Hypogonadism

Two places the problem can start

Hormone production runs on a chain of command. The hypothalamus in the brain signals the pituitary, the pituitary releases LH and FSH, and those hormones tell the testes to make testosterone and sperm.

• Primary hypogonadism: the testes themselves are not responding. LH is usually high because the brain keeps pushing. Causes include Klinefelter syndrome, testicular injury, mumps orchitis, chemotherapy or radiation.
• Secondary (central) hypogonadism: the testes are capable but the signal is weak. LH is low or inappropriately normal. Causes include pituitary disorders, high prolactin, obesity, opioid or steroid use, and severe illness.

How it is confirmed in men

Both the American Urological Association and the Endocrine Society require two things: symptoms or signs of deficiency and lab evidence that is clearly and consistently low. The AUA uses a total testosterone below 300 ng/dL as a reasonable cutoff and asks for two early-morning measurements on separate days.

If testosterone is low, guidelines recommend checking LH, and prolactin when LH is low or low-normal. Free testosterone may be useful when SHBG is abnormal or total testosterone sits near the line. The Endocrine Society advises against screening men without symptoms.

Symptoms people notice

• Lower sex drive, fewer morning erections or erectile changes.
• Fatigue, low mood or reduced motivation.
• Loss of muscle, more body fat, or declining bone density.
• Reduced body hair, breast tissue enlargement or fertility problems.

Treatment depends on the type and your goals

Testosterone therapy can relieve symptoms in men with confirmed deficiency, but it suppresses the body's own sperm production, so it is not appropriate for men trying to conceive. In secondary hypogonadism, options that stimulate the body's own production may be considered when fertility matters. Treatment requires monitoring of hematocrit and, for men over 40, PSA.

In women, hypogonadism usually shows up as missed periods or early menopause and is evaluated differently. A HealifyMD clinician can review your symptoms and morning labs and explain which, if any, treatment path fits.

Getting the testing right

Testosterone runs highest early in the day and can be suppressed by acute illness, poor sleep and heavy training, so labs are best drawn in the morning when you are well. Assay accuracy also matters; the Endocrine Society recommends a reliable, accurate assay. If one result is low and the other is normal, a third test or a free testosterone measurement may be needed before any diagnosis is made.