From the Guidelines
Hypogonadism symptoms primarily include erectile dysfunction, decreased sex drive, and loss of energy or increased tiredness, as reported by 66.3%, 55.8%, and 47.4% of patients, respectively. These symptoms are the most bothersome for patients with hypogonadism, as shown in a survey of 95 patients who had not received testosterone replacement therapy (TRT) 1.
Common Symptoms
- Erectile dysfunction
- Decreased sex drive
- Loss of energy or increased tiredness
- Decreased libido
- Infertility
- Hot flashes
- Decreased muscle mass
- Gynecomastia
- Reduced facial/body hair
- Fatigue
- Decreased energy
- Poor concentration
- Depression
- Irritability
- Sleep disturbances
Diagnosis and Treatment
Diagnosis of hypogonadism requires both clinical symptoms and laboratory confirmation of low sex hormone levels. Treatment typically involves hormone replacement therapy tailored to the patient's sex, age, and specific needs, which can alleviate most symptoms when properly administered. However, the annual cost of testosterone replacement therapy (TRT) can be significant, with an average cost of $2135.32 for transdermal and $156.24 for intramuscular formulation 1.
Important Considerations
It is essential to note that evidence on long-term benefits or harms of testosterone treatment is lacking, and mortality data is inconclusive 1. Therefore, treatment decisions should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.
From the FDA Drug Label
Male hypogonadism, a clinical syndrome resulting from insufficient secretion of testosterone, has two main etiologies. Primary hypogonadism is caused by defects of the gonads, such as Klinefelter's syndrome or Leydig cell aplasia, whereas secondary hypogonadism is the failure of the hypothalamus (or pituitary) to produce sufficient gonadotropins (FSH, LH).
Individuals taking supratherapeutic doses of testosterone may experience withdrawal symptoms lasting for weeks or months which include depressed mood, major depression, fatigue, craving, restlessness, irritability, anorexia, insomnia, decreased libido and hypogonadotropic hypogonadism
The symptoms of hypogonadism (reduced production of sex hormones) include:
- Depressed mood
- Major depression
- Fatigue
- Craving
- Restlessness
- Irritability
- Anorexia
- Insomnia
- Decreased libido
- Hypogonadotropic hypogonadism 2
From the Research
Symptoms of Hypogonadism
The symptoms of hypogonadism, a condition characterized by reduced production of sex hormones, can vary among individuals. According to 3, 4, 5, some common symptoms include:
- Reduced sex drive
- Fatigue
- Mood disturbances
- Decreased libido
- Erectile dysfunction
- Decreased vitality
- Decreased muscle mass
- Increased adiposity
- Depressed mood
- Osteopenia
- Osteoporosis
Classification of Hypogonadism
Hypogonadism can be classified into primary and secondary hypogonadism, each with different underlying causes and characteristics 3, 5. Primary hypogonadism is characterized by low testosterone and increased luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, while secondary hypogonadism is characterized by low testosterone and low or inappropriately normal LH and FSH levels.
Diagnosis and Treatment
Diagnosis of hypogonadism is based on symptoms and laboratory measurements, including serum testosterone levels 4, 5. Treatment options include hormone replacement therapy, which aims to restore physiologic testosterone levels and alleviate symptoms 3, 4. However, treatment should be individualized, and potential risks and benefits should be considered, particularly in men with certain medical conditions, such as prostate cancer 4, 6.
Impact on Relationships
Treatment of hypogonadism can also have a positive impact on a man's partner and their relationship, with improvements in sexual function and satisfaction reported by women partners after their partner's treatment 7.