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Hypogonadism in men – with different manifestations depending on age

Hypogonadism in men is a condition in which the body does not synthesize enough testosterone, a hormone whose main function is the formation of secondary sexual characteristics during puberty in boys, or the number of sperm released during ejaculation is low.

Both disorders may be present at the same time.

Hypogonadism may result from diseases of the hypothalamus, pituitary gland, or testes that suppress hormone secretion and testosterone production. Depending on age, insufficient testosterone production can lead to abnormal development of muscles and bones, underdevelopment of the genitals, and reduced masculinity. In addition, normal testosterone levels support the body’s energy levels, mood, fertility, and sex drive.

The reasons

Testosterone deficiency (hypogonadism) can be congenital, or it can develop later – acquired. The classification of violations is determined by the degree of damage:

  • Primary hypogonadism – disorders in the testicles;
  • Secondary hypogonadism – disorders in the pituitary gland;
  • Tertiary hypogonadism is a disorder in the hypothalamus.

The primary is associated with a problem in the testicles of a man. Causes may include Klinefelter’s syndrome, undescended testicles, mumps, or testicular injury.

The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to produce follicle-stimulating and luteinizing hormones, which in turn reach the testicles, resulting in testosterone production. Causes of secondary hypogonadism may include pituitary disease, inflammatory diseases affecting the pituitary gland, HIV/AIDS, obesity, and medications.


If the body does not produce enough testosterone already during fetal development, the result may be fetal and vulvar growth disorders:

  • cryptorchidism;
  • underdevelopment of the male genital organs;
  • female genitalia.

The onset of hypogonadism during adolescence can lead to delayed sexual development. The following symptoms are observed:

  • underdeveloped muscle mass;
  • violation of the development of the penis and testicles of the boy;
  • insufficient body hair, especially in the genital area;
  • breast enlargement – gynecomastia.

In older men, hypogonadism can cause some physical changes and interfere with male reproductive functions (andropause), such as:

  • painted libido;
  • erectile dysfunction;
  • muscle weakness;
  • loss of body hair;
  • depression and other mood disorders.


Male hypogonadism is diagnosed by the presence of clinical signs of a decrease in the secretion of testicular hormones, a low level of total testosterone in the blood. Men with metabolic syndrome and obesity, as well as people with erectile dysfunction and decreased libido, are also eligible for testing.


Treatment includes hormone replacement therapy. The method of administration is determined by the age and duration of testosterone deficiency and is carried out with the help of regular injections, and the placement of specially-made patches containing hormones or gels. Treatment of elderly men is aimed at preserving secondary sexual characteristics, increasing energy, strength, mood, and well-being, and preventing bone degeneration.

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