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Male Hypogonadism

What is male hypogonadism?

Hypogonadism in a male refers to a decrease in one or both major functions of the testes: sperm production or testosterone production.

There are two gonads called testes in men. This organ produces the hormones testosterone and sperm needed for fertility. It is regulated by hormones called gonadotrophins – luteinizing hormone (LH) and follicle-stimulating hormone (FSH) produced by the pituitary gland- a pea-sized gland found at the base of the brain.

Male hypogonadism can occur either due to:

  1. Diseases of the testes – referred to as primary hypogonadism.
  2. Disease of the hypothalamus or pituitary – referred to as secondary hypogonadism.

The symptom of male hypogonadism depends upon the age of onset, the severity of testosterone deficiency, and whether there is a decrease in one or both of the two major functions of the testes: sperm production and testosterone production.

  1. Adolescents and young adults who have not yet completed puberty appear younger than their chronologic age. They may report small genitalia, difficulty gaining muscle mass, lack of a beard, and failure of the voice to deepen.
  2. Adults with male hypogonadism may experience a decrease in energy and libido that occurs within days to weeks, decreased muscle mass and bone mineral density, or fracture of bones, which occurs over several years.
  3. Hot flashes occur only when the degree of hypogonadism is severe and especially when the rate of fall is rapid.
  4. Enlargement of one or both breasts in men
  5. Infertility can occur in primary rather than secondary hypogonadism.

Dr Reena Thomas will help diagnose this condition by conducting a comprehensive medical evaluation and physical examination. She will order blood tests to evaluate the testosterone hormone profile, complete blood counts, and metabolic panel. She will do the relevant tests to discover the type and cause of hypogonadism. Semen analysis is only done if fertility is a problem.

She will arrange for you to get imaging studies like an MRI of the pituitary or, if needed, an ultrasound of the testes.

Dr Reena Thomas will review and discuss the results of the clinical exam, blood tests, and imaging study with you. She will then discuss whether you need testosterone replacement therapy, highlighting the benefits and risks associated with this.

Long-term follow-up is required when you are on testosterone hormone replacement therapy.

Dr. Thomas will do a comprehensive medical evaluation, blood tests to monitor the blood counts, a metabolic panel including liver function and lipid profile, and prostate specific antigen levels. She will check the serum testosterone levels and adjust the dose of testosterone replacement therapy, which is essential to help keep the testosterone levels in the therapeutic range. She will monitor the side effects of testosterone replacement therapy, including the risk of cardiovascular disease and venous clotting disorders.

At a Glance

Dr. Reena Thomas, MD

  • Dual American board-certified endocrinologist
  • Author of numerous academic and clinic research
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