Hypogonadism: Types, Causes, Symptoms, Diagnosis, Treatment and Perspective

It occurs when the sex glands produce little or no sex hormones.

The sexual glands are also called gonads, in men are the testicles and in women the ovaries.

Sex hormones help control secondary sexual 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 is also known as gonad deficiency.

It can be called low serum testosterone or andropause when it occurs in men. Most cases of this disorder respond well to appropriate medical treatment.

Types of hypogonadism

  • Primary hypogonadism: Means that you do not have enough sex hormones in your body due to a problem in your gonads. Your gonads still get the message that they produce hormones in your brain, but they can not produce them.
  • Central  hypogonadism or secondary hypogonadism: In central hypogonadism, the problem lies in your brain. The hypothalamus and the pituitary gland in the brain that control the gonads do not work properly.

What are the causes?

The causes of primary hypogonadism include:

  • Autoimmune disorders, such as Addison’s disease and hypoparathyroidism.
  • Genetic disorders, such as Turner syndrome and Klinefelter syndrome.
  • Severe infections
  • Liver and kidney diseases.
  • Testicles not descended.
  • Hemochromatosis , which occurs when the body absorbs too much iron exposure to radiation surgery on its sex organs.

Central or secondary hypogonadism may be due to:

  • Genetic disorders, such as Kallmann syndrome (abnormal hypothalamic development).
  • Infections, including HIV and AIDS.
  • Pituitary disorders inflammatory diseases, including sarcoidosis , tuberculosis and histiocytosis.
  • Obesity.
  • Rapid weight loss
  • Nutritional deficiencies
  • Use of steroids or opiates (especially long-term).
  • Brain surgery
  • Exposure to radiation.
  • Injury in the pituitary gland or hypothalamus.
  • A tumor in or near your pituitary gland.


Symptoms that can affect women include:

  • Lack of menstruation
  • Hot flushes.
  • Loss of body hair.
  • Low libido.
  • Milky discharge from your breasts.
  • Slow or absent breast growth.

Symptoms that can affect men include:

  • Loss of body hair.
  • Erectile dysfunction.
  • Muscle loss
  • Osteoporosis.
  • Low or absent sexual impulse.
  • Sterility.
  • Fatigue.
  • Abnormal growth of the bust.
  • Hot flushes.
  • Difficult to focus.
  • Reduced growth of penis and testicles.

How is hypogonadism diagnosed?

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

Hormonal tests: If your doctor thinks you might have hypogonadism, the first round of testing will be to check your sex hormone levels.

You will need a blood test to check your level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Your pituitary gland produces these reproductive hormones.

You will have your estrogen level tested if you are a woman and if you are male, your testosterone level will be tested. These tests are usually taken in the morning, which is when your hormone levels are higher.

If you are a man, your doctor can also order a semen analysis to check your sperm count. Hypogonadism can reduce sperm count. Your doctor may order more blood tests to help confirm the diagnosis of hypogonadism and rule out any underlying cause.

Iron levels can affect your sex hormones. For this reason, your doctor can evaluate anemia or iron deficiency. Your doctor may also want to measure your prolactin levels.

Prolactin is a hormone that drives breast development and breast milk production in women, but is present in both sexes. Your doctor can also control your thyroid hormone levels because thyroid problems can cause symptoms similar to hypogonadism.

Imaging tests: Imaging tests can also be useful in diagnosis. An ultrasound of the ovaries uses sound waves to create an image of the ovaries and detect any problems, including ovarian cysts and polycystic ovarian syndrome (PCOS).

The doctor may order magnetic resonance tomography or CT scans to detect tumors in the pituitary gland.


The treatment for men and women is similar if the hypogonadism is due to a tumor in the pituitary gland. Treatment may include radiation, medication or surgery to reduce or eliminate the tumor.

The treatment of hypogonadism in women:

It will involve increasing the amount of female sex hormones. Your first line of treatment will probably be estrogen therapy if you have had a hysterectomy . Or a patch or pill can administer the supplemental estrogen hormone.

Because increased estrogen levels can increase your risk of endometrial cancer, you will be given a combination of estrogen and progesterone if the women have not had a hysterectomy. Progesterone can reduce the risk of endometrial cancer if you are taking estrogen.

Other treatments may point to specific symptoms. Women can receive low doses of testosterone if they have low sexual desire.

If you have menstrual irregularities or trouble conceiving, you may receive injections of the human choriogonadotropin hormone (hCG) or pills that contain FSH to trigger ovulation.

Treatment of hypogonadism in men:

Testosterone is a male sex hormone. Testosterone replacement therapy (TRT) is a widely used treatment for hypogonadism in men.

You can get testosterone replacement therapy as follows:

  • Injection.
  • Patch.
  • Gel.
  • Pills

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

What is the long-term perspective?

According to the Urology Care Foundation, hypogonadism is a chronic disease that requires lifelong treatment. Your sex hormone level will probably decrease if you stop treatment. It is advisable to seek support through therapy or support groups can help you before, during and after treatment.