Division of Urologic Surgery - UNC School of Medicine
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Overview of Hypogonadism
What is hypogonadism?
Hypogonadism is a medical term for a defect of the reproductive system that results in lack of function of the gonads (testes). The gonads have two functions: to produce hormones (testosterone) and to produce gametes (sperm). Male hypogonadism is deinfed as the failure of the testes to produce testosterone, sperm, or both. Although the disorder is exceedingly common, its exact prevalence is uncertain. Deficiency of male sex hormones can result in defective primary or secondary sexual development, or withdrawal effects in adults. Defective sperm development results in infertility.
The term hypogonadism is usually applied to permanent rather than transient or reversible defects, and usually implies deficiency of reproductive hormones, with or without fertility defects. back to top
Types of hypogonadism and causes.
Primary (testicular)
- Congenital - Klinefelter's and variants
- Acquired - Mumps and other viruses
- Trama
- Aging
- HIV/AIDS
Secondary (pituitary)
- Aging
- Chronic illness
- HIV/AIDS
- Certain drugs/alcohol (back to top)
Key Signs and Symptoms Associated with Low Testosterone
Signs
- Increased body fat, BMI (Body Mass Index)
- Reduced muscle bulk and strength
- Low bone mineral density (BMD)
- Loss of body hair (axillary and pubic), reduced shaving
Symptoms
- Decreased energy or motivation
- Depressed mood
- Diminished libido, erectile dysfunction
- Diminished work performance
- Poor concentration and memory
- Sleep disturbance (back to top)
Diagnosis and Treatment
Hypogonadism is most often treated by replacement of testosterone. Low testosterone can be identified through a simple blood test performed by a larboratory, ordered by a physician. Normal testosterone levels are in excess of 300 ng/dl. Commonly used testosterone treatments include gel, patch, or injections. The ideal testosterone replacement therapy (TRT) is effective in correcting signs and symptoms of androgen deficiency, convenient and acceptable route of administration, predictable pharmacokinetics, and safe. Transdermal gels are the most commonly prescribed form of TRT with 70% of patients using gel as treatment.
Even when patients are diagnosed and treated only 20% of patients starting on TRT will remain on therapy at month 12. In chronic conditions, adherence is problematic. TRT is treating a chronic condition. To ensure success of TRT physician counsel the patient in regards to adherence of TRT for success and identify patient's expectations when prescribing TRT. back to top
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