Types and Causes of Hypogonadism

Written by Professor Kean, Updated on February 18th, 2024
Reading Time: 3 minutes


You've likely heard a lot about Testosterone Deficiency in the media. The medical term for Low-T is Hypogonadism. Men are diagnosed with Hypogonadism when they don't produce enough Testosterone and/or the Testosterone precursors Luteinizing Hormone(LH)/Follicle Stimulating Hormone(FSH).

Testosterone Replacement Therapy is an effective means to treat Hypogonadism symptoms, allowing patients to achieve the health and well-being associated with healthy Testosterone Levels. Testosterone HRT relieves fatigue and body composition issues related to Low-T while also restoring libido and erectile function.

A simple diagnosis of Hypogonadism does not tell the whole story, however. For example, Hypogonadism can be divided into several categories depending on the source and circumstances of the condition.

Primary Hypogonadism

Primary Hypogonadism is Testosterone Deficiency and/or Low Sperm Count that results from the underperformance of the testes. The sex organs are getting the appropriate signals from the brain for the production of Testosterone, but the testes are not converting the signal into action. Another term for Primary Hypogonadism is Hypergonadotrophic Hypogonadism.

Gonadotrophic Hormones are hormones that stimulate testicular activity. The most common of these hormones are Follicle Stimulating Hormone and Luteinizing Hormone. This form of Low-T is referred to as Hypergonadotrophic because the body reacts to dysfunctional testes by ramping up the production of Testosterone precursors. This means that the patient will have low levels of Testosterone in their bloodstream while displaying abnormally high levels of Luteinizing Hormone and Follicle Stimulating Hormone. This represents the pituitary working extra hard to try to make up for abnormally Low Testosterone.

Hypergonadotrophic Hypogonadism can result from genetics or developmental abnormalities (such as Klinefelter's Syndrome), but it can also be acquired during adulthood through various causes. Some causes of Primary Hypogonadism include testicular trauma, testicular tumors, hemochromatosis, radiation, and mumps.

Secondary Hypogonadism

While some men experience Low-T resulting from Primary Hypogonadism, most men with Testosterone Deficiency have healthy testes. It is more common for men to have healthy testes but not have enough signal for Testosterone production. This means that the pituitary isn't making enough of the Testosterone Precursors necessary to stimulate proper testicular function.

Secondary Hypogonadism is also medically known as Hypogonadotropic Hypogonadism. As opposed to Primary Hypogonadism, Hypogonadotropic Hypogonadism is diagnosed when a man displays Low Testosterone in combination with low FSH/LH Levels. Some genetic and developmental issues can lead to Secondary Hypogonadism, including Kallman Syndrome. Tumors in or around the Pituitary can also lead to diminished Testosterone Levels. There are also certain Pituitary Disorders and Inflammatory Diseases which can lead to Low-T, along with the AIDS Virus.

Many of the causes of Secondary Hypogonadism are environmental/lifestyle-oriented, which is why Secondary Hypogonadism is much more common than Primary Hypogonadism. For example, obesity has a negative effect on Testosterone Production that can become symptomatic. Body fat converts Testosterone into Estrogen. Many drugs, including Opioids, NSAIDs, and Corticoid Steroids can also contribute to Secondary Hypogonadism. Rapid weight loss, high stress, and extreme physical exertion can also disrupt Testosterone signaling.

Late-Onset Hypogonadism (Age-Related Low-T)

The older that men get, the more vulnerable they become to Testosterone Deficiency symptoms. Late-Onset Hypogonadism refers to Low Testosterone Levels that are at least partially the result of the natural decline in circulating Testosterone that occurs as a function of age. Testosterone Levels are at their peak from puberty through early adulthood and start to drop as men enter their thirties. This drop is prolonged but also constant throughout the rest of life.

Every man's body is different, but they can expect to lose 10-15% of total Testosterone every decade. Late-Onset Hypogonadism is a function of aspects of both Primary and Secondary Hypogonadism. Various changes in male physiology lead to the diminished production of Testosterone. The timing of Late-Onset Hypogonadism diagnosis leads it to often be referred to as Andropause. However, changes in Testosterone Levels occur much more gradually in men as compared to sex-hormone disruption during Menopause.

Testosterone Replacement Therapy is an effective means to treat all forms of Low-T. Research shows that for most men, Testosterone HRT has an excellent safety profile and can provide relief from the symptoms of Hypogonadism, including fatigue, low sex drive, erectile dysfunction, depression, and more. While Testosterone Therapy isn't right for everyone, a Men's Clinic or Clinical Endocrinologist can help determine if you are an ideal candidate for Bio-Identical Testosterone.

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