Male Hypogonadism or Male Andropause

Male Hypogonadism or Male Andropause

The primary male sex steroid is testosterone. It is made at the testicle. The normal range for adult males is about 300ng/dl to 1000ng/dl. Testosterone is also made by women. It is one of the major androgens in normal cycling women. The adrenal gland is responsible for making 25%, the ovary makes 25% and the rest is made through peripheral conversion of other circulating androgens. The normal levels for adult women range from 20ng/dl to 70ng/dl. The causes of deficiency or decreased production and function of testosterone and/or sperm is referred to as Hypogonadism. There are two classifications: Primary deficiency refers to a medical issue pertaining to the testes. The major causes include congenital abnormalities, infections, prior radiation and systemic illnesses. Secondary deficiency refers to a medical process that can be related to the pituitary gland or hypothalamus of the brain with decreased production of the gonadotropins, FSH and LH.

Signs and Symptoms of Hypogonadism include

Although these are non-specific signs and symptoms the diagnosis is made through the patient history, physical exam and laboratory evaluation.

  • Decreased libido and sexual desire
  • Depressed Mood
  • Weight Gain
  • Decrease in Lean Muscle Mass
  • Hot Flashes
  • Gynecomastia (Male breast tissue growth)
  • Poor concentration
  • Poor sleep quality
  • Poor concentration

Laboratory Tests

Basic laboratory includes total and free testosterone, FSH and LH. The diagnosis of hypogonadism can be confirmed by finding decreased sperm in the semen and/or a low serum concentration of testosterone. Measurement of the serum testosterone concentration is usually the most important single diagnostic test for male hypogonadism because a low value usually indicates hypogonadism.


Testosterone replacement is available through many different modalities. The best way, in my experience, is by injection of testosterone hormone. It is the least costly and works very well, as long as the patient is agreeable to the injection. The injection is basically painless, and can be done twice a month. Men usually can be treated with 100mg weekly or 200mg every two weeks. Women can be treated with testosterone also. The dose is significantly smaller and less frequent. There are other methods of delivery of testosterone such as patches, creams, and pellets. These methods are expensive and may be difficult to continue. Follow-up labs are usually done in 6-8 week intervals. Adverse effects from abuse of testosterone can include changes in blood cholesterol, Gynecomastia, hepatitis, jaundice, elevated calcium levels, hypoglycemia, polycythemia, prostate hypertrophy or cancer, decreased spermatogenesis. Testosterone replacement to deficient males is very safe and effective. When used according to the stated guidelines, there are generally no bad side effects. Proper monitoring reduces any side effects to a minimum.

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