- Hypogonadism in males is the medical term given to the condition that results in low testosterone with clinical symptoms.
- The most common symptoms of testosterone deficiency are attributed to erectile function and sexual desire.
- Self-testing and consequently self-treatment can lead to complications and potential harm.
- There are multiple treatment options available to help manage symptoms of hypogonadism, depending on the underlying cause and individual needs.
- Make sure to visit your healthcare professional for a professional diagnosis.
Testosterone is a sex hormone naturally produced by all individuals, albeit in smaller quantities in women.1 Its role predominantly revolves around the development and maintenance of male physical characteristics, such as muscle mass, bone density, facial and body hair growth, and deepening of the voice.2 However, it also plays a big part in male reproductive function, including sperm production and sex drive.2
Hypogonadism in males is the medical term given to the condition that results in low testosterone, often due to decreased function of the tests.3 It can be either primary, where the testosterone deficiency is due to problems with the testes, or secondary, where problems elsewhere in the body, such as the hypothalamus or pituitary gland, influence lower testosterone levels.3
Common signs and symptoms of low testosterone
Despite societal norms shifting towards the empowerment of men to express themselves better, many men remain confined to outdated beliefs, meaning that they’re less likely to report symptoms of anything until it’s too late.4 As such, symptoms of low testosterone levels are more frequently noticed by a spouse or partner.
The most common symptoms of testosterone deficiency are attributed to erectile function and sexual desire.3 While these symptoms are often the ones that will prompt men, and their partners, to seek treatment, the impact of low testosterone extends beyond just the sexual issues. Low levels of testosterone are associated with significantly lower quality of life, increased risk of type 2 diabetes, worse outcomes in other diseases, and lower energy levels, to name a few.3
Signs and symptoms of hypogonadism
Beyond the sexual issues, low testosterone can have a physiological toll as well as a physical impact.5 Psychological impacts include mood changes (e.g., anger, irritability, sadness, depression), decreased well-being, and impaired cognitive function (including concentration, verbal memory, and spatial performance).3
Epidemiological studies have shown that low testosterone levels are associated with obesity, insulin resistance and a worsening fat profile in men, with further evidence suggesting that low testosterone can increase the risk for heart disease and its associated risk factors.3,6
On the physical front, individuals may experience diminished body hair, gynaecomastia (swelling of breast tissue), reduced muscle mass and strength, hot flushes, sleep disturbances, fatigue, heightened susceptibility to osteoporosis, height loss, and low-trauma fractures.3
Sexual aspects affected by testosterone deficiency involve delayed puberty (in children), small testes, infertility, reduced sexual desire and activity, decreased frequency of sexual thoughts, erectile dysfunction, delayed ejaculation, and changes in ejaculate volume and morning/night-time erections.3
Hypogonadism (low testosterone with symptoms) treatment
There are multiple treatment options available to help manage symptoms of hypogonadism, depending on the underlying cause and individual needs.
The most commonly used approach in treating hypogonadism is testosterone replacement therapy (TRT). In the UK, the most common types of TRT used are transdermal gels, which are absorbed through the skin, and intramuscular injections. Gels are applied daily whereas injections are used every 2–14 weeks depending on the clinical need.
A clinician must evaluate testosterone levels when treatment is initiated so that the dose of TRT can be adjusted accordingly to suit individual needs. Once a stable and suitable dose has been achieved, blood levels will continue to be monitored for safety every 3 - 6 months.3
As they’re easier to use and more convenient to manage, testosterone gels are the preferred and most common delivery method for TRT. The need for daily application may create issues surrounding compliance with some patients, and others may find it irritates the skin at the application site. Additionally, as gels are often applied using bare hands, there is also a risk of secondary transference.3
Secondary transference occurs when testosterone gel accidentally transfers to someone else via touching.7 The chance of this occurring increases if you or your partner do not wash hands following application as the residue remaining may accidentally transfer to the skin of another. If this happens frequently, repeated unintended exposure to testosterone can cause detrimental effects, particularly if the recipient is female or prepubescent.8 The risk can be mitigated using a hands-free applicator which improves usability and safety.8
The safe way to test testosterone levels
Self-testing and consequently self-treatment can lead to complications and potential harm. While at-home testing has become increasingly popular due to its convenience and privacy, it may not provide the most reliable results.
Firstly, how and when samples are taken, and later how they are handled, will affect the quality of the results. For example, samples are best taken in the morning, before food and testing is to be repeated after 4 weeks to confirm testosterone deficiency.3 Secondly, to fully understand testosterone levels, free testosterone needs to be calculated based on levels of sex hormone-binding globulin, meaning that a qualified healthcare professional is required to interpret results and relay accurate information.3
If in doubt, speak to a professional
If you think you, or your partner, may be showing signs of hypogonadism, it is important to arrange a consultation with a qualified healthcare professional. Your doctor will conduct the appropriate diagnostic tests in addition to discussing with you the available treatment options.
- Nassar GN, Leslie SW. Physiology, Testosterone. In: StatPearls 2023.
- Kane J,et al. Ann Clin Biochem 2007; 44: 5–15.
- Hackett G, Kirby M. Trends Urol Men S Health 2023; 14: 21–25.
- McKenzie SK, et al. Am J Mens Health 2018; 12: 1247–1261.
- Muraleedharan V, Jones TH. Ther Adv Endocrinol Metab 2010 Oct;1(5):207-23.
- Zitzmann M. Nat Rev Endocrinol 2009 Dec;5(12):673-81.
- Yuen F, et al. Andrology 2019; 7: 235–243.
- Arver S, et al. Andrology 2018; 6: 396–407.