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Hypogonadism - Types, Causes, Risk Factors, Symptoms, Diagnosis and Treatment

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Hypogonadism is the problem of sex hormones, and it can affect both the genders. Read this article to know more.

Written by

Dr. Lochana .k

Medically reviewed by

Dr. Thiyagarajan. T

Published At March 21, 2022
Reviewed AtSeptember 14, 2023


Hypogonadism is defined as a condition where a person’s reproductive organs produce very little or completely no sex hormones. The sex organs are also known as the gonads. The gonads are primarily the testes in males and the ovaries in females. Sex hormones mainly control the secondary sexual characteristics in both males and females. Those secondary sexual characteristics include breast development in females, testes in men, and pubic hair growth in both the genders. Sex hormones also play a significant role in the regularization of the menstrual cycle and sperm production. Hypogonadism is also frequently termed as gonad deficiency.

How Common Is Hypogonadism?

Hypogonadism is a condition that affects approximately four to five million men in the United States every year. It can occur in people who belong to any age group. However, it is more common in reproductive-aged adults. Studies have shown that almost 60 % of men above 65 have below-average testosterone levels.

What Are the Types of Hypogonadism?

Hypogonadism has been broadly classified as the primary and central hypogonadism.

1. Primary hypogonadism:

Primary hypogonadism is defined as a condition where the affected individual does not have enough sex hormones in his or her body. This problem is primarily due to any abnormality in the gonads. In this condition, the hypothalamus and pituitary glands’ stimuli are intact, while the gonads fail to act to the received stimulus properly.

2. Central or the secondary hypogonadism:

In central hypogonadism, the primary site of the problem is the affected individual’s brain. In these cases, the hypothalamus and pituitary glands usually designated to control human gonads are not working properly.

What Are the Risk Factors?

Risk factors for hypogonadism can increase the chance of the person to acquire hypogonadism at any stage of his or her lifetime. They are:

What Are the Causes of Hypogonadism?

Primary Hypogonadism -

The following are the common causes of primary hypogonadism:

1. Klinefelter Syndrome:

This condition occurs due to a congenital abnormality of the sex chromosomes, X and Y, where two or more X chromosomes and one Y chromosome are inherited. The additional X chromosome that is seen in Klinefelter syndrome can lead to abnormal development of the testicles. As a result of abnormal testicles, there is an underproduction of testosterone.

2. Undescended Testicles:

This condition is termed as cryptorchidism. Embryologically, the testicles usually develop inside the abdomen and normally descend down step by step into their permanent location at the scrotum. This condition can potentially result in the testicles’ malfunction and a decrease in the production of testosterone.

3. Mumps Orchitis:

A mumps infection which affects the testicles can cause damage to the testicles. This process affects the normal physiological function of the testicles and testosterone production.

4. Hemochromatosis:

Increased iron load in the blood can lead to testicular failure or pituitary gland dysfunction. This can affect testosterone production.

5. Injury to the Testicles.

6. Cancer Treatment:

Cancer treatment that usually involves chemotherapy or radiation therapy can affect normal testosterone and sperm production. Though the effects of both modes of treatments are temporary, it can result in permanent infertility.

Secondary Hypogonadism-

The following are the various causes of secondary hypogonadism.

1. Kallmann's Syndrome.

2. Pituitary Disorders: Any abnormality in the pituitary gland can potentially affect the release of hormones from the pituitary gland to the testicles and ovaries. This results in decreased testosterone or estrogen production. A pituitary tumor can also lead to hormone deficiencies.

3. Inflammatory Disease: Inflammatory conditions like sarcoidosis, histiocytosis, or tuberculosis usually involve the hypothalamus and pituitary gland regions. This can also affect testosterone and estrogen production.

4. HIV or AIDS.

5. Opiates: Intake of certain opioid pain medications can affect the normal physiology of the testicles.

6. Obesity.

7. Normal Aging: As men and women age, there is a progressive decrease in testosterone and estrogen production. In older women, menopause is the most important cause of hypogonadism.

What Are the Symptoms of Hypogonadism?

The symptoms of hypogonadism depend on the following:

  • The age of onset.

  • The degree and severity of testosterone or estrogen deficiency.

  • The duration of the deficiency in sex hormones.

The following are the common symptoms that are seen in hypogonadism.

  • Erectile dysfunction.

  • A decrease in sperm count.

  • Frequent episodes of depressed mood.

  • Decreased libido (sexual drive).

  • Lethargy.

  • Sleep deprivation.

  • A significant reduction in muscle mass and strength.

  • Loss of body hair in the pubic, axillary, and facial regions.

  • Osteoporosis presents with a decreased bone mineral density.

  • Obesity.

  • Enlargement of breasts which is accompanied by discomfort.

  • Hot flashes.

  • Profuse sweating.

  • Poor concentration in daily activities.

  • Loss of appetite.

How Is It Diagnosed?


In males, it can be usually diagnosed by measuring the person’s levels of early morning serum testosterone. This test must be repeated if the value seems low. In addition to testosterone, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin should also need to be measured. Suppose the patient’s clinical signs and symptoms strongly suggest hypogonadism, but the serum testosterone level is near to normal. In that case, an assay of serum testosterone should be done with SHBG (sex hormone-binding globin).


In females, a blood test is required to check the follicle-stimulating hormone (FSH) and luteinizing hormone (LH). It is also very important to get the estrogen levels tested in females.

What Are the Treatment Options?

Male hypogonadism can be treated with the help of testosterone replacement therapy. This method is done to return the testosterone levels to normal. The reason behind this is that testosterone can help improve hypogonadal symptoms, which include reduced sexual desire, loss of appetite, decreased facial and body hair, etc. In the females, treatment primarily involves increasing the female sex hormones. Thus, the first line of female hypogonadism management is estrogen therapy. It can be administered either as a skin patch or a pill.

What Are the Complications?

The following are the various complications that can result from untreated hypogonadism.

  • Anomalies of genitalia.

  • Enlarged male breasts which are known as gynecomastia.

  • Infertility.

  • Erectile dysfunction.

  • Osteoporosis.

  • Poor self-image and psychological issues such as depression.


Hypogonadism can affect both men and women of any age and requires treatment for appropriate development of physical, cognitive and sexual characteristics. The etiology can be different in each case but there is need for more awareness among people and the treating physician regarding such conditions. For more information, you can consult an online doctor.

Frequently Asked Questions


Does Hypogonadism Affect Males?

Gonads are organs that produce sex hormones in males and females. In males, the testes (gonads) generate testosterone (sex hormone) that helps develop the testes, sperm production and regulates sexual drive and body hair growth. Thus, the decreased production of testosterone hormones in males is called hypogonadism. The various symptoms in males depend on the age of onset; the common among them are:
Loss of body hair.
Breast enlargement.
Low sexual drive.
Low energy.
Erectile dysfunction.


How Is Hypogonadism Treated?

Hypogonadism refers to the reduced production of sex hormones. It happens due to sex organ abnormalities or problems in the hypothalamus or pituitary gland to trigger the sex organs producing hormones. It causes various effects in men ad women. It is managed as follows:
In men: Testosterone replacement therapy is advised in males to increase the reduced hormone levels. Testosterone is available as gels, patches, and injectables.
In women: The main aim of the treatment in women is to elevate the estrogen level through pills or patches that contain estrogen.


What Are the Features of Testicular Hypogonadism?

The decreased production of testosterone in males is referred to as testicular hypogonadism. It arises due to abnormal testes or defective signals from the hypothalamus and pituitary to produce sex hormones. The various features of testicular hypogonadism are listed down:
Low sexual drive.
Loss of body hair.
Hot flashes.
Erectile dysfunction.
Disturbed sleep.
Enlarged breast.
Low sperm count.


Are Hypogonadism and Low Testosterone the Same?

Low testosterone level is when the testosterone level falls below 300 ng/dL. Studies show that the testosterone level naturally reduces in men over 65 years of age. In comparison, hypogonadism is a condition that occurs in men and women due to decreased production of sex hormones by the testes and ovaries, respectively. In men, it causes reduced sexual drive, erectile dysfunction, breast enlargement, etc. In women, lack of menstruation, reduced breast growth, and loss of body hair may occur. The doctor suggests hormone replacement therapy in such cases.


Do Testosterone Levels Decrease With Masturbation?

Testosterone is a male sex hormone produced by the testes on command from the pituitary gland. It is responsible for the sexual drive in men and also has sperm and increases body hair. The act done by men to achieve sexual pleasure is termed masturbation. The testosterone levels rise during the sexual act. However, no study proves that testosterone levels decrease during or after masturbation.


How Is Hypogonadism Diagnosed?

The decreased testosterone production in males and estrogen in females is called hypogonadism. Early diagnosis is essential in preventing further complications. It is done as follows:
The doctor may order a blood test for males to determine testosterone levels, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels. Early morning blood workup is advised as hormone levels are high. Other tests like semen analysis and pituitary imaging also aid in diagnosing any testicular or pituitary gland abnormalities.
For females - If suspected of hypogonadism, the doctor suggests a blood test to evaluate the estrogen, FSH, and LH levels.


Which Food Increases My Testosterone Levels?

The primary male sex hormone is testosterone, and the following foods can increase their levels:
Red meat.
Fruits like pomegranates and cherries.
Vitamin D-rich foods (milk, egg, fish, etc.).


Can I Increase My Testosterone Level With Exercise?

Testosterone significantly improves sexual drive, sperm production, muscle mass, and body hair growth. It is also found in lesser amounts in females. The reduced level of testosterone significantly affects males. Therefore, it is essential to maintain adequate testosterone levels in men. Certain studies show specific exercises increase testosterone levels in the body. For example, weight lifting is resistance training that improves testosterone levels in males.


Should I Be Concerned About the Low Testosterone Level?

Testosterone is produced by the male sex organ (testes), and its average level is 300 to 1,000 ng/dL. An adequate testosterone level is essential in males to aid in several activities. It is advisable to consult the specialist if you feel the following symptoms that occur due to low testosterone levels,
Low sexual drive.
Erectile dysfunction.
Loss of body hair.
Low muscle mass.
Breast enlargement.


Does Hypogonadism Stay Long?

Hypogonadism is a condition that leads to the decreased production of testosterone by the male reproductive organ. Every year, about four to five million individuals in the United States are affected by hypogonadism. It occurs due to the abnormalities in the testes or the pituitary gland that send signals to the testes to produce sex hormones. The condition may last longer depending on its cause. If any underlying systemic diseases cause hypogonadism, treating it may improve hypogonadism symptoms.


Is Hypogonadism Serious?

Hypogonadism refers to the decreased production of sex hormones by the gonads in males and females. In males, the testosterone level is low, and in females, it is the estrogen hormone. Testosterone maintains sperm production, sexual drive, and bodily hair growth in males. However, the reduced amounts cause various problems, and if left untreated, it may lead to the following:
Brittle and weak bones.
Breast enlargement.
Erectile dysfunction.
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Dr. Lochana .k
Dr. Lochana .k



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