From the Guidelines
Male hypogonadism symptoms include decreased libido, erectile dysfunction, reduced muscle mass, increased body fat, fatigue, decreased energy, depressed mood, irritability, and difficulty concentrating, which can be alleviated with testosterone replacement therapy, as evidenced by the most recent study in 2020 1.
Symptoms of Male Hypogonadism
The symptoms of male hypogonadism can vary based on the degree of hormone deficiency, age of onset, and individual factors. Some common symptoms include:
- Decreased libido
- Erectile dysfunction
- Reduced muscle mass
- Increased body fat
- Fatigue
- Decreased energy
- Depressed mood
- Irritability
- Difficulty concentrating Physical signs may include reduced facial and body hair growth, gynecomastia (enlarged breast tissue), decreased testicular size, and osteoporosis with increased fracture risk. Some men experience hot flashes, sleep disturbances, and anemia. In younger males who haven't gone through puberty, symptoms might include delayed development of secondary sexual characteristics, disproportionately long limbs, and a high-pitched voice.
Importance of Testosterone
Testosterone plays a crucial role in male sexual development and function, muscle and bone maintenance, mood regulation, and energy levels. The severity of symptoms varies based on the degree of hormone deficiency, age of onset, and individual factors. If experiencing these symptoms, medical evaluation is important as treatment with testosterone replacement therapy can effectively alleviate many symptoms, though it should be carefully monitored by a healthcare provider to manage potential side effects like increased red blood cell production, acne, or effects on prostate health, as noted in a study published in the Annals of Internal Medicine in 2020 1.
Treatment and Monitoring
Testosterone replacement therapy can provide small improvements in sexual functioning and quality of life but little to no benefit for other common symptoms of aging, and its long-term efficacy and safety are unknown, as reported in a study published in the Annals of Internal Medicine in 2020 1. It is essential to carefully weigh the benefits and risks of testosterone replacement therapy and to monitor patients closely for potential side effects. The American College of Physicians has published guidelines for the treatment of adult men with age-related low testosterone, which emphasize the importance of patient preferences and the need for careful monitoring of treatment outcomes, as discussed in a study published in the Annals of Internal Medicine in 2020 1.
From the Research
Male Hypogonadism Symptoms
- The main symptoms of hypogonadism are reduced libido/erectile dysfunction, reduced muscle mass and strength, increased adiposity, osteoporosis/low bone mass, depressed mood, and fatigue 2
- Hypogonadism associated with aging (andropause) may present a mixed picture, with low testosterone levels and low to low-normal gonadotropin levels 3
Diagnosis and Treatment
- Diagnosis of the condition requires the presence of low serum testosterone levels and the presence of hypogonadal symptoms 2
- The diagnosis is based on clinical signs and symptoms plus laboratory confirmation via the measurement of low morning testosterone levels on two different occasions 3
- Androgen replacement therapy in hypogonadal men has many potential benefits, including improved sexual function, an enhanced sense of well-being, increased lean body mass, decreased body fat, and increased bone density 3
- Testosterone treatment induces reversible suppression of spermatogenesis; if fertility is desired in the near future, human chronic gonadotropin, selective estrogen receptor modulator, estrogen antagonist, or an aromatase inhibitor that stimulates endogenous testosterone production may be used 4
Treatment Options
- Several products are currently marketed for the treatment of male hypogonadism, including weekly-to-biweekly injections of testosterone cypionate or testosterone enanthate, once-daily transdermal therapies, and intramuscular injection of testosterone undecanoate 3
- All approved testosterone replacement methods, when used according to recommendations, can restore normal serum testosterone concentrations and relieve symptoms in most hypogonadal men 4
- Alternatives such as clomiphene citrate and human chorionic gonadotropin have been shown to increase endogenous testosterone production and may be used in young hypogonadal patients who desire future fertility 5, 6