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Causes of Low Testosterone in Men (Hypogonadism)

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Hypogonadism, commonly known as low testosterone, is a condition that affects men and can significantly impact their well-being and overall health. Low testosterone affects masculinity and can lead to various health issues if left untreated.

Understanding the causes of low testosterone is crucial for effective treatment. This article will explore the primary and secondary causes of hypogonadism and shed light on when this condition can occur throughout a man's life.

Low testosterone can have significant impacts on men's health and well-being. It not only affects sexual function but also plays a role in mood, energy levels, and overall vitality. Identifying the underlying causes and providing appropriate treatment is essential to help men regain their quality of life and optimize their overall health.

Dr. Jeremy Johnson, Endocrinologist

Quick Facts Overview

Before delving into the causes, let's review some quick facts about hypogonadism:

  • Hypogonadism can result from testicular causes or pituitary/hypothalamus causes.
  • It can occur before birth, during puberty, or well into adulthood.
  • Treatment options vary depending on the severity and root cause of low testosterone.

Primary Causes of Hypogonadism

Primary causes, also known as hypergonadotropic hypogonadism, are related to problems with the testes, where testosterone production occurs. Here are some common primary causes:

  • Undescended Testicles: Occurs when a baby's testicles fail to descend into the scrotum within the first few months after birth. The testes must be cooler than the body's core temperature for optimal testosterone production.
  • Mumps Orchitis: Testicular inflammation causing swelling and pain, commonly associated with viral illnesses like mumps. The inflammation can lead to shrinking testes, inhibiting normal testosterone production.
  • Klinefelter Syndrome: Males born with an extra X chromosome (XXY) instead of the usual XY combination. This disrupts normal testosterone production.
  • Hemochromatosis: Excessive iron retention in the body due to a genetic condition. The accumulation of iron can damage organs and adversely affect erectile strength, testicular function, and testosterone production.
  • Cancer Treatment: Radiotherapy and chemotherapy used in cancer treatment can disrupt sperm and testosterone production. While most individuals recover within a few months, permanent infertility can occur.
  • Testicular Injury: Injuries such as torsion or rupture can permanently suppress testosterone production. These injuries have the same impact as missing, stunted, or undescended testicles.

Secondary Causes of Hypogonadism

Secondary causes, also known as hypogonadotropic hypogonadism, are more complex and indirect reasons for low testosterone. They involve problems with the function of the pituitary gland and hypothalamus, which play a role in regulating testosterone production. Secondary causes of hypogonadism include:

  • Aging: Aging is the number one cause of low testosterone. As men age, the prevalence of low testosterone increases. Approximately 1 in 50 men are affected, and the prevalence rises to 2 in 5 for males aged 45 and older.
  • Pituitary Disorders: Disorders affecting the pituitary gland, such as infections, injuries, tumors, surgery, or radiotherapy, can disrupt the normal regulation of testosterone production.
  • Kallman Syndrome: Kallman syndrome is a condition characterized by the stunting or loss of nerve cells in the hypothalamus. This disruption can impair the release of hormones that regulate testosterone production.
  • HIV/AIDS: HIV/AIDS can contribute to low testosterone levels, as approximately 30% of HIV-positive men and 50% of men with AIDS experience low testosterone. The virus and its impact on the immune system can disrupt hormonal balance.
  • Inflammatory Diseases: Certain inflammatory diseases, including tuberculosis, sarcoidosis, and histiocytosis, can affect testosterone production. The inflammation and immune response associated with these conditions can interfere with the normal functioning of the reproductive system.
  • Obesity: Obesity and low testosterone have a bidirectional relationship. Excess body weight, particularly visceral fat, can lead to hormonal imbalances, including decreased testosterone levels. In turn, low testosterone can contribute to weight gain and difficulty in losing weight.
  • Some Medications: Certain medications, such as corticosteroids, opioids, and hormone treatments, can suppress testosterone production. If you are taking any medications and experiencing symptoms of low testosterone, it's essential to discuss them with your doctor.

When Can This Condition Start

Hypogonadism can occur at various stages of life, and the causes may differ depending on the timing:

  • Fetal Development: If a male fetus fails to generate adequate amounts of testosterone during development, it can lead to hypogonadism. The severity of testosterone deficiency determines the outcome, which can include undeveloped male sexual organs, male with female sexual organs, or ambiguous sexual organs that cannot be classified as male or female.
  • Puberty: Hypogonadism can delay or disrupt puberty. This can result in stunted growth of male sexual organs, insufficient growth of body and facial hair, failure of the voice to deepen, inadequate muscle development, disproportionate growth of arm and leg length, and breast growth.
  • Adulthood: Low testosterone in adulthood affects masculine traits and normal reproductive function. Early warning signs may include mood swings and reduced libido. If left untreated, adult hypogonadism can lead to balding and loss of body/facial hair, erectile dysfunction, infertility, shrinking muscle mass, diminishing bone density, lack of concentration, hot flashes, and breast growth.

Treatment options for low testosterone have advanced significantly in recent years, providing effective solutions for men experiencing symptoms. From testosterone replacement therapy to addressing underlying medical conditions, personalized treatment plans can help restore testosterone levels and improve overall well-being. It is crucial for individuals to consult with their healthcare providers to explore the most suitable treatment approach based on their unique circumstances.

Dr. Michael Anderson, Urologist

When Should I Consult A Doctor?

If you have any concerns or suspicions regarding low testosterone, it is advisable to consult a doctor. Acting promptly allows for a broader range of treatment options. Pay attention to early signs such as reduced libido and abrupt mood changes.

The doctor will evaluate your symptoms and may conduct various tests to confirm low testosterone. Once diagnosed, the most appropriate treatment option will be recommended. In moderate to severe cases, testosterone replacement therapy may be considered.

If you are concerned about your preteen or teen, scheduling an appointment with a doctor when they reach 14 years of age and have not shown signs of puberty is recommended.


Hypogonadism, or low testosterone, can result from a variety of causes, including primary and secondary factors. While some causes are congenital or genetic, others are influenced by age, weight, lifestyle, and underlying medical conditions.

Fortunately, hypogonadism is a treatable condition, and timely diagnosis plays a crucial role in effective management. If you suspect low testosterone, it is essential to consult a doctor to explore potential causes and determine the most suitable treatment approach.

Remember, taking action and seeking medical advice can help address the symptoms of low testosterone and improve overall well-being.

FAQs (Frequently Asked Questions)

1. Can hypogonadism be reversed or cured?

While hypogonadism can be managed and treated, it's important to note that some causes, such as certain genetic conditions, may not have a complete cure. However, with appropriate medical intervention and treatment, the symptoms of low testosterone can often be improved, and individuals can experience a better quality of life.

2. Are there lifestyle changes that can help with low testosterone?

Yes, certain lifestyle changes can support healthy testosterone levels. Regular exercise, particularly strength training, can stimulate testosterone production. Maintaining a balanced diet, getting sufficient sleep, managing stress levels, and avoiding excessive alcohol consumption can also contribute to overall hormonal health. It's always best to consult with a healthcare professional for personalized advice.

3. Is testosterone replacement therapy the only treatment option?

Testosterone replacement therapy (TRT) is a common treatment for hypogonadism, especially in cases where testosterone levels are significantly low. However, the treatment approach depends on the individual's specific situation and underlying causes. Other treatment options may include medications to address underlying conditions, fertility treatments, or surgical interventions in certain cases. A healthcare provider will determine the most suitable treatment plan based on individual needs.

4. Can low testosterone affect mental health?

Yes, low testosterone levels can have an impact on mental health. Symptoms such as mood swings, decreased energy, irritability, and reduced motivation can be associated with low testosterone. Addressing hormonal imbalances through proper treatment can potentially improve mental well-being and overall mood.

5. Can women experience low testosterone?

While testosterone is predominantly associated with male physiology, women also produce testosterone, although in smaller amounts. Women can also experience low testosterone levels, which may manifest as symptoms such as fatigue, reduced sex drive, and mood changes. If women suspect low testosterone, it's important to consult with a healthcare provider for appropriate evaluation and management.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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