Hypogonadism
Hypogonadism, the inability of the testes to produce adequate testosterone, can arise as a result of genetic, environmental, or physiological causes. There is no strict clinical definition of the testosterone deficiency producing “hypogonadism” and experts note that this condition can be extremely difficult to detect through clinical symptoms alone, particularly in men of advanced age.4 While conservative estimates place the percentage at 20% of men, those figures are likely to be low because they are based on total testosterone levels. It is noted that, based on bioavailable levels, the rate of hypogonadism could actually reach as high as 50% of men.5
Causes of Hypogonadism
- Congenital
- Cryptorchidism
- Chronic/systemic illness
- Surgery
- Chemotherapy
- Premature aging
- Testicular trauma
- Stress
- Klinefelter’s syndrome
- Autoimmune damage
- Tobacco, alcohol and cannabis
- Sleep apnea
- Excessive heat
- Obesity
- Hypercortisolism
- Medications
Primary hypogonadism is characterized by testicular dysfunction. It can develop from congenital causes, such as Klinefelter’s syndrome, which can remain undiagnosed until late in adult life. Primary hypogonadism may also be induced by various disease conditions and treatments, including chemotherapy, surgery, autoimmune damage, infections, and testicular trauma.6
Secondary hypogonadism can develop as a result of hypothalamic or pituitary disease, obesity, hypothyroidism, or other causes. Some conditions, such as hypercortisolemia, AIDS, and severe systemic illnesses, can trigger hypogonadism through a combination of both primary and secondary mechanisms.
Signs and Symptoms
Subtle clinical signs of hypogonadism may include slight gynecomastia and soft small testes. However, researchers have noted that “the findings of physical examination in men with adult-onset hypogonadism are often normal. This underscores the need for precise evaluation of bioavailable hormone levels to ensure accurate diagnosis.” Noting that low libido is “the most common predictor of low testosterone syndrome, “other clinicians at the University of St. Louis have composed a series of questions to alert their male patients to possible low testosterone levels. While not strict guidelines for clinical diagnosis, this “low testosterone checklist” can help identify patients who may benefit from testing and treatment.
