15603 Low Testosterone Male Hypogonadism

Overview

Hypogonadism in men happens when the testicles do not make enough testosterone, the main male sex hormone. Testosterone helps with sex drive, muscle strength, bone health, mood, and many other body functions. When levels are too low, it can cause a range of physical and emotional symptoms.

Yes, low testosterone is fairly common, especially as men get older. It can also affect younger men who have certain medical conditions.

It mainly affects men and people assigned male at birth. It can occur at any age, but the risk increases with age. It is also more likely if you have testicular or pituitary gland problems, certain genetic conditions, or long-term illnesses such as diabetes or obesity.

Symptoms

Common symptoms

• Low sex drive or reduced interest in sex
• Difficulty getting or keeping an erection
• Low energy and constant tiredness
• Low mood or feelings of depression
• Loss of muscle mass and increased body fat
• Poor concentration or memory loss
• Sleep problems, such as feeling sleepy during the day

Symptoms in children

• Delayed puberty, such as a slower voice change
• Less growth of hair on the face and body
• Slower muscle development
• Longer arms and legs compared with the body

Symptoms in older adults

• Symptoms can be similar to those in younger men, but may be mistaken for normal aging.
• Loss of bone strength or osteoporosis
• Reduced muscle strength and balance
• Problems with memory or thinking
• Increased tiredness and lower energy

Causes

Main causes

• Testicular injury or infection, such as mumps orchitis
• Undescended testicles that are not treated in childhood
• Problems with the pituitary gland in the brain
• Genetic conditions, such as Klinefelter syndrome
• Haemochromatosis — a condition where the body stores too much iron
• Certain medicines, including steroid or opiate use
• Long-term health conditions like diabetes, liver disease, or kidney disease
• Heavy alcohol use or drug misuse

Risk factors

• Being older
• Being obese or overweight
• Having type 2 diabetes
• Sleep apnoea, which causes interrupted breathing during sleep
• Previous chemotherapy or radiation to the testicles
• Heavy alcohol use or smoking
• Using anabolic steroids without a prescription

When to see a doctor

See a doctor urgently if:

• Sudden severe pain or swelling in one testicle
• An injury to the testicles followed by ongoing pain
• Sudden loss of vision or a severe new headache

Book a routine appointment if:

• You have a low sex drive, erectile problems, fatigue, or low mood that lasts for weeks
• You are worried about symptoms that could be related to low testosterone
• You have a condition that may increase your risk, such as diabetes or a pituitary problem

Diagnosis

Your doctor will ask about your symptoms, medical history, and lifestyle. They may also do a physical examination. If they suspect low testosterone, they will order a blood test, usually in the morning, to check your testosterone level.

Tests that may be done

• Total testosterone blood test (done in the morning, often twice to confirm)
• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) blood tests to check pituitary function
• Prolactin blood test to rule out pituitary problems
• Full blood count to check for anaemia
• Sometimes an MRI scan if a pituitary tumour is suspected

What to expect at your appointment

The blood test is simple and goes through your arm. If your testosterone is low, your doctor may refer you to a specialist, such as an endocrinologist or urologist, to find the cause and discuss treatment. You will not usually get a diagnosis from a single test — doctors like to confirm low levels with at least two morning samples.

Treatment

Treatment for low testosterone aims to bring your hormone levels back to normal and reduce symptoms. It depends on the cause of your hypogonadism, your age, and whether you might want to have children. Your doctor will help decide what, if any, treatment is right for you.

Self-care at home

• Try to eat a healthy balanced diet
• Get regular physical activity, especially strength training
• Aim for good quality sleep each night
• Limit alcohol intake
• Look after your mental health — speak to someone if you feel low
• Maintain a healthy weight

Medical treatments

Testosterone replacement therapy (TRT) is the main medical treatment. It is available as gels, patches, injections, or implants. TRT can improve symptoms, but it is not suitable for everyone and can have side effects, so it must be prescribed and regularly monitored by a doctor. Depending on the cause, other treatments may be used to address the underlying problem, such as medicines to lower prolactin levels or help fertility. Always talk to your healthcare provider about the options and what is best for you.

When is surgery considered?

Surgery may be needed if a pituitary tumour or testicular cancer is causing the hypogonadism. Your specialist will discuss whether surgery is appropriate in your case.

Living with this condition

Living with low testosterone often means managing ongoing treatment and having regular check-ups. You will need to keep track of your symptoms and report any changes to your doctor. Treatment can take time to work, so be patient and stay in touch with your healthcare team.

Lifestyle tips

• Stay active — exercise can boost energy and mood
• Strength training helps build muscle and improve body composition
• Get outdoors for some sunlight and try to keep a regular sleep schedule
• Cut back on alcohol and stop smoking
• Talk to friends, family, or a support group if you feel stressed or isolated

Diet and exercise

Eat plenty of protein (such as beans, poultry, fish, and low-fat dairy), healthy fats, vegetables, and whole grains. Regular exercise, especially weight-bearing activity, helps maintain bone density and muscle mass. Aim for at least 150 minutes of moderate exercise per week, but start slowly if you are new to exercise.

Mental health and emotional wellbeing

Low testosterone can affect your mood, self-esteem, and relationships. It is common to feel frustrated, anxious, or depressed. If you are struggling, ask your doctor about counselling or psychological support. You are not alone, and reaching out is a sign of strength.

Prevention

Not all cases can be prevented, but you can lower your risk by maintaining a healthy weight, limiting alcohol, avoiding the misuse of anabolic steroids, and managing chronic conditions like diabetes. Getting good treatment for infections like mumps also helps.

Vaccines

The MMR vaccine protects against mumps, which can sometimes cause testicular damage and lead to low testosterone. Make sure your vaccinations are up to date.

Screening programmes

There is no routine screening for low testosterone in the general population. However, your doctor may test your hormone levels if you have symptoms or a higher risk, such as diabetes, obesity, or a known pituitary condition.

Complications

If left untreated

• Loss of bone density, which can lead to osteoporosis and fractures
• Increased body fat and loss of muscle strength
• Depression and reduced quality of life
• Anaemia, or low red blood cells causing tiredness
• Problems with memory and concentration
• Reduced sex drive and erectile dysfunction

Long-term outlook

With proper diagnosis and treatment, most men with hypogonadism can expect their symptoms to improve significantly. Testosterone replacement therapy can help restore energy, mood, sex drive, muscle strength, and bone health. However, treatment requires regular monitoring to avoid side effects. The outlook is generally good when the condition is managed together with a healthcare provider.

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