Diagnosis

Early detection in boys can help prevent problems from delayed puberty. Early diagnosis and treatment in men offer better protection against osteoporosis and other related conditions.

Your doctor will conduct a physical exam and note whether your sexual development, such as your pubic hair, muscle mass and size of your testes, is consistent with your age.

Your doctor will test your blood level of testosterone if you have signs or symptoms of hypogonadism. Because testosterone levels vary and are generally highest in the morning, blood testing is usually done early in the day, before 10 a.m., possibly on more than one day.

If tests confirm that you have low testosterone, further testing can determine if a testicular disorder or a pituitary abnormality is the cause. These studies might include:

  • Hormone testing
  • Semen analysis
  • Pituitary imaging
  • Genetic studies
  • Testicular biopsy

More Information

Treatment

Adult men

Male hypogonadism usually is treated with testosterone replacement to return testosterone levels to normal. Testosterone can help counter the signs and symptoms of male hypogonadism, such as decreased sexual desire, decreased energy, decreased facial and body hair, and loss of muscle mass and bone density.

For older men who have low testosterone and signs and symptoms of hypogonadism due to aging, the benefits of testosterone replacement are less clear.

While you're taking testosterone, the Endocrine Society recommends that your doctor monitor you for treatment effectiveness and side effects several times during your first year of treatment and yearly after that.

Types of testosterone replacement therapy

Oral testosterone preparations have not been used for treatment of hypogonadism because they can cause serious liver problems. Also, they don't keep testosterone levels steady.

Recently the FDA approved an oral testosterone replacement preparation, testosterone undecanoate (Jatenzo) that is absorbed by the lymph system. It might avoid the liver problems seen with other oral forms of testosterone.

Other preparations you might choose, depending on convenience, cost and your insurance coverage, include:

  • Gel. There are several gels and solutions available, with different ways of applying them. Depending on the brand, you rub the testosterone into your skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo)or apply it to the front and inner thigh (Fortesta).

    Your body absorbs testosterone through your skin. Don't shower or bathe for several hours after a gel application, to be sure it gets absorbed.

    Side effects include skin irritation and the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry, or cover the area after an application.

  • Injection. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate are given in a muscle or under the skin. Your symptoms might waver between doses depending on the frequency of injections.

    You or a family member can learn to give testosterone injections at home. If you're uncomfortable giving yourself injections, a nurse or doctor can give the injections.

    Testosterone undecanoate (Aveed) is given by deep intramuscular injection, typically every 10 weeks. It must be given at your doctor's office and can have serious side effects.

  • Patch. A patch containing testosterone (Androderm) is applied each night to your thighs or torso. A possible side effect is severe skin reaction.
  • Gum and cheek (buccal cavity). A small putty-like substance, gum-and-cheek testosterone replacement delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity).

    This product, taken three times a day, sticks to your gumline and allows testosterone to be absorbed into your bloodstream. It can cause gum irritation.

  • Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This option reduces the risk that medication will be transferred to another person through skin contact. Nasal-delivered testosterone must be applied twice in each nostril, three times daily, which might be more inconvenient than other delivery methods.
  • Implantable pellets. Testosterone-containing pellets (Testopel) are surgically implanted under the skin every three to six months. This requires an incision.

Testosterone therapy carries various risks, including:

  • Increased production of red blood cells
  • Acne
  • Enlarged breasts
  • Sleep disturbances
  • Prostate enlargement
  • Limited sperm production

Treatment of infertility due to hypogonadism

If a pituitary problem is the cause, pituitary hormones can be given to stimulate sperm production and restore fertility. A pituitary tumor may require surgical removal, medication, radiation or the replacement of other hormones.

There's often no effective treatment to restore fertility in a man with primary hypogonadism, but assisted reproductive technology may be helpful. This technology covers a variety of techniques designed to help couples who have been unable to conceive.

Treatment for boys

Treatment of delayed puberty in boys depends on the underlying cause. Three to six months of testosterone supplementation given as an injection can stimulate puberty and the development of secondary sex characteristics, such as increased muscle mass, beard and pubic hair growth, and growth of the penis.

Coping and support

Having male hypogonadism can affect your self-image and, possibly, your relationships. Talk with your doctor about how you can reduce the anxiety and stress that often accompany these conditions. Many men benefit from psychological or family counseling.

Find out if there are support groups in your area or online. Support groups put you in touch with other people with similar challenges.

Preparing for your appointment

Although you're likely to start by seeing your family doctor, you might be referred to a doctor who specializes in the hormone-producing glands (endocrinologist).

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including any major stresses, recent life changes, and history of childhood illnesses or surgeries
  • All medications, vitamins or other supplements you take, including doses
  • Questions to ask your doctor

For male hypogonadism, some questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Are there other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions I need to follow?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • When did you begin puberty? Did it seem to be earlier or later than your peers?
  • Did you have any growth problems as a child or adolescent?
  • Have you injured your testicles?
  • Did you have the mumps as a child or teen? Do you recall if you felt pain in your testicles while you had the mumps?
  • Did you have undescended testicles as a baby?
  • Did you have surgery for a groin hernia or genital surgery as a child?
Nov. 05, 2019
  1. Ferri FF. Hypogonadism, male. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Aug. 13, 2019.
  2. Snyder PJ. Clinical features and diagnosis of male hypogonadism. https://www.uptodate.com/contents/search. Accessed Aug. 13, 2019.
  3. AskMayoExpert. Male hypogonadism (adult). Mayo Clinic; 2018.
  4. Snyder PJ. Testosterone treatment of male hypogonadism. https://www.uptodate.com/contents/search. Accessed Aug. 13, 2019.
  5. AskMayoExpert. Delayed male puberty (child). Mayo Clinic; 2019.
  6. Sargis RM, et al. Evaluation and treatment of male hypogonadism. Journal of the American Medical Association. 2018; doi:10.1001/jama.2018.3182.
  7. Gardner DG, et al., eds. Testes. In: Greenspan's Basic and Clinical Endocrinology. 10th ed. McGraw-Hill Education; 2018. https://accessmedicine.mhmedical.com. Accessed Aug. 13, 2019
  8. Male hypogonadism. Merck Manual Professional Version. https://www.merckmanuals.com/professional/genitourinary-disorders/male-reproductive-endocrinology-and-related-disorders/male-hypogonadism#. Accessed Aug. 13, 2019.
  9. FDA approves new oral testosterone capsule for treatment of men with certain forms of hypogonadism. U.S. Food & Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-new-oral-testosterone-capsule-treatment-men-certain-forms-hypogonadism. Accessed Sept. 26, 2019.
  10. Bhasin S, et al. Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2018;103:1715.

Related

Associated Procedures