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Primary Versus Secondary Hypogonadism


Written by Professor Anna Gray, Published on March 15th, 2021
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Male hypogonadism could be a serious diagnosis for a man, but do you even know what it is? And that there are two different types of hypogonadism? In recent decades, it is becoming are more common issue with older men, and even younger men due to environmental pollutants and poor lifestyle habits. In order to compare the two types, lets start with the basics.

Testosterone: The Male Sex Hormone

Testosterone is one of the most important hormones that a man produces in his body. It plays so many roles in general health as well as fertility. It is considered a primary sex hormone and is produced in the testicles. Even women make testosterone in their ovaries, but in much smaller amounts. Testosterone peaks significantly during puberty and causes the changes that boys see and feel that turn them into men.

In addition, testosterone increases a man’s sex drive and is one of the major hormones that stimulates sperm production. Other roles that it plays in the male body are: muscle and bone development, sex organ development (penis and prostate), hair growth, mood and sexual functions.

As you can see, testosterone is vital to a man’s health. If his levels are low, he may be in serious trouble. If a man’s testosterone levels fall below 300 ng/mL, then he is clinically diagnosed with low testosterone, or hypogonadism.

What is Hypogonadism?

Hypogonadism can occur in men or boys during fetal development, before puberty or during adulthood. The different signs and symptoms depend on when exactly the condition develops in a man’s life.

During fetal development, when poor levels of testosterone are produced, the external sex organs may not develop properly. Sometimes, the child may be born with female genitals. Otherwise, the more commonly seen symptoms are ambiguous genitals or underdeveloped male genitals.

If hypogonadism hits during puberty, the normal development from boyhood to manhood may be incomplete or barely happen at all. Muscle mass may not develop, the voice may never deepen, facial and body hair may not grow and the growth of the penis and testicles may be hampered. In addition, an excessive growth of arms and legs in relation to the body may occur as well as gynecomastia.

For adult men, when hypogonadism occurs, their already developed masculine characteristics may be negatively affected as well as reproductive function. Symptoms include decreased sex drive and energy, depression, infertility, low muscle mass, gynecomastia, decrease in hair growth, erectile dysfunction and loss of bone mass.

If hypogonadism goes on long enough without treatment, men may even experience symptoms that are similar to menopause for women, and eventually, severe depression. Hormones are not something to play with or treat lightly as a medical concern.

Primary Vs. Secondary Hypogonadism

What distinguishes primary and secondary hypogonadism is the cause of the condition. Hypogonadism can be caused for different reasons, but in medical terms, if the testicles are not producing enough testosterone…

Primary Hypgonadism

...because the actual testicles are failing to, then this is defined as primary hypogonadism. It can also be called primary testicular failure. The issue of low testosterone production originates in the testicles. This may be due to causes such as: damage to the testicles (physical/radiation/toxins), Klinefelter syndrome (genetic abnormality), undescended testicles, mumps infection, excess iron in the blood and cancer treatment.

Secondary Hypogonadism

When the issue originates in the hypothalamus or pituitary gland, then this is defined as secondary hypogonadism. These areas of the brain are what send hormone signals to the testicles telling them to start testosterone production. If they aren’t sending signals, then no testosterone is produced.

The hypothalamus starts by producing gonadotropin-releasing hormone, which travels to the pituitary gland. Two other hormones are then produced called follicle-stimulating hormone (FSH) and luteinizing hormone (LH) which then travel to the testicles stimulating testosterone production.

Therefore, secondary hypogonadism is seen when the testicles function normally but aren’t being stimulated to produce testosterone by the brain. Causes of such a condition include Kallmann’s syndrome (brain abnormality), disorders of the pituitary gland, inflammatory disease, HIV/AIDS, medications (opiates/hormones), obesity and natural aging.

Treating Hypogonadism

If you are suffering from either primary or secondary hypogonadism, it can be an easy condition to treat, especially when the patient follows the precise directions given by his physician. A patient can undergo hormone replacement therapy (HRT) to replace the missing testosterone. There are many different options for low testosterone patients including injections, creams and gels. Our clinic offers all three of these options. If you are concerned about your testosterone levels, take the time to get your levels tested. You definitely do not want to experience the above symptoms if you don’t have to.

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