Hypogonadism is a condition in which the body either doesn’t produce enough testosterone or sperm, or both.

A patient may be born with hypogonadism or develop it later in life. Hypogonadism can be primary or secondary.
  • In primary hypogonadism, which is sometimes called testicular failure, the condition is caused by a problem with the patient’s testicles. Primary hypogonadism is the more common form.
  • Secondary hypogonadism is caused by problems with the pituitary gland or hypothalamus that impair their ability to produce testosterone. Either type can be congenital or acquired.

Causes of Hypogonadism

Causes of primary hypogonadism include:

  • A congenital disorder called Klinefelter Syndrome
  • Injury to the testicles
  • Radiation therapy or chemotherapy
  • Undescended testicles
  • Anabolic steroid abuse

Causes of secondary hypogonadism include:

  • The aging process
  • Obesity
  • Some medications
  • Disorders of the pituitary gland
  • Kallman syndrome, a congenital disorder of the hypothalamus


The symptoms of hypogonadism vary depending on when the patient develops the condition. In congenital hypogonadism, the patient will be born with abnormal genitalia; they can be underdeveloped or ambiguous. Some patients are even born with female genitalia.

If the patient develops hypogonadism in adolescence, the condition may delay puberty or impair their development. In this case, the patient may show the following symptoms:

  • Gynecomastia or development of breast tissue
  • Little development of muscle mass
  • Impaired growth of male genitals
  • Impaired growth of body hair
  • Excessive growth of the limbs in proportion to the body
  • No deepening of the voice

An adult who develops hypogonadism may show the following symptoms:

  • Decreased muscle mass
  • Gynecomastia
  • Osteoporosis
  • Infertility
  • Erectile dysfunction
  • Loss of body and facial hair

Some men may also experience symptoms similar to those of women undergoing menopause like hot flashes, fatigue, trouble concentrating, and decreased sex drive.

Treatment Options

The doctor will start by testing the patient’s testosterone levels. If they are indeed low, the doctor will perform a variety of other tests to try to determine the cause.

The most common treatment for hypogonadism in teenagers and men is some form of testosterone replacement therapy (TRT). The treatment will stimulate puberty in boys and restore muscle mass, energy, sexual function, and a greater sense of well-being in men.

There are many ways to administer TRT. Testosterone can cause liver damage if taken orally for a long time, but it can be safely injected or administered topically. The patient can rub a gel on their skin or wear patches at night. They can also pump a gel up their nose or keep a putty laced with testosterone near their gum line. The doctor may also decide to implant testosterone-administering pellets under the patient’s skin.

Some men will also want fertility treatments. A patient with secondary hypogonadism may be given medications to stimulate their testicles’ production of testosterone and sperm. Such drugs don’t work for patients with primary hypogonadism, so these patients may need to consider methods like in vitro (test tube baby) fertilization.

Patients born with conditions like undescended testicles or underdeveloped or ambiguous genitalia need surgery to correct the problem.