Hypogonadism is the decrease in testosterone or sperm production. Hypogonadism is divided into two categories call primary hypogonadism and secondary hypogonadism. Primary hypogonadism is a disease involving the testes. Secondary hypogonadism is a disease involving the hypothalamus or pituitary gland. Signs and symptoms of hypogonadism include fatigue, low libido, small genital organs, decreased facial or body hair, decreased muscle mass, increased male breast tissue, hot flashes, and infertility.
Hypogonadism is diagnosed by obtaining a history, performing a physical exam, and obtaining lab work. A patient must have a low testosterone level between 8 and 10 AM on two separate occasions to diagnose hypogonadism. A luteinizing hormone (LH) and follicle stimulating hormone (FSH) are usually drawn to determine primary vs. secondary hypogonadism. Men who are being evaluated for infertility or who have hypogonadism and desire to evaluate their fertility may have a semen analysis performed.
Hypogonadism is treated with testosterone replacement therapy. The goals of treatment are to improve fatigue, libido, and other symptoms listed above. There are various forms of testosterone replacement therapy including injections, patches, topical gels, and insertable pellets. Side effects associated with testosterone replacement therapy include, acne, increased red blood cell counts, increased liver enzymes, blood clots, prostate enlargement, and increased risk of heart attack and stroke. There is also a potential for dependence or abuse. Patients on testosterone replacement therapy need regular exams and blood tests to monitor treatment and look for side effects.