Low testosterone (Hypogonadism)

Male hypogonadism means when the testes produce little or do not produce enough of the testosterone which is the primary male sex hormone. 
Testosterone plays a crucial role in various aspects of male health and development:

• Sexual Function
• Muscle Mass and Strength
• Bone Density
• Fat Distribution
• Libido (Sex Drive)
• Mood and Energy
• Cognitive Function

Types of Hypogonadism:

• Primary Hypogonadism (Testicular Hypogonadism): This type of hypogonadism occurs when there is a problem with the testicles themselves, leading to inadequate production of testosterone.

• Secondary Hypogonadism (Hypothalamic-Pituitary Hypogonadism): This type of hypogonadism occurs when there is a problem with the hypothalamus or the pituitary gland in the brain.

Symptoms:
Hypogonadism can occur at any age. The symptoms will be different depending on your age when it develops. Common symptoms in adult men include:

Sexual Symptoms:

• Decreased Libido: Reduced interest in sexual activity.
• Erectile Dysfunction: Difficulty achieving or maintaining an erection.

Physical Symptoms:

• Decreased Muscle Mass: Loss of muscle strength and tone.
• Increased Body Fat: Particularly around the abdomen.
• Decreased Bone Density: Leading to osteoporosis or osteopenia.
• Fatigue: Reduced energy levels and overall tiredness.
• Hot Flashes: Sudden feelings of heat, typically in the upper body.
• Decreased Facial or Body Hair: Thinning or loss of hair growth.

Emotional and Psychological Symptoms:

• Mood Changes: Irritability, low mood, or depression.
• Difficulty Concentrating: Reduced mental clarity or focus.
• Memory Impairment: Difficulty remembering things.

Other Symptoms:

• Sleep Disturbances: Trouble sleeping or increased sleepiness.
• Infertility: Reduced sperm production and fertility.

Diagnosis:

Clinical Evaluation:

• A healthcare provider will begin by taking a detailed medical history, including symptoms related to hypogonadism such as decreased libido, erectile dysfunction, fatigue, and other associated symptoms.
• They will also inquire about any relevant medical conditions, medications, family history, and lifestyle factors that could contribute to hormonal imbalances.

Physical Examination:

• A thorough physical exam may reveal signs such as decreased muscle mass, increased body fat (especially around the abdomen), reduced facial or body hair, and gynecomastia (enlarged breast tissue).
• Examination of the genitalia may identify abnormalities such as small or underdeveloped testicles.

Laboratory Testing:

• Blood tests are crucial for confirm ing the diagnosis of hypogonadism. The main test is measuring total testosterone levels in the blood.
• In addition to total testosterone, free testosterone levels (the active form of testosterone not bound to proteins) may also be measured.
• Other blood tests may include measuring levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are hormones produced by the pituitary gland that stimulate the testes to produce testosterone and sperm.
• Sometimes, additional tests such as thyroid function tests or prolactin levels may be ordered to rule out other potential causes of hypogonadism.

Imaging Studies:

• In some cases, imaging studies such as a pituitary MRI may be performed if secondary hypogonadism is suspected. This helps evaluate the structure and function of the pituitary gland and hypothalamus.

Specialized Testing:

• Occasionally, specialized tests such as semen analysis (if infertility is a concern) or bone density testing (if osteoporosis is suspected) may be recommended.

Diagnosis and Classification:

• Based on the results of these tests, hypogonadism can be classified as primary (testicular) or secondary (hypothalamic-pituitary) based on the underlying cause.
• The severity of testosterone deficiency and the presence of symptoms will guide treatment decisions.

Treatment:

Treatment of hypogonadism aims to restore testosterone levels to normal range and alleviate symptoms associated with testosterone deficiency. The choice of treatment depends on the underlying cause of hypogonadism (primary or secondary) and the individual's overall health and preferences. The main treatment options:

• Testosterone Replacement Therapy (TRT)
• Management of Underlying Conditions
• Lifestyle Modifications
• Monitoring and Follow-Up
• Potential Risks and Considerations
• Fertility Considerations

TRT is the most common and effective treatment for hypogonadism. It involves replacing testosterone to restore levels to the normal range for adult men.

Forms of TRT include:

• Injections: Testosterone can be injected intramuscularly (e.g., testosterone cypionate, testosterone enanthate) typically every 1-2 weeks.

• Transdermal (Topical) Delivery: Testosterone can be applied to the skin as gels (e.g., Androgel, Testim), patches (e.g., Androderm), or topical solutions (e.g., Axiron).

• Buccal Tablets: Testosterone can be absorbed through the gums with tablets that adhere to the gumline (e.g., Striant).

• Implants: Testosterone pellets are implanted under the skin and release testosterone gradually over several months (e.g., Testopel).

The choice of TRT depends on factors such as convenience, adherence, cost, and patient preference.