Male hypogonadism, also known as testosterone deficiency, occurs when the testes fail to produce the male sex hormone testosterone, sperm, or both. This condition might stem from disorders of the testes or diseases affecting the hypothalamus and pituitary gland. Hypogonadism can influence the function of many organs and negatively impact an individual’s quality of life.
Hypogonadism is a condition that leads to inadequate production of sex hormones in the body. There are various forms of hypogonadism, including late-onset hypogonadism (LOH), which develops later in life.
LOH is also referred to as “male menopause” or “andropause,” as it typically occurs around the same age as menopause in women.
Late-onset hypogonadism can trigger several symptoms such as low sex drive, erectile dysfunction, depression, tiredness, and decreased bone density, among others.
LOH often goes undiagnosed and untreated because there is disagreement within the medical community about how to diagnose it. There are no definite guidelines for what constitutes low testosterone levels in older men.
This article will provide details on the symptoms, causes, and diagnosis of late-onset hypogonadism. It will also offer advice on how to manage this condition and other possible reasons for your symptoms.
What Is Hypogonadism?
To grasp what late-onset hypogonadism is, it’s essential to first know what hypogonadism means generally.
Hypogonadism is a collection of conditions characterized by the body’s failure to produce enough sex hormones. For men, the key sex hormone is testosterone, also known as androgen. In women, estrogen is the primary sex hormone.
Testosterone is crucial for numerous bodily functions and processes in men, and this hormone diminishes by about 1% each year starting at age 30. Some of its roles include:
- Development of sperm
- Sexual desire
- Tolerance for pain
- Muscle mass
- Learning and memory
Late-onset hypogonadism is a form of hypogonadism that appears later in a man’s life, typically in the late 40s to early 50s.
Symptoms of Late-Onset Hypogonadism
Sometimes, late-onset hypogonadism may occur without any noticeable symptoms. However, when symptoms are present, an individual with late-onset hypogonadism might experience:
- Decreased libido (sexual desire)
- Erectile dysfunction (ED)
- Depression
- Tiredness
- Less hair growth
- Irritability or mood changes
- Difficulty concentrating
- Hot flashes
- Lowered bone density and muscle mass
Causes
In males, hypogonadism involves a reduction in one or both of the key functions of the testes: the production of sperm and the production of testosterone.
This condition can arise from various causes.
In primary hypogonadism, the testicles are unresponsive to hormone signals. This condition can stem from a congenital issue like Klinefelter’s syndrome or can be acquired due to factors such as radiation treatment, chemotherapy, mumps, tumors, or injuries to the testes.
In secondary hypogonadism, a disease affects either the hypothalamus or the pituitary gland—these are the key glands that send hormones to stimulate the testes to produce testosterone.
Situations that can lead to secondary hypogonadism include:
- Malnutrition
- Systemic illness
- Stress
- Side effects of medications
- Liver cirrhosis
- Exposure to toxins such as alcohol and heavy metals
- Severe obesity.
Andropause is a term sometimes used to describe the decrease in testosterone levels that occurs as part of the normal aging process. Testosterone levels in males peak by the age of 17 years. Then, beginning around 40 years of age, testosterone levels start to decline at a rate of 1.2-2 percent per year.
Risk factors for hypogonadism include type 2 diabetes, obesity, renal failure, HIV, hypertension, chronic obstructive pulmonary disease (COPD), and the use of medications such as glucocorticoids (steroids), opioids, or antipsychotics.
Treatment
Testosterone replacement therapy is the preferred treatment for male hypogonadism. It is typically administered as a topical gel, transdermal patch, or by injection. Oral forms of testosterone are avoided due to their high risk of side effects like stomach upset.
TRT can alleviate many, if not all, of the symptoms of male hypogonadism.
Benefits include:
- Increased libido
- Improved mood
- Enhanced bone mineral density
- Generally improved quality of life
However, there are some risks associated with this therapy.
Testosterone replacement therapy may exacerbate benign prostatic hyperplasia (BPH), speed up the progression of pre-existing prostate cancer, and worsen conditions such as sleep apnea and congestive heart failure. TRT should not be initiated without first addressing these health issues.
All men undergoing TRT need continuous medical monitoring to assess the effectiveness of the treatment. This includes routine blood tests and periodic digital rectal exams.
TRT is not recommended for men with erythrocytosis, which is characterized by an unusually high concentration of red blood cells in the blood.
The effectiveness of TRT varies from person to person, and testosterone levels do not predict who will benefit from TRT and who will not. It is important to note that while TRT can alleviate symptoms of hypogonadism, it does not restore fertility.
Final Thoughts
Awareness of male hypogonadism is increasing, yet many adult men with this condition are still undiagnosed and untreated. This lack of treatment can adversely affect their quality of life and potentially their lifespan.
Any man who suspects he may have low testosterone levels should consult a healthcare professional, as treatment can alleviate most symptoms and risks associated with male hypogonadism.
However, before beginning treatment with TRT, all men should thoroughly discuss the potential risks and benefits with their healthcare provider.
