Most Common Bothersome Symptoms Reported by Men Seeking Treatment for Hypogonadism
Erectile dysfunction is the most frequently reported bothersome symptom (66.3%) among men seeking treatment for hypogonadism, followed by decreased sex drive/libido (55.8%) and loss of energy or increased tiredness (47.4%) 1.
Primary Bothersome Symptoms by Frequency
Sexual Function Symptoms
- Erectile dysfunction (66.3%) - Most commonly reported reason for seeking treatment 1
- Decreased sex drive/libido (55.8%) - Second most common complaint 1
- Ejaculatory issues - Including anejaculation and climacturia 1
Energy-Related Symptoms
- Loss of energy/increased fatigue (47.4-90%) - Extremely common and significantly impacts quality of life 1
- Decreased strength and endurance (86%) - Particularly bothersome for men who elect to receive testosterone replacement therapy 1
- Diminished sense of vitality and well-being - Frequently reported 1
Work and Cognitive Performance
- Deterioration in work performance (52%) - Significantly more common in men who elect to receive treatment versus those who refuse (52% vs. 31%) 1
- Impaired cognition - Though less commonly the primary complaint 1
Symptom Patterns and Clinical Significance
The symptom profile varies somewhat depending on whether patients have already elected to receive testosterone replacement therapy (TRT) or are treatment-naïve:
Among men who elected to receive TRT: Lack of energy (90%), decreased strength/endurance (86%), and work performance deterioration (52%) were most bothersome 1
Among treatment-naïve patients: Erectile dysfunction (66.3%), decreased sex drive (55.8%), and fatigue (47.4%) were most bothersome 1
Impact on Quality of Life
These symptoms significantly impact quality of life through multiple mechanisms:
- Psychological impact: Depression, anxiety, and decreased sense of well-being 1, 2
- Relationship strain: Sexual dysfunction affects both the patient and their partner 1
- Professional impact: Deterioration in work performance 1
- Physical limitations: Reduced muscle mass, increased body fat, and decreased strength 1, 3
Clinical Implications
Understanding the most bothersome symptoms helps guide treatment priorities:
- Focus initial assessment on sexual function, energy levels, and mood as these represent the most common concerns
- Monitor these key symptoms to assess treatment efficacy
- Address both physical and psychological aspects of hypogonadism symptoms
- Consider partner involvement when addressing sexual symptoms, as they affect relationships
Common Pitfalls in Symptom Assessment
- Attributing symptoms solely to aging rather than recognizing treatable hypogonadism 3
- Overlooking psychological symptoms like depression that may be related to hypogonadism 2
- Failing to distinguish between primary symptoms of hypogonadism and side effects of other medications
- Not recognizing that some patients may be reluctant to discuss sexual symptoms despite these being among the most bothersome
By recognizing these common bothersome symptoms, clinicians can better identify, evaluate, and treat men with hypogonadism, potentially improving both quality of life and treatment adherence.