Hypogonadism is when your sex glands do not produce enough sex hormone. In men, this means the testes do not produce enough testosterone. In women, this means the ovaries do not produce enough estrogen.
There are a lot of potential root causes, including unhealthy weight, advanced age, genetic disorders, cancer treatment, and certain medications. The main treatment option is hormone replacement therapy, which is more effective in younger individuals.
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What is hypogonadism?
Hypogonadism is when sex glands (gonads) produce little, or no, sex hormones. Also called gonad deficiency, this condition impacts teenagers and adults, men and women — even infants, in rare cases.
- Males — Testes (testicles) in the male reproductive system produce testosterone, the primary male hormone. Men with hypogonadism experience total testosterone deficiency and the many symptoms that come with it.
- Females — Ovaries in the female reproductive system produce estrogen, progesterone, and smaller amounts of testosterone. Women with hypogonadism typically experience low estrogen and progesterone.
- Teenagers — Young individuals with hypogonadism could experience delayed puberty.
- Fetuses — Humans can develop hypogonadism in fetal development, leading to the growth of sex organs that do not match chromosomal gender.
Prevalence is higher than you might think. A lot of cases of hypogonadism go undiagnosed and untreated, so it’s hard to accurately estimate the prevalence. Up to 14 million men in the United States experience hypogonadism, but it is less common in women.
Is hypogonadism the same as low testosterone? No, hypogonadism and low testosterone are not exactly the same terms. Hypogonadism means that a male produces low testosterone, or it means that a female produces low estrogen.
2 Types of Hypogonadism
There are two types of hypogonadism:
- Primary hypogonadism — Also known as primary testicular failure in men, the root cause of this type originates in the gonads (testes or ovaries). Your brain is sending the signals to produce sex hormones, but your gonads aren’t listening.
- Secondary hypogonadism — Also known as central or hypogonadotropic hypogonadism, this type originates outside the gonads. The root cause for this type typically originates in the hypothalamus or the pituitary gland, which are supposed to signal the gonads to produce sex hormones.
Your hypothalamus produces gonadotropin-releasing hormone, the hormone that signals your pituitary gland to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which signals the gonads to produce sex hormones. Any dysfunction in this process may lead to secondary hypogonadism.
Both types of hypogonadism may occur due to a genetic trait or external forces, like an infection or injury to the gonads. In rare cases, primary and secondary hypogonadism happen at the same time.
13 Causes of Hypogonadism
The direct cause of hypogonadism is when the gonads do not produce much, if any, sex hormone. (Testosterone in men, estrogen and progesterone in women.)
What is the main cause of hypogonadism? The main cause of hypogonadism is low sex hormone production, which can result from gonad injury, endocrine disorders, nutritional deficiencies, old age, or genetics.
Below are the underlying causes that can lead to hypogonadism.
1. Genetic conditions
Genetic conditions like Klinefelter syndrome, Prader-Willi syndrome, or Turner syndrome can lead to hypogonadism.
Klinefelter, for example, is caused by a congenital abnormality of a male’s sex chromosomes: X and Y. A male usually possesses an X and a Y chromosome. With Klinefelter syndrome, however, two or more X chromosomes occur in addition to the one Y chromosome. Since the Y chromosome determines the sex of a child, this extra X chromosome results in abnormal development of the testes, leading to hypogonadism.
2. Undescended testicles
Before birth, testicles develop inside the abdomen of males and drop down into their permanent location of the scrotum. Sometimes, one or both testicles don’t descend at birth — called bilateral cryptorchidism, or undescended testicles.
If not corrected in early childhood, it can lead to malfunction of the testicles and low testosterone levels.
3. Infection
Infections, such as HIV/AIDS, can cause primary or secondary hypogonadism. Also, a mumps infection involving the gonads can impact gonad function and sex hormone production.
4. Injury to the gonads
Traumatic injury to the gonads can negatively impact sex hormone production. Injury could occur with a sports accident or surgery on your gonads.
A male’s testicles are vulnerable to injury because of where they’re located. Hypogonadism could possibly occur after damage to one testicle, but almost certainly after damage to both.
5. Cancer treatment
Cancer treatment, such as chemotherapy or radiation exposure, may affect estrogen, free testosterone, and sperm production. Permanent infertility may take place.
6. Pituitary disorders
Any pituitary gland disorder may impact the release of pituitary hormones that regulates normal testosterone production and estrogen production.
A pituitary tumor may lead to sex hormone deficiencies.
7. Hypothalamus disorders
Disorders of the hypothalamus, such as Kallmann’s syndrome, can impact sex hormone production.
Kallmann’s syndrome is a hormonal disorder, characterized by abnormal development of the hypothalamus, which regulates the secretion of pituitary hormones. This condition affects sex hormone production, as well as your sense of smell.
8. Hemochromatosis
Hemochromatosis is a buildup of iron in the skin, cardiovascular system, liver, pancreas, pituitary gland, and joints. Too much iron in the blood can cause gonadal failure or pituitary gland dysfunction, potentially leading to primary or secondary hypogonadism.
9. Inflammatory disease
Some inflammatory diseases, such as sarcoidosis or tuberculosis, impact the hypothalamus or pituitary gland, leading to lower sex hormone production.
10. Certain medications
Medications such as opiate pain medications, anabolic steroids, and some prescription hormones can directly affect sex hormone production.
Opioids can mess with your hypothalamus. Steroids can impair hypothalamus and pituitary gland function. Certain prescription hormones may throw your sex hormones out of balance.
11. Nutritional deficiencies
Vitamin deficiencies affect the pituitary gland, such as involving vitamin A or vitamin E.
Deficiencies in zinc, magnesium, and vitamin D are associated with dysfunction in the hypothalamus and pituitary gland.
12. Obesity
Obesity may be linked to hypogonadism, at all ages.
Rapid weight loss also carries a risk of hypogonadism. Careful not to swing the pendulum too hard in the other direction.
13. Aging
As humans age, we all experience changes in sex hormone production. Older men experience a drop in testosterone, and women produce less estrogen especially once menopause sets in.
Common Risk Factors
These risk factors may increase your likelihood for hypogonadism:
- Excess iron in bloodstream
- Diabetes
- Kidney disease
- Liver disease
- Steroid and opioid use
- Cancer treatments
- Pituitary tumors (adenomas)
- Brain surgery
- Surgery on reproductive organs
- HIV/AIDS
- Malnutrition
- Autoimmunity
- Obesity
- Older age
- Genetics
What are the symptoms of hypogonadism?
Symptoms of hypogonadism in women include:
- Abnormal menstruation
- Milky discharge from nipples
- Hot flashes
- Slow breast growth
- Loss of body hair
- Loss of sexual function
- Low sex drive
- Mood changes
- Chronic fatigue
- Difficulty concentrating
Symptoms of hypogonadism in men include:
- Development of breast tissue (gynecomastia)
- Erectile dysfunction
- Infertility due to low sperm count
- Loss of muscle mass
- Loss of bone mass (osteoporosis)
- Later-than-normal voice deepening
- Hair loss
- Hot flashes
- Slow body and facial hair growth
- Slow growth of penis and testicles
- Faster growth of limbs than mid-body
- Sexual dysfunction
- Low sex drive
- Low energy
- Mood changes
- Underdeveloped male genitals, in fetal hypogonadism
- Female or ambiguous genitals, in fetal hypogonadism
Diagnosis
Diagnosis of hypogonadism may include a medical history, blood test, imaging tests, and more. The earlier hypogonadism is detected, the better your chances of effective treatment.
You may receive one or more of these diagnostic tests from your endocrinologist or other healthcare provider:
- Discussion — Your healthcare provider may ask about your symptoms, medical history, and even your family medical history. Keep a diary of your symptoms to better facilitate the diagnostic process. Interview family members for evidence of genetic hypogonadism.
- Physical exam — A simple physical examination of body hair, muscle mass, pelvis, or sexual organs can help doctors determine whether you are at a proper stage of sexual development for your age, according to established diagnostic guidelines.
- Blood test — Blood tests will check for normal levels of sex hormones, thyroid hormones, iron, or pituitary gland hormones like prolactin, follicle-stimulating hormone, and luteinizing hormone. Men’s serum testosterone levels and women’s estrogen should be measured with a blood test. These blood tests work best in the morning when hormone levels are highest.
- Imaging tests — An MRI or CT scan may look for pituitary gland tumors or brain growths, both of which may impact sex hormone production. An ultrasound uses sound waves to harmlessly check females for ovarian cysts or polycystic ovary syndrome (PCOS).
- Semen analysis — For males, a semen analysis test measures sperm count, which will be reduced if you have hypogonadism.
Here are some questions you may want to ask your doctor:
- What’s the most likely root cause of my symptoms?
- Is my condition short-term or chronic?
- What tests will I need?
- What are the risks and side effects of treatment?
- Should I look for signs of serious complications?
- What type of hypogonadism do I have?
Treatment Options for Hypogonadism
Can hypogonadism be corrected? Yes, hypogonadism can be corrected with science-based treatment options like those listed below.
Hypogonadism treatment for women
For women who have had a hysterectomy, estrogen pills, patches, gels and implants are the first treatment against hypogonadism.
For women who have never gone through a hysterectomy, estrogen hormone therapy may be administered alongside progesterone, to reduce risk of endometrial cancer (which can be caused by elevated estrogen levels without an increase in progesterone).
Treating the root cause should be the primary goal, but treating symptoms may offer you temporary relief while the underlying cause is being addressed. Low-dose testosterone can treat low libido, cognitive behavioral therapy is good for concentration, and stress reduction may regulate mood swings and reduce fatigue.
Hypogonadism treatment for men
Testosterone replacement therapy is a common treatment option for adult men with hypogonadism, which helps males return to healthy levels of testosterone. Testosterone treatment should address all your hypogonadism symptoms though this treatment may be less effective the older you get.
Prescription testosterone can be administered via pill, patch, injection, gel, or even twice-yearly implantable pellets in your skin.
For younger males at increased risk of delayed puberty, injections of gonadotropin-releasing hormone may help trigger puberty at a healthy age. (Note that “delayed puberty” is rarely considered a disease and may lead to higher final height and better fertility.)
Testosterone therapy carries various risks, including:
- Excess red blood cell production
- Acne
- Sleep apnea
- Prostate enlargement
- Limited sperm production, potentially resulting in infertility
Hypogonadism treatment for men and women
If a pituitary gland tumor is causing secondary hypogonadism, you may need one of the following pituitary treatments to shrink or remove the tumor:
- Medication
- Radiation therapy
- Surgery
For when nutritional deficiencies or obesity causes hypogonadism, maintaining a balanced diet may reverse your symptoms.
Prognosis
If you catch hypogonadism early, the prognosis is probably good. If you use effective treatment options, the prognosis is probably good. If you let your symptoms run rampant or don’t keep up with your treatment, the prognosis is not so good.
Primary hypogonadism may require ongoing treatment. If you halt treatment, hormone levels could fall below normal ranges, leading to the return of hypogonadism symptoms.
If a treatable condition (like a pituitary tumor or medication side effect) is the root cause of your secondary hypogonadism, hormone levels may permanently return to normal after effective treatment.
Untreated hypogonadism can lead to serious health complications, such as:
- Infertility
- Anxiety
- Depression
- Difficulty concentrating
- Muscle loss
- Osteoporosis
- Atypical genitalia
- Erectile dysfunction
- Relationship issues
- Negative self-image
You should contact your healthcare provider right away if you’re experiencing:
- Changes to menstruation
- Unexplained hot flashes
- Nipple discharge
- Slow onset of puberty (in teens)
- Impotence
- Infertility
- Weakness
- Headaches
- Vision problems
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