# data[].attributes.attachment_link.description
Hypogonadism occurs when the body’s sex glands (gonads) produce little or no hormones. In men, these glands are the testes. In women, these glands are the ovaries.

# data[].attributes.attachment_link.readable_text
Hypogonadism is when your body does not produce enough sex hormones. Treatment options will depend, in part, on whether you're trying to conceive.

Hypogonadism occurs when the sex glands produce little to no sex hormones.

Hypogonadism is also known as gonadal deficiency. It may be called andropause or low serum testosterone when it occurs in people AMAB.

There are three types of hypogonadism: primary, secondary, and eugonadotropic.

Primary hypogonadism

Primary hypogonadism that you do not have enough sex hormones in your body due to a problem in your gonads.

Your gonads are still receiving the message to produce hormones from your brain, but they can't produce the hormones.

It's also known as hyper gonadotropic hypogonadism.

Secondary hypogonadism

In secondary hypogonadism, the issue originates in your brain.

If you have secondary hypogonadism, your gonads aren't being stimulated.

Secondary hypogonadism is also known as hypogonadotropic or central hypogonadism.

Eugonadotropic hypogonadism

In eugonadotropic hypogonadism, you experience the effects of hypogonadism even though your pituitary gland is functioning as expected.

The of primary hypogonadism include:

Secondary hypogonadism may be the result of the following:

genetic disorders such as Kallmann syndrome (abnormal hypothalamic development)

injury to your hypothalamus or pituitary gland

a tumor in or near your pituitary gland

pituitary disorders

infections, including HIV

inflammatory diseases such as sarcoidosis and tuberculosis

rapid weight loss

nutritional deficiencies

use of steroids or opioids

brain surgery

radiation exposure

hemochromatosis, which occurs when your body absorbs too much iron

Eugonadotropic hypogonadism may be caused by:

A doctor will conduct a physical exam to confirm your sexual development is typical for a person your age. They may examine your muscle mass, body hair, and sexual organs.

Laboratory tests

If the doctor thinks you might have hypogonadism, they'll first check the levels of your sex hormones.

In addition, the doctor may order additional blood tests to help confirm a diagnosis and rule out any underlying causes. These include:

Prolactin tests: The hormone prolactin promotes breast development and breast milk production in people AFAB, but it's present in people AMAB too.

Thyroid function tests: The doctor may also check your thyroid hormone levels. Thyroid problems can cause symptoms similar to hypogonadism.

Iron tests: Iron levels can affect your sex hormones. For this reason, the doctor may perform an iron test to check for high blood iron levels.

Genetic tests: The doctor may perform genetic testing, especially if they suspect you have a chromosomal irregularity such as Turner syndrome.

Imaging tests

Imaging tests can also be useful in diagnosis.

Treatment for all genders is similar if the hypogonadism is due to a tumor affecting the pituitary gland. Treatment to shrink or remove the tumor may include medication, radiation, or surgery.

Treatments that are specific to female or male hypogonadism are described below.

Treatment for female hypogonadism

Your treatment will involve increasing your amount of female sex hormones. Treatments will vary depending on the type of hypogonadism you have and whether you're trying to conceive.

If you have primary hypogonadism and true ovarian failure, you'll typically need to explore alternative forms of family building. Options include:

Some people will also require estrogen therapy. Supplemental estrogen can be administered via a patch or pill.

If you've had a hysterectomy, estrogen therapy will probably be your first line of treatment.

Other treatments can target specific symptoms. For eugonadotropic hypogonadism, a doctor will usually treat the underlying cause, such as PCOS.

Treatment for male hypogonadism

Injections of a gonadotropin-releasing hormone (GnRH) or gonadotropins (such as hCG or FSH) may trigger puberty or increase sperm production. These treatments are appropriate if you're interested in conceiving and have primary hypogonadism.

If you have primary hypogonadism, you can explore sperm harvesting and sperm donation as options for conception, as well as intracytoplasmic sperm injection (ICSI).

Unless a treatable condition causes it, hypogonadism is chronic and may require lifelong treatment. Your levels of sex hormones may decrease if you stop hormone therapy.

Most cases of hypogonadism respond well to appropriate medical treatment, though.

Seeking support through therapy or support groups can help you before, during, and after treatment.

# data[].attributes.attachment_link.title
What You Need to Know About Female and Male Hypogonadism

# data[].attributes.attachment_link.description
Hypogonadism occurs when the sex glands produce little to no sex hormones. Get the facts on types, female and male hypogonadism, diagnosis, and more.

# data[].attributes.attachment_link.readable_text
Am Fam Physician. 2024;109(6):543-549
This clinical content conforms to AAFP criteria for CME.
Author disclosure: No relevant financial relationships.

Testosterone deficiency, or male hypogonadism, is a clinical syndrome that can be defined as persistently low serum testosterone levels in the setting of symptoms consistent with testosterone deficiency. Studies suggest that testosterone replacement therapy may improve sexual function, depressive symptoms, bone density, and lean body mass. Evidence is conflicting regarding its effect on cardiovascular events and mortality. Although prior studies suggested that testosterone replacement therapy increased the risk of cardiovascular disease, a large, randomized trial showed that it does not increase the risk of myocardial infarction or stroke, even in patients at high risk. After a detailed discussion of the potential benefits and risks through shared decision-making, testosterone replacement therapy should be considered for men with testosterone deficiency to correct selected symptoms and induce and maintain secondary sex characteristics. Treatment method should take into consideration patient preference, pharmacokinetics, potential for medication interactions, formulation-specific adverse effects, treatment burden, and cost. Clinicians should monitor men receiving testosterone replacement therapy for symptom improvement, potential adverse effects, and adherence. Serum testosterone, hematocrit, and prostate-specific antigen levels should be measured at baseline and at least annually in men 40 years or older receiving testosterone replacement therapy. ( Am Fam Physician. 2024;109(6):543-549. Copyright © 2024 American Academy of Family Physicians.)

Already a member/subscriber? Log In

Subscribe
From $165

Immediate, unlimited access to all AFP content

More than 130 CME credits/year

AAFP app access

Print delivery available

Subscribe

Issue Access
$59.95

Immediate, unlimited access to this issue's content

CME credits

AAFP app access

Print delivery available

Buy Issue

Article Only
$25.95

Immediate, unlimited access to just this article

CME credits

AAFP app access

Print delivery available

Buy Article

1. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.

2. Anaissie J, DeLay KJ, Wang W, et al. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Transl Androl Urol. 2017;6(2):183-191.

3. Harman SM, Metter EJ, Tobin JD, et al.; Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab. 2001;86(2):724-731.

4. Klein DA, Paradise SL, Goodwin ET. Caring for transgender and gender-diverse persons: what clinicians should know. Am Fam Physician. 2018;98(11):645-653.

5. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2021; 106(7): e2848]. J Clin Endocrinol Metab. 2010;95(6):2537.

6. Morley JE, Charlton E, Patrick P, et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000;49(9):1239-1242.

7. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423-432.

8. Petering RC, Brooks NA. Testosterone therapy: review of clinical applications [published correction appears in Am Fam Physician. 2019; 100(7): 393]. Am Fam Physician. 2017;96(7):441-449.

9. Sharma R, Oni OA, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015;36(40):2706-2715.

10. Basaria S, Harman SM, Travison TG, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial. JAMA. 2015;314(6):570-581.

11. Brock G, Heiselman D, Maggi M, et al. Effect of testosterone solution 2% on testosterone concentration, sex drive and energy in hypogonadal men: results of a placebo controlled study. J Urol. 2016;195(3):699-705.

12. Wang C, Alexander G, Berman N, et al. Testosterone replacement therapy improves mood in hypogonadal men-a clinical research center study. J Clin Endocrinol Metab. 1996;81(10):3578-3583.

13. Snyder PJ, Bhasin S, Cunningham GR, et al.; Testosterone Trials Investigators. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611-624.

14. Qaseem A, Horwitch CA, Vijan S, et al. testosterone treatment in adult men with age-related low testosterone: a clinical guideline from the American College of Physicians [published correction appears in Ann Intern Med. 2023; 176(4): 584]. Ann Intern Med. 2020;172(2):126-133.

15. Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone: a controlled clinical trial [published corrections appear in JAMA Intern Med. 2017; 177(4): 600 and JAMA Intern Med. 2019; 179(3): 457]. JAMA Intern Med. 2017;177(4):471-479.

16. Srinivas-Shankar U, Roberts SA, Connolly MJ, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010;95(2):639-650.

17. Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363(2):109-122.

18. Finkle WD, Greenland S, Ridgeway GK, et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9(1):e85805.

19. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke with use. Updated February 26, 2018. Accessed February 4, 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-cautions-about-using-testosterone-products-low-testosterone-due

20. Lincoff AM, Bhasin S, Flevaris P, et al.; TRAVERSE Study Investigators. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med. 2023;389(2):107-117.

21. Fugh-Berman A. Treating aging with testosterone. Am Fam Physician. 2017;96(7):428-430.

22. National Library of Medicine DailyMed. Label: androderm-testosterone patch. Updated January 18, 2020. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e58a5328-fdd9-40cba19f-8ed798989b9c

23. National Library of Medicine DailyMed. Label: androgel-testosterone gel. Updated November 1, 2020. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8677ba5b-8374-46cb-854c-403972e9ddf3

24. National Library of Medicine DailyMed. Label: depo-testosterone-testosterone cypionate injection, solution. Updated August 18, 2020. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=735b5bf3-4464-412c-a072-1bd02f2e5380

25. National Library of Medicine DailyMed. Label: testosterone enanthate injection, solution. Updated November 12, 2021. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e89d6458-428c-4256-97a3-f1fa851293c1

26. National Library of Medicine DailyMed. Label: aveed-testosterone undecanoate injection. Updated August 28, 2021. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f80f025b-17d8-40af-8739-20ce07902045

27. National Library of Medicine DailyMed. Label: jatenzo-testosterone undecanoate capsule, liquid filled. Updated August 15, 2023. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed7b5d41-7475-4c10-99b9-b62b3434ae60

28. National Library of Medicine DailyMed. Label: testopel-testosterone pellet. Updated March 28, 2024. Accessed April 28, 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=03b9c0b1-5884-11e4-8ed6-0800200c9a66

29. Margo K, Winn R. Testosterone treatments: why, when, and how?. Am Fam Physician. 2006;73(9):1591-1598.

# data[].attributes.attachment_link.title
Testosterone Replacement Therapy for Male Hypogonadism

# data[].attributes.attachment_link.description
Testosterone deficiency, or male hypogonadism, is a clinical syndrome that can be defined as persistently low serum testosterone levels in the setting of symptoms consistent with testosterone deficiency. Studies suggest that testosterone replacement therapy may improve sexual function, depressive symptoms, bone density, and lean body mass.

# data[].attributes.attachment_link.readable_text
Diagnosis

Early detection in boys can help prevent problems from delayed puberty. Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions.

Your doctor will conduct a physical exam and note whether your sexual development, such as your pubic hair, muscle mass and size of your testes, is consistent with your age.

Your doctor will test your blood level of testosterone if you have signs or symptoms of hypogonadism. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day, before 10 a.m., possibly on more than one day.

If tests confirm that you have low testosterone, further testing can determine if a testicular disorder or a pituitary abnormality is the cause. These studies might include:

Hormone testing

Semen analysis

Pituitary imaging

Genetic studies

Testicular biopsy

Treatment

Adult men

Male hypogonadism usually is treated with testosterone replacement to return testosterone levels to normal. Testosterone can help counter the signs and symptoms of male hypogonadism, such as decreased sexual desire, decreased energy, decreased facial and body hair, and loss of muscle mass and bone density.

For older men who have low testosterone and signs and symptoms of hypogonadism due to aging, the benefits of testosterone replacement are less clear.

While you're taking testosterone, the Endocrine Society recommends that your doctor monitor you for treatment effectiveness and side effects several times during your first year of treatment and yearly after that.

Types of testosterone replacement therapy

Oral testosterone preparations have not been used for treatment of hypogonadism because they can cause serious liver problems. Also, they don't keep testosterone levels steady.

Recently the FDA approved an oral testosterone replacement preparation, testosterone undecanoate (Jatenzo) that is absorbed by the lymph system. It might avoid the liver problems seen with other oral forms of testosterone.

Other preparations you might choose, depending on convenience, cost and your insurance coverage, include:

Gel. There are several gels and solutions available, with different ways of applying them. Depending on the brand, you rub the testosterone into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo)or apply it to the front and inner thigh (Fortesta).

Your body absorbs testosterone through your skin. Don't shower or bathe for several hours after a gel application, to be sure it gets absorbed.

Side effects include skin irritation and the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry, or cover the area after an application.

Injection. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate are given in a muscle or under the skin. Your symptoms might waver between doses depending on the frequency of injections.

You or a family member can learn to give testosterone injections at home. If you're uncomfortable giving yourself injections, a nurse or doctor can give the injections.

Testosterone undecanoate (Aveed) is given by deep intramuscular injection, typically every 10 weeks. It must be given at your doctor's office and can have serious side effects.

Patch. A patch containing testosterone (Androderm) is applied each night to your thighs or torso. A possible side effect is severe skin reaction.

Gum and cheek (buccal cavity). A small putty-like substance, gum-and-cheek testosterone replacement delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity).

This product, taken three times a day, sticks to your gumline and allows testosterone to be absorbed into your bloodstream. It can cause gum irritation.

Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This option reduces the risk that medication will be transferred to another person through skin contact. Nasal-delivered testosterone must be applied twice in each nostril, three times daily, which might be more inconvenient than other delivery methods.

Implantable pellets. Testosterone-containing pellets (Testopel) are surgically implanted under the skin every three to six months. This requires an incision.

Testosterone therapy carries various risks, including:

Increased production of red blood cells

Acne

Enlarged breasts

Sleep disturbances

Prostate enlargement

Limited sperm production

Treatment of infertility due to hypogonadism

If a pituitary problem is the cause, pituitary hormones can be given to stimulate sperm production and restore fertility. A pituitary tumor may require surgical removal, medication, radiation or the replacement of other hormones.

There's often no effective treatment to restore fertility in a man with primary hypogonadism, but assisted reproductive technology may be helpful. This technology covers a variety of techniques designed to help couples who have been unable to conceive.

Treatment for boys

Treatment of delayed puberty in boys depends on the underlying cause. Three to six months of testosterone supplementation given as an injection can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

Having male hypogonadism can affect your self-image and, possibly, your relationships. Talk with your doctor about how you can reduce the anxiety and stress that often accompany these conditions. Many men benefit from psychological or family counseling.

Find out if there are support groups in your area or online. Support groups put you in touch with other people with similar challenges.

Preparing for your appointment

Although you're likely to start by seeing your family doctor, you might be referred to a doctor who specializes in the hormone-producing glands (endocrinologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began

Key personal information, including any major stresses, recent life changes, and history of childhood illnesses or surgeries

All medications, vitamins or other supplements you take, including doses

Questions to ask your doctor

For male hypogonadism, some questions to ask your doctor include:

What's the most likely cause of my symptoms?

Are there other possible causes for my symptoms?

What tests do I need?

Is my condition likely temporary or chronic?

What treatments are available?

I have other health conditions. How can I best manage them together?

Are there restrictions I need to follow?

Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

Have your symptoms been continuous or occasional?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

When did you begin puberty? Did it seem to be earlier or later than your peers?

Did you have any growth problems as a child or adolescent?

Have you injured your testicles?

Did you have the mumps as a child or teen? Do you recall if you felt pain in your testicles while you had the mumps?

Did you have undescended testicles as a baby?

Did you have surgery for a groin hernia or genital surgery as a child?

# data[].attributes.attachment_link.description
Early detection in boys can help prevent problems from delayed puberty. Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions. Your doctor will conduct a physical exam and note whether your sexual development, such as your pubic hair, muscle mass and size of your testes, is consistent with your age.