Male Hypogonadism

Diagnosis

Timely identification in boys can help prevent complications related to delayed puberty. Early diagnosis and intervention in men offer improved safeguarding against conditions like osteoporosis.

During a physical examination, your doctor will assess whether your sexual development, including pubic hair, muscle mass, and testes size, aligns with your age. If signs or symptoms of hypogonadism are present, your doctor may conduct a blood test to measure your testosterone levels. Since testosterone levels vary and are typically highest in the morning, blood testing is usually performed early in the day, before 10 a.m., and may be repeated on multiple days.

If tests confirm low testosterone levels, additional investigations can identify whether a testicular disorder or pituitary abnormality is the underlying cause, which may include semen analysis, hormone testing, pituitary imaging, testicular biopsy, or genetic studies.

Treatment

Treatment for boys

Treating delayed puberty in boys depends on the underlying cause. Administering testosterone supplementation via injections for three to six months can stimulate puberty and the development of secondary sexual characteristics. These include increased muscle mass, growth of facial and pubic hair, and growth of the penis.

Adult men

The primary treatment for male hypogonadism typically involves testosterone replacement therapy aimed at restoring testosterone levels to normal. This therapy effectively addresses symptoms such as reduced sexual desire, decreased energy, diminished facial and body hair, and loss of muscle mass and bone density associated with the condition.

For older men experiencing low testosterone levels and hypogonadism symptoms due to aging, the benefits of testosterone replacement therapy are not as conclusively established.

During testosterone replacement therapy, it’s recommended by the Endocrine Society that your doctor regularly assesses treatment efficacy and monitors for potential side effects. Monitoring is particularly crucial during the initial year of treatment and should continue annually thereafter.

Types of testosterone replacement therapy

In the treatment of hypogonadism, oral testosterone preparations are generally avoided due to the risk of causing severe liver issues and the challenge of maintaining consistent testosterone levels. However, an exception to this is testosterone undecanoate, an oral testosterone replacement therapy approved by the Food and Drug Administration. It’s absorbed through the lymphatic system, potentially circumventing the liver-related concerns associated with other oral testosterone forms.

Alternatively, other preparations can be considered based on factors such as convenience, cost, and insurance coverage including:

• Gel: Various gels and solutions are available for application in different ways. Depending on the brand, you can rub the testosterone onto your skin on the upper arm or shoulder or apply it to the front and inner thigh.
  Your skin absorbs the testosterone, so refrain from showering or bathing for several hours after applying the gel to ensure proper absorption.|
  Side effects may include skin irritation and the potential for medication transfer to another person. Refrain from skin-to-skin contact until the gel has fully dried or cover the treated area post-application.
• Injection: Testosterone cypionate and testosterone enanthate are administered into a muscle or under the skin. Symptoms may fluctuate between doses depending on the injection frequency. Testosterone undecanoate is administered by deep intramuscular injection, typically every 10 weeks, at your provider’s office and may have serious side effects.
  You or a family member can be trained to administer testosterone injections at home. If self-administration is uncomfortable, your doctor can perform the injections.
• Patch: A testosterone patch is applied nightly to the thighs or torso. Potential side effects include severe skin reactions.
• Gum and cheek (buccal cavity): This putty-like substance, used three times a day, delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity). It can cause gum irritation.
• Nasal: Testosterone gel can be pumped into the nostrils, reducing the risk of medication transfer through skin contact. It must be applied twice in each nostril three times daily, which may be less convenient than other methods.
• Implantable pellets: Testosterone-containing pellets are surgically implanted under the skin every three to six months, requiring an incision.

Testosterone therapy comes with several potential risks, such as:

• Breast enlargement
• Enlargement of the prostate
• Restricted sperm production
• Elevated production of red blood cells
• Acne
• Sleep disturbances

Infertility treatment caused by hypogonadism

When a pituitary issue underlies hypogonadism, administering pituitary hormones can stimulate sperm production and restore fertility. Treatment may involve surgical removal, medication, radiation, or hormone replacement therapy for pituitary tumors.

Restoring fertility in cases of primary hypogonadism can be challenging, but assisted reproductive technology offers options. This includes various techniques designed to assist couples experiencing difficulties conceiving.