What are symptoms of hypogonadism?

What are symptoms of hypogonadism?

The symptom most associated with hypogonadism is reduced libido, however other manifestations can also be associated with low testosterone, and a diagnosis of hypogonadism is made on the basis of low serum testosterone levels occurring in association with one or more of the symptoms and signs listed in the Table.1,2 However, please consult guidelines relevant to your country of practice as country-specific differences in the diagnosis and treatment of hypogonadism exist.

Figure: Common symptoms and physical signs of hypogonadism (low testosterone).

Figure: Common symptoms and physical signs of hypogonadism (low testosterone).

    General signs and symptoms for hypogonadism

    Signs and symptoms suggestive of hypogonadism in men Other, less specific symptoms and signs associated with hypogonadism
    Incomplete sexual development, eunuchoidism, aspermia Decreased energy, motivation, initiative, aggressiveness, self-confidence
    Reduced sexual desire (libido) and activity Feeling sad or blue, depressed mood, dysthymia
    Decreased spontaneous erections Diminished physical or work performance
    Reduced muscle bulk and strength Poor concentration and memory
    Hot flushes, night sweats Increased body fat, body mass index
    Loss of body (axillary and pubic) hair, reduced shaving Insulin resistance
    Breast discomfort, gynecomastia Sleep disturbance, increased sleepiness
    Very small or shrinking testes Mild anemia
    Inability to father children, low or zero sperm counts  
    Height loss, low trauma fracture, low bone mineral density (osteoporosis)  

    Symptoms for hypogonadism based on onset of hypogonadism

    Organ/ ­affected function Onset of hypogonadism before completion of puberty Onset of hypogonadism after completion of puberty
    Larynx No voice mutation No change
    Hair Horizontal pubic hair line; straight frontal hair line; diminished beard growth Diminished secondary body hair; decreased beard growth
    Skin Absent sebum production; lack of acne; pallor; fine skin wrinkling Decreased sebum production; pallor; fine skin wrinkling
    Bone Eunuchoid tall stature; osteoporosis Osteoporosis
    Haematopoiesis Anaemia Anaemia
    Breast Sometimes gynaecomastia Sometimes gynaecomastia
    Muscles Underdeveloped Atrophia
    Penis Infantile No change/atrophy
    Prostate Underdeveloped Atrophy
    Testes Small volume; often maldescensus Decrease of volume
    Spermatogenesis Not initiated Arrest
    Mood Reduced Reduced
    Erectile function and libido Not developed Loss

    Symptoms typically met in late-onset hypogonadism (LOH)

    Sexual Other
    Diminished sexual desire and arousability (libido)
    Loss of erectile quality and frequenc
    Loss of particularly nocturnal erections
    Depression, fatigue, lack of vigor, irritability
    Decreased intellectual activity: cognitive functions, spatial orientation
    Sleep disturbances
    Decrease in lean body mass, diminution of muscle volume, and strength
    Increase in visceral fat
    Decrease in body hair and skin alterations
    Osteopenia, osteoporosis, and increased risk of bone fractures


    Treatment guidelines

    How to diagnose hypogonadism?


    1. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91(6): 1995-2010.
    2. Wang, C., E. Nieschlag, R. Swerdloff, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 2008, 159(5): 507-514.
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