Male Hypogonadism

Low testosterone in men, also called male hypogonadism, happens when the body doesn't make enough testosterone. Testosterone is a key hormone for male development, including growth during puberty and sperm production. This condition can affect a man's ability to produce enough sperm, or it could just mean he has low testosterone, or both.

Sometimes, male hypogonadism is present from birth. Other times, it can develop later in life, potentially due to things like an injury or an infection. How male hypogonadism affects a person, and what can be done about it, depends on what caused it and when it started. For example, if the problem is low testosterone production, it might be treated with a therapy that adds testosterone back into the body.

Low testosterone levels, a condition called hypogonadism, can start in the womb, before puberty, or later in life. The specific signs and symptoms depend on when the problem begins.

Low testosterone in men, called male hypogonadism, happens when the testicles don't make enough testosterone. This can have various causes, broadly divided into two main types:

• Primary hypogonadism: This means there's a problem directly with the testicles themselves. Think of it like a factory malfunction—the testicles aren't producing enough testosterone because something is wrong within the testicles. This could be due to various reasons, such as genetic conditions, infections, or injuries.

• Secondary hypogonadism: This type of low testosterone is caused by a problem in the brain's control center for testosterone production. The hypothalamus and pituitary gland are like the managers of the testosterone factory in the brain. The hypothalamus sends a message (gonadotropin-releasing hormone) to the pituitary gland. The pituitary gland then sends two important messages (follicle-stimulating hormone (FSH) and luteinizing hormone (LH)) to the testicles. LH tells the testicles to make testosterone. If there's a problem with the hypothalamus or pituitary gland, the messages to the testicles might be weak or missing, leading to low testosterone production. This could be caused by conditions like tumors, certain medications, or problems with the pituitary gland itself.

Low testosterone (hypogonadism) can happen for several reasons. Some things increase your chances of having low testosterone. These include:

• Infections like HIV/AIDS: Having HIV/AIDS can sometimes lead to low testosterone levels.
• Cancer treatments: Chemotherapy or radiation therapy used to treat cancer can also affect testosterone production.
• Getting older: As you age, your testosterone levels naturally tend to decrease.
• Carrying extra weight (obesity): Being significantly overweight can impact testosterone production.
• Poor nutrition (malnutrition): Not getting enough essential nutrients can affect hormone levels, including testosterone.

Low testosterone can sometimes run in families. If you have a family history of low testosterone, it's important to talk to your doctor. Knowing your family health history can help your doctor better understand your risk and provide appropriate care. If you have any of these risk factors, or if you're concerned about your testosterone levels, it's always a good idea to discuss it with your doctor.

Low testosterone levels, a condition called hypogonadism, can cause various problems depending on when they start. These problems can appear during pregnancy, when a child is going through puberty, or later in adulthood.

If hypogonadism develops during a person's development in the womb, it can lead to unusual or abnormal reproductive organs.

In cases where low testosterone levels begin during puberty, a person might experience:

• Changes in the development of male characteristics. This can include breast growth in males (gynecomastia).
• Difficulty having children (infertility). This is because low testosterone levels can affect sperm production.
• Problems with erections (erectile dysfunction).

If hypogonadism starts later in life, it can still cause several issues, including:

• Weakening of bones (osteoporosis). This can increase the risk of fractures.
• A negative impact on a person's self-esteem. The physical changes and other symptoms can affect how a person feels about themselves.

All these problems can be challenging, but importantly, they are treatable. Early diagnosis and appropriate medical intervention can often help manage and reduce the impact of these issues.

Catching puberty problems early can help boys avoid future issues. Early diagnosis and treatment in men can also protect them from bone thinning (osteoporosis) and other related health problems.

To check for potential puberty delays, your doctor will do a physical exam. They'll look at your physical development, including things like pubic hair growth, muscle growth, and the size of your testicles, to see if they match your age.

If you have any signs or symptoms of a low testosterone level (hypogonadism), your doctor might test your blood testosterone level. Testosterone levels naturally change throughout the day and are usually highest in the morning. So, blood tests are often done early in the morning, before 10 a.m., and sometimes on more than one day to get a clearer picture.

If your blood tests show low testosterone, your doctor will need to figure out why. Further tests might be necessary to determine if the problem is with your testicles, your pituitary gland (a small gland at the base of your brain), or something else. These additional tests could include:

• Hormone tests: Checking the levels of other hormones related to testosterone production.
• Semen analysis: Examining the quality and quantity of sperm, if applicable.
• Pituitary imaging: Using X-rays or other imaging to look at the pituitary gland.
• Genetic studies: Testing for any potential genetic conditions that might be contributing to the problem.
• Testicular biopsy: Taking a small sample of tissue from your testicle to examine under a microscope.

These tests help doctors pinpoint the cause of the low testosterone and create a personalized treatment plan.

Testosterone Replacement Therapy: Understanding the Options and Risks

Low testosterone levels, or male hypogonadism, can cause various problems, including reduced sex drive, fatigue, less body and facial hair, and loss of muscle and bone mass. A doctor might prescribe testosterone replacement therapy to address these symptoms.

How Effective is it for Older Adults?

For older adults experiencing low testosterone due to aging, the effectiveness of testosterone replacement therapy isn't as clear-cut as for younger men with diagnosed hypogonadism. It's important to discuss the potential benefits and risks with a doctor.

Important Considerations:

Regular checkups and blood tests are crucial for monitoring testosterone levels and potential side effects. This is especially important during the first year of treatment and annually thereafter.

Different Forms of Testosterone Replacement:

Oral testosterone is not frequently used for hypogonadism. Oral forms can lead to significant liver problems and don't maintain consistent testosterone levels in the body. One exception is testosterone undecanoate, which is absorbed by the lymphatic system and may not cause the same liver issues. However, it's not typically used for age-related hypogonadism.

Several other forms are available, each with its own advantages and disadvantages:

• Gels: Testosterone gels are applied to the skin on the upper arm, shoulder, or inner thigh. The body absorbs the testosterone through the skin. Wait several hours after applying the gel before showering to allow full absorption. Possible side effects include skin irritation, and if the gel comes into contact with another person, it can transfer to them. Cover the treated area until the gel is dry to avoid transfer. (Examples: AndroGel, Testim, Vogelxo, Fortesta)

• Shots: Testosterone can be administered by injection into a muscle or under the skin. The specific amount and frequency of injections may vary depending on the individual and the type of testosterone used. Some forms of testosterone injections can be given at home by the patient or a family member, while others require a medical professional. (Examples: Depo-Testosterone, Xyosted, Aveed - this form requires a medical professional and is injected deep into a muscle)

• Patches: Testosterone patches are applied to the skin on the arm or torso and released into the body over time. Potential side effects include skin reactions, ranging from mild to severe.

• Gum/Cheek (Buccal): A putty-like testosterone product is placed in the buccal cavity (the area above the top teeth, where the gum meets the upper lip). It's applied three times daily and releases testosterone into the bloodstream. This method can cause gum irritation.

• Nasal: A gel form of testosterone (Natesto) is applied to the nostrils three times daily. This method reduces the risk of transferring the medication to others through skin contact. However, it may be less convenient to use than other methods.

• Implants (Pellets): Small pellets containing testosterone are surgically implanted under the skin. These implants release testosterone over a period of three to six months.

Possible Risks of Testosterone Therapy:

High doses of testosterone therapy can lead to various side effects. These typically resolve when the dosage is adjusted. Regular medical checkups are essential to monitor testosterone levels and address any potential side effects.

Specific Concerns:

• Blood Cell Production: Testosterone therapy can increase red blood cell production.
• Acne: Testosterone can trigger acne.
• Breast Enlargement: Some men may experience breast enlargement.
• Sleep Problems: Testosterone therapy can sometimes disrupt sleep patterns.
• Prostate Growth: Testosterone can contribute to prostate growth.
• Reduced Sperm Production: In some cases, testosterone therapy can decrease sperm production.

Other Conditions:

• Hypogonadism: If the cause of low testosterone is a problem with the pituitary gland, pituitary hormones can be administered to stimulate sperm production and fertility. Pituitary tumors may require surgical removal, medication, radiation therapy, or other hormone replacement.
• Primary Hypogonadism: In some cases, there's no way to restore sperm production. Assisted reproductive technology can help couples with fertility issues.
• Delayed Puberty: Testosterone shots can help trigger puberty in boys, but only if their bones have reached a certain stage of maturity. This treatment is typically administered for three to six months and can help with muscle growth, hair development (facial and pubic), and penis growth.

This information is not a substitute for professional medical advice. Always consult with a healthcare provider for diagnosis and treatment.