Most Common Symptoms of Hypogonadism
The most common symptoms of hypogonadism include diminished libido, erectile dysfunction, decreased energy/vitality, fatigue, depressed mood, reduced muscle mass and strength, and decreased bone density. 1
Primary Symptoms
Hypogonadism presents with a constellation of symptoms that affect multiple body systems:
Sexual Function
- Decreased sexual desire (libido) or activity
- Erectile dysfunction
- Reduced morning erections
Energy and Mood
- Diminished energy and sense of vitality
- Increased fatigue
- Depressed mood
- Irritability
Physical Changes
- Reduced muscle mass and strength
- Decreased bone density (which can lead to osteoporosis)
- Increased adiposity (body fat)
- Anemia
Cognitive Function
- Impaired cognition
- Difficulty concentrating
Symptom Recognition and Diagnostic Considerations
When evaluating for hypogonadism, it's important to recognize that:
- Symptoms may vary in severity among individuals
- The presence of multiple symptoms increases the likelihood of hypogonadism
- Symptoms must be correlated with low serum testosterone levels for diagnosis
Special Populations
Older Men
In older men, hypogonadism is often referred to as "andropause" or "androgen deficiency of the aging male" 1. The prevalence increases with age, affecting an estimated 2-4 million men in the United States.
Men with Diabetes
Men with diabetes have lower mean testosterone levels compared to age-matched men without diabetes 1. In these patients, symptoms of hypogonadism may be masked by or confused with symptoms of diabetes.
Clinical Pitfalls to Avoid
Missing the diagnosis: Only about 5% of men with hypogonadism receive treatment 1, suggesting significant underdiagnosis.
Treating based on symptoms alone: Testosterone replacement therapy is only warranted when both clinical symptoms and decreased hormone levels are present 2.
Overlooking obesity as a confounder: Obesity can significantly confound testosterone levels and symptoms 1.
Ignoring secondary causes: Further testing (such as luteinizing hormone and follicle-stimulating hormone levels) may be needed to distinguish between primary and secondary hypogonadism 1.
Failure to consider quality of life impact: Hypogonadism significantly affects quality of life and is linked to poorer health outcomes, including increased risk for cardiovascular disease, diabetes mellitus, metabolic syndrome, and premature death 3.
By recognizing these common symptoms and understanding their significance, clinicians can better identify patients who may benefit from testosterone level testing and potential treatment, ultimately improving morbidity, mortality, and quality of life outcomes.