Urology

Hypogonadism (Low Testosterone)

UW Health urologist Dan Williams, MD, discusses hypogonadism.

UW Health urologists provide specialized care for men with low testosterone, or hypogonadism.

In men, the testicles are responsible for producing sperm and the hormone testosterone.

Testosterone can affect many different aspects of a man's overall health, including energy level, mood, libido (sex drive), strength, sexual function, and bone density.

Low testosterone, also called hypogonadism, is a condition that generally occurs with time.

As men age, their testosterone levels slowly decline. In some men, that decline is faster than in others.

Certain medical conditions, including diabetes and chronic pain, can affect testosterone levels, as can certain medications.

Symptoms of Hypogonadism

Symptoms of low testosterone can be non-specific and can be associated with other medical conditions.

These symptoms include:

Low energy/fatigue
Difficulty with concentration
Depression
Decreased work performance
Sexual dysfunction
Decreased strength
Loss of lean body mass
Decreased sex drive
Infertility

Long standing low testosterone levels can decrease bone mineral density and increase the risk of osteoporosis in some men.

Types of Hypogonadism

The two types of hypogonadism are primary and secondary. Some men have a combination of both.

Primary Hypogonadism

Primary hypogonadism originates from a problem in the testicles. Common causes of primary hypogonadism include:

Normal aging
Injury to the testicles
Cancer treatment
Infection
Undescended testicles
Mumps orchitis (mumps infection involving the testicles)
Hemochromatosis (too much iron in the blood)
Klinefelter syndrome (abnormality of the sex chromosomes X and Y)

Secondary Hypogonadism

In secondary hypogonadism, the testicles are normal but function improperly due to a problem in the hypothalamus or the pituitary gland, parts of the brain that signal the testicles to produce testosterone. If chemical messages from the pituitary gland to the testicles aren't sent, impaired testicular function occurs.

Common causes of secondary hypogonadism include:

Abnormality in the pituitary gland
Kallmann syndrome (abnormal development of the hypothalamus, the area of the brain that controls the secretion of pituitary hormones)
Inflammatory disease
The use of certain medications, including narcotics for chronic pain
Obesity

Either type of hypogonadism may be caused by an inherited (congenital) trait or something that happens later in life (acquired), such as the normal aging process, an injury or an infection.

Testing for Hypogonadism

If you are experiencing any of the symptoms of low testosterone, your physician may recommend checking your testosterone levels.

If tests confirm low testosterone, additional studies can pinpoint the cause.

These studies may include:

Further hormone testing
Pituitary imaging
Genetic studies

If fertility is a concern, other studies may include semen analysis.

Treating Hypogonadism

If symptomatic men are found to have low testosterone, testosterone replacement therapy is a safe and effective way to return testosterone levels to the normal range. Depending on the underlying cause of the low testosterone levels, your urologist will recommend a specific course of treatment.

Testosterone treatments available at UW Health include:

Topical gel
Transdermal patch (skin patch)
Injections
Buccal estosterone (applied on the gum and cheek to get into bloodstream)
Long-acting injectable pellets

Any of the above testosterone treatments can lower a man's sperm count. For men wishing to maintain their reproductive potential, there are other medications to help the body improve testosterone levels while maintaining sperm production.

Male Sexual Health