014; 83(5): 980-8. PubMed

Seftel AD, Kathrins M, Niederberger C. Critical Update of the 2010 Endocrine Society Clinical Practice Guidelines for Male Hypogonadism: A Systematic Analysis. Mayo Clin Proc. 2015; 90(8): 1104-15. PubMed

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Hypogonadism, Male | ARUPConsult Lab Test Selection

Hypogonadism Testosterone Therapy Treatment | Ageonics Medical

Hypogonadism is the underproduction of sex hormones by the gonads, or sex organs. Male hypogonadism refers to the underproduction of testosterone, which can severely limit a growing boys sexual development and frustrate an adult males quality of life.

The easiest way to understand the effects of hypogonadism is to understand the effects of proper testosterone levels in a mans development. The male sex hormone contributes to everything from the deepening of the voice, the growth of body hair, and muscle building to sex drive and general self confidence. A lack of testosterone has the opposite effect, and can contribute to a higher-pitched voice, loss of body hair, muscle loss, lowered sex drive, and decreased confidence.

Hypogonadism can occur as early as fetal development, which may lead to androgyny, but male hypogonadism in particular can also occur as a result of testicular injury. Hypogonadism sustained before puberty is particularly problematic, as it will greatly affect puberty. Low testosterone during puberty can lead to:

Hypogonadism that occurs after puberty is less obvious, but can also lead to major problems, such as:

While these are some of the physical symptoms of hypogonadism, it is worth noting that hypogonadism, no matter when it occurs, can also lead to persistent psychological and emotional duress. Common stressors that accompany male hypogonadism may include:

Areas Low Testosterone Can Affect

Many adult males who have gone through puberty normally but experience hypogonadism in later life may not recognize its symptoms. If you suspect that you may be suffering from hypogonadism, testosterone replacement therapy is a potential treatment option. The pervasive symptoms of hypogonadism are caused in large part by low testosterone, and testosterone replacement therapy can greatly improve quality of life and sex drive.

Dr. Olivieri has many decades of experience treating men with low testosterone, and has helped thousands of men experience the benefits of normal testosterone levels, improving their lives, marriages, and mobility. If you know someone who may be suffering from hypogonadism or low testosterone in general, consider calling Aegonics Medical for a consultation.

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Hypogonadism Testosterone Therapy Treatment | Ageonics Medical

Hypogonadism: Types, Causes, & Symptoms –

What Is Hypogonadism?

Hypogonadism occurs when your sex glands produce little or no sex hormones. The sex glands, also calledgonads, are primarily the testes in men and the ovaries in women. Sex hormones help control secondary sex characteristics, such as breast development in women, testicular development in men, and pubic hair growth. Sex hormones also play a role in the menstrual cycle and sperm production.

Hypogonadism may also be known asgonad deficiency. It may be calledlow serum testosteroneorandropause when it happens in males.

Most cases of this disorder respond well to appropriate medical treatment.

9 Warning Signs of Low Testosterone


There two types of hypogonadism are primary and central hypogonadism.

Primary hypogonadism means that you dont have enough sex hormones in your body due to a problem in your gonads. Your gonads are still receiving the message to produce hormones from your brain, but they arent able to produce them.

In central hypogonadism, the problem lies in your brain. The hypothalamus and pituitary gland in your brain, which control your gonads, arent working properly.


The causes of primary hypogonadism include:

Central, or secondary, hypogonadism may be due to:


Symptoms that may affect females include:

Symptoms that may affect males include:


Your doctor will conduct a physical exam to confirm that your sexual development is at the proper level for your age. They may examine your muscle mass, body hair, and your sexual organs.

If your doctor thinks you might have hypogonadism, the first round of testing will involve checking your sex hormone levels. Youll need a blood test to check your level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Your pituitary gland makes these reproductive hormones.

Youll have your estrogen level tested if youre female. Youll have your testosterone level tested if youre male. These tests are usually drawn in the morning, which is when your hormone levels are highest. If youre male, your doctor may also order a semen analysis to check your sperm count. Hypogonadism can reduce your sperm count.

Your doctor may order more blood tests to help confirm the diagnosis of hypogonadism and rule out any underlying causes.

Iron levels can affect your sex hormones. For this reason, your doctor may test for anemia, or iron deficiency. Your doctor may also wish to measure your prolactin levels. Prolactin is a hormone that promotes breast development and breast milk production in women, but its present in both genders. Your doctor may also check your thyroid hormone levels because thyroid problems can cause symptoms similar to hypogonadism.

Imaging tests can also be useful in diagnosis. Anultrasoundof the ovaries uses sound waves to create an image of the ovaries and check for any problems, including ovarian cysts and polycystic ovarian syndrome (PCOS).Your doctor may order MRIscans or CTscans to check for tumors in your pituitary gland.


Your treatment will involve increasing the amount of female sex hormones in your body if youre a woman.

Your first line of treatment will probably be estrogen therapy if youve had a hysterectomy. Either a patch or pill can administer the supplemental estrogen hormone.

Because increased estrogen levels can increase your risk of endometrial cancer, youll be given a combination of estrogen and progesterone if women who havent had a hysterectomy. Progesterone can lower your risk of endometrial cancer if youre taking estrogen.

Other treatments can target specific symptoms. If youre a woman and you have a decreased sex drive, you may receive low doses of testosterone. If you have menstrual irregularities or trouble conceiving, you may receive injections of the hormone human choriogonadotropin (hCG) or pills containing FSH to trigger ovulation.

Testosterone is a male sex hormone. Testosterone replacement therapy (TRT) is a widely used treatment for hypogonadism in males. You can get testosterone replacement therapy by:

Injections of a gonadotropin-releasing hormone may trigger puberty or increase your sperm production.

Treatment for males and females is similar if the hypogonadism is due to a tumor on the pituitary gland. Treatment may include radiation, medication, or surgery to shrink or remove the tumor.


According to the Urology Care Foundation, hypogonadism is a chronic condition that requires lifelong treatment. Your sex hormone level will probably decrease if you stop treatment.

Seeking support through therapy or support groups can help you before, during, and after treatment.

Can Testosterone Supplements Improve Your Sex Drive?

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