Male Hypogonadism

Male hypogonadism occurs when the testes produce insufficient testosterone, affecting sexual development, fertility, and overall health.

Causes

  • Primary (testicular problem):
    • Klinefelter syndrome
    • Undescended testes
    • Testicular injury or infection (e.g., mumps orchitis)
    • Chemotherapy or radiation
  • Secondary (pituitary or hypothalamic problem):
    • Pituitary tumors
    • Pituitary surgery or radiation
    • Certain medications
    • Genetic or congenital conditions affecting hormone regulatio
  • Functional (Reversible/Health and Lifestyle Related): 
    • Obesity
    • High prolactin levels
    • Alcohol and Marijuana use
    • Excessive exercise/nutritional deficiency
    • Eating disorder
    • Systemic illness

Symptoms

  • Low libido and sexual dysfunction
  • Erectile dysfunction
  • Reduced muscle mass and strength
  • Fatigue and low energy
  • Mood changes, depression, or irritability
  • Decreased body hair and beard growth
  • Infertility

Treatment

  • Testosterone replacement therapy: injections, gels, or patches
  • Treatment of underlying causes if possible (e.g., pituitary tumor)
  • Lifestyle measures: healthy diet, regular exercise, and weight management
  • Regular monitoring of testosterone levels, blood counts, and prostate health

Does Testosterone Replacement Cause Side Effects?

Some men undergoing testosterone replacement therapy may experience side effects, which can include:

  • Increased red blood cell count, especially with testosterone injections. In rare cases, this can lead to blood clots.
  • Acne.
  • Increased blood pressure
  • Increased Cholesterol
  • Male pattern balding
  • Mood fluctuations
  • Gynaecomastia
  • Changes in libido
  • Inhibition of sperm formation and even testicular atrophy and impotence if used inappropriately.

There were previous concerns that testosterone replacement could increase the risk of heart attacks and strokes. However, recent studies have shown that this is not a significant risk for men with low testosterone levels who are receiving treatment to bring their levels back to normal. However, doctors do not prescribe testosterone for men with normal testosterone levels who want to look or feel younger. Raising testosterone levels above the normal range can lead to serious health issues.

If you are undergoing testosterone replacement, it’s important to have regular exams and blood tests. Dr. Imran will monitor your testosterone levels, red blood cell count, and check for any potential side effects.

How Is Testosterone Replacement Administered?

Testosterone is available in various forms, including injections, gels, and capsules.

If you’re using testosterone gels, it’s crucial to wash your hands thoroughly after application. Testosterone can transfer to other people through skin contact, which may lead to harmful side effects, particularly in children. Always apply the gel to areas of your skin that are covered by clothing to prevent it from transferring.

Should Men Over 60 Use Testosterone Replacement?

The decision isn’t always clear-cut. Low testosterone levels are not always treated in men over 60, since it’s normal for testosterone to decrease slightly with age. Many of the symptoms associated with low testosterone, such as reduced energy or low libido, can also be attributed to the natural aging process.

Men over 60 may be considered for testosterone replacement if:

  • Two or three blood tests show they have significantly low testosterone.
  • They experience bothersome symptoms of low testosterone, such as extreme fatigue or low libido.
  • Their symptoms are not caused by other medical conditions that can be treated.
  • They have no history of heart attacks or strokes.

For older men receiving testosterone replacement, regular screenings for prostate cancer are also recommended