Hypotestosteronism – Low Testosterone and Hypogonadism

Posted by Professor Anna Gray, Updated on January 10th, 2023
Reading Time: 5 minutes

Sounds scary, doesn't it? That's because it is! Hypotestosteronism is another word for hypogonadism, or low testosterone – a diagnosis that no man wants to hear! Besides the physical impacts of low testosterone on a man, low testosterone can lead to severe depression and low self-esteem – left undiagnosed, severe depression can cause one to act on suicidal thoughts. Despite what some people say about low testosterone, it can be a serious diagnosis. Learn more about this, unfortunately increasing in the U.S. population, deficiency below.

What is Hypotestosteronism?

Hypotestosteronism occurs with the decreased functionality of the gonads – ovaries in women and testes in men. Both men and women produce the hormone testosterone, but men produce much more of it than women do, leading to their secondary sex characteristics such as facial hair and deeper voice. Without testosterone, boys would not develop properly during puberty and lead to the absence of several or all secondary sex characteristics.

The brain is where the production of testosterone begins, specifically the cerebral cortex. The cortex signals the hypothalamus which in turn stimulates the pituitary gland. The pituitary gland is one important organ, located beneath the brain, and dubbed the “master gland.” It releases many different hormones that regulate such critical functions as growth regulation, blood pressure, ovulation and functioning of the thyroid.

In terms of testosterone production, the pituitary gland, once stimulated by the hypothalamus, releases follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormones trigger cells in the testes to convert cholesterol into testosterone. Now that we understand the basic physiology behind the production of testosterone in men, what happens when men do not produce enough??

Symptoms of Hypotestosteronism

The best way to tell if your testosterone levels are low is with a simple blood test. If the serum testosterone levels are below 300 ng/dL, this is considered low testosterone. Usually, at this concentration, a man will experience at least one symptom of low testosterone. Symptoms include:

  • lack of or regression of secondary sex characteristics: when a boy going through puberty does not develop properly with typical male characteristics such as growth of facial hair, deepening of the voice and/or muscle growth
  • reduced muscle mass: testosterone plays a major role in muscle development and a noticeable decrease in muscle mass is a common symptom of hypotestosteronism
  • belly fat: A man's waist size can be the strongest predictor of low testosterone levels and this symptom follows the reduced muscle mass one. Without lean muscle mass, the belly fat piles on. Increased fat also promotes the conversion of testosterone to estrogen, thus perpetuating the cycle of low-T.
  • erectile dysfunction: Another major symptom of hypotestosteronism. Adequate levels of testosterone are necessary for healthy erections.
  • diminished penile sensation: Testosterone is a sex hormone and without it, men will not experience sex like they used to. Couple this with erectile dysfunction and one's sex life is non-existent.
  • fatigue: Testosterone regulates vitality in men, maintaining a steady metabolism and boosting athletic performance. The fatigue experienced by hypotestosteronism patients is typically chronic in nature.
  • depression: One of the more serious symptoms of hypotestosteronism as it can lead to self-harm or suicidal thoughts/actions. Many men who suffer from low-T report "just not feeling like themselves" and some of these psychological issues may stem from the other unwanted symptoms such as weight gain or erectile dysfunction. Keep on the look out for this important symptom!
  • brain fog: Testosterone plays an important role in several functions of the brain, including memory. "Brain fog" could refer to general confusion, difficulty concentrating on work or even not being able to follow directions without becoming muddled. It can stem from hormonal imbalance and interestingly, have found that men with mild cognitive impairments were able to improve their verbal fluency, spatial scores, spatial memory and other brain functions after undergoing TRT.
  • hot flashes: Another symptom of hormonal imbalance and not just from low testosterone -- women experience these when going through menopause as well. Another term for this is "night sweats."
  • difficulty achieving orgasm: Another symptom linked to erectile dysfunction and decreased penile sensation. The overall physical sensation and reaction to sexual stimuli is reduced in low-T sufferers.
  • Memory problems: Testosterone plays a role in memory, as well as other brain functions as mentioned previously and without adequate levels, the brain suffers resulting in increased confusion and "brain fog."
  • Feelings of insecurity: A psychological issue stemming from hormonal imbalance and increased feelings of depression.
  • Feeling sad for no reason: The first sign of depression in men with low testosterone. If there is nothing in your life that you can point to that is making you upset or sad, the likely culprit is a hormonal imbalance -- most likely hypotestosteronism in men.

There are other symptoms but these are the more common ones experienced by low-t sufferers. Early detection of these symptoms, or regular blood tests, can catch the disease early on and avoid getting to the point of severe depression, other psychological issues such as brain fog or difficulty concentrating or the development of osteoporosis. As men age, the risk and prevalence of this disease increases. Many middle-aged men and older suffer from hypogonadism and do not even know it. They just think that their ED or chronic fatigue is a normal part of aging — it doesn't have to be!

Treatment Options for Hypotestosteronism

The most effective treatment option for men suffering from hypogonadism is testosterone replacement therapy (TRT). The goal is to bring the level back up within the range of 300 to 800 ng/dL. The other goals of TRT, per the American Association of Clinical Endocrinologists, are to restore sexual function, prevent osteoporosis, normalize growth hormone levels, lower the risk of heart disease and maintain virilization (maintaining male characteristics such as body hair, muscle mass and a deep voice).

TRT involves the use of intramuscular injections, topical testosterone gels or creams, transdermal patches and/or testosterone pellets. Which option is best for you needs to be discussed with your doctor or endocrinologist.

At our clinic, we offer advice from some of the leading and most knowledgeable endocrinologists in the United States. If you feel that some of your “aging” symptoms are caused by more than just aging or you want to get tested for low testosterone, simply contact one of our hormone advisors by calling the number at the top of this webpage or filling out the contact form in the upper right. It's so easy to get started NOW!

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