From the Guidelines
Hypogonadism symptoms should be treated with testosterone replacement therapy (TRT) to alleviate bothersome symptoms such as lack of energy, decreased strength and endurance, and deterioration in work performance, as these are the most commonly reported symptoms by patients with hypogonadism 1.
Common Symptoms of Hypogonadism
The symptoms of hypogonadism can vary depending on the age of onset and severity of the condition. In males, common symptoms include:
- Decreased libido
- Erectile dysfunction
- Reduced muscle mass
- Increased body fat
- Decreased body hair
- Fatigue
- Hot flashes
- Mood changes, including depression or irritability Men may also experience decreased bone density leading to osteoporosis, reduced testicle size, infertility, and gynecomastia (enlarged breast tissue).
Treatment of Hypogonadism
Treatment of hypogonadism typically involves hormone replacement therapy, which can be administered through various formulations, including injectable testosterone, gel-based regimens, or patches. The choice of formulation should be based on patient preferences, with some studies suggesting that patients prefer topical gels due to convenience, ease of use, and nonstaining of clothes 1.
Importance of Early Recognition and Treatment
Early recognition and treatment of hypogonadism are crucial to prevent long-term complications, such as osteoporosis and cardiovascular issues. According to a clinical guideline from the American College of Physicians, testosterone treatment in adult men with age-related low testosterone is generally safe, with no increased risk for mortality, cardiovascular events, prostate cancer, or pulmonary embolism or deep venous thrombosis 1.
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). These effects include the growth and maturation of prostate, seminal vesicles, penis and scrotum; the development of male hair distribution, such as facial, pubic, chest and axillary hair; laryngeal enlargement; vocal chord thickening; and alterations in body musculature and fat distribution.
The symptoms of hypogonadism include:
- Insufficient growth and maturation of male sex organs (prostate, seminal vesicles, penis, and scrotum)
- Lack of development of secondary sex characteristics, such as:
- Male hair distribution (facial, pubic, chest, and axillary hair)
- Laryngeal enlargement and vocal chord thickening
- Alterations in body musculature and fat distribution 2
From the Research
Hypogonadism Symptoms
- Hypogonadism is associated with several signs and symptoms, including:
- Feelings of low energy and fatigue
- Decreased sex drive and performance
- Decreased muscle mass and strength
- Decreased bone mineral density
- Increased body fat, particularly abdominal fat, which is a risk factor for metabolic syndrome and type 2 diabetes mellitus 3
- Hypogonadism can also be associated with erectile dysfunction (ED), and testosterone-replacement therapy (TRT) may be an effective treatment for men with ED, particularly when accompanied by diminished libido or other sexual symptoms 4
- The symptoms of hypogonadism can vary and may include physical outcomes related to sex hormone deficiencies, as well as psychological problems and implications on fertility 5
- Testosterone replacement therapy (TRT) has been shown to improve sexual function and hypogonadal symptoms in men with hypogonadism, including improved sexual activity, hypogonadal symptoms, and sexual desire 6
Diagnosis and Treatment
- The diagnosis of hypogonadism typically involves assessing testosterone levels, and treatment may involve testosterone replacement therapy (TRT) 3, 4
- The Society for Endocrinology has published guidelines for testosterone replacement therapy in male hypogonadism, which provide a multidisciplinary approach to treating patients with hypogonadism 7
- TRT has been shown to have several benefits, including improvements in body composition, bone density, and sexual function, as well as potential benefits for mood and cognitive function 3, 4