Male hypogonadism (low testosterone)
ICD-10 E29.1
- <0 ng/dL
- morning total T diagnostic threshold
- ~0%
- men ≥45 with low T (HIM study)
- ~0-12 weeks
- TRT effect on libido / energy
- PSA + Hct
- monitor every 3-6 months
What is male hypogonadism (low testosterone)?
Male hypogonadism is failure of the testes to produce adequate testosterone, sperm, or both. Primary (testicular failure) vs secondary (pituitary/hypothalamic). Symptoms include low libido, fatigue, depressed mood, reduced muscle mass, and erectile dysfunction. Prevalence rises with age, obesity, and chronic disease.
What are the symptoms of male hypogonadism (low testosterone)?
- Reduced libido and morning erections (most specific)
- Erectile dysfunction overlapping with reduced spontaneous erections
- Fatigue and reduced exercise capacity
- Decreased muscle mass and strength
- Increased body fat, especially abdominal
- Mood changes: irritability, mild depression, reduced motivation
- Reduced beard growth and body hair (advanced)
- Decreased bone density (osteoporosis risk in long-standing low T)
Who is at risk for male hypogonadism (low testosterone)?
- Age — total T declines ~1-2%/year after 30
- Obesity (each BMI unit above 30 ≈ 2% reduction in T)
- Type 2 diabetes
- Obstructive sleep apnea (treating OSA often raises T)
- Chronic opioid use
- Long-term high-dose glucocorticoids
- Pituitary or testicular injury, surgery, or radiation
How is male hypogonadism (low testosterone) diagnosed?
Morning fasting total testosterone, confirmed on two separate occasions. Free testosterone and SHBG when total is borderline. LH/FSH distinguish primary from secondary. Prolactin to rule out pituitary cause. Workup for sleep apnea, T2D, depression — common reversible contributors.
How is male hypogonadism (low testosterone) treated?
Testosterone replacement (gels, injections, pellets, oral nasal) for confirmed deficiency with symptoms. Monitor hematocrit (polycythemia risk), PSA, and lipid panel. Treat underlying contributors (weight loss, OSA treatment, depression). Telehealth testosterone has been controversial; reputable platforms confirm diagnosis with lab work before prescribing.
Authority reference: www.auanet.org
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Related topics
Sources
Primary sources cited above. FDA labeling, peer-reviewed trials, and specialty-society guidelines only.
- Testosterone Deficiency: AUA Guideline · American Urological Association, 2018
- Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE trial) · New England Journal of Medicine, 2023 · PMID 37326322
- Endocrine Society Clinical Practice Guideline: Testosterone Therapy in Men with Hypogonadism · Journal of Clinical Endocrinology & Metabolism, 2018 · PMID 29562364
People also ask
What's the difference between low T and 'hypogonadism'?
Hypogonadism is the clinical diagnosis: low T (typically <300 ng/dL morning fasting, confirmed twice) PLUS symptoms. Asymptomatic low T is not by itself an indication for TRT in current AUA guidelines. The treatable condition requires both halves.
Will TRT cause prostate cancer?
Current evidence does not show TRT initiates prostate cancer in men without preexisting cancer. However, TRT can accelerate growth of an existing prostate cancer. PSA monitoring is standard before and during TRT, and a normal pre-TRT prostate exam is part of the workup.
Can TRT make me infertile?
Yes — exogenous testosterone suppresses LH/FSH and shuts down endogenous testicular testosterone production and sperm production. Men who want to preserve fertility while treating low T should consider clomiphene, hCG, or other strategies that preserve the HPG axis. Discuss with prescriber before TRT.
Does losing weight actually raise testosterone?
Yes, often substantially. The relationship is direct: visceral fat aromatizes testosterone to estradiol and suppresses the HPG axis. Trials of significant weight loss (bariatric surgery, GLP-1-mediated) show ~30-50% increases in total T in men with obesity-related secondary hypogonadism.