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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Contrary to what movies and television would have you believe, sex drive isn’t constant. It’s normal to experience fluctuations and even low sex drive from time to time. But if you suddenly experience low sex drive and it doesn’t return, or if low sex drive is accompanied by symptoms like weight gain, depression, or erectile dysfunction, it may be a symptom of a condition called hypogonadism. Continue reading to learn about the types of hypogonadism, causes, treatments, and more.
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What is hypogonadism?
Hypogonadism, also called gonadal failure, is a condition in which the body produces very low (or no) sex hormones. Some people are born with hypogonadism or develop it later in life.
Types of hypogonadism
There are two types of hypogonadism: primary and secondary. These are categorized by the part of the body causing the low hormone levels (i.e., inside or outside the sex organs).
In primary hypogonadism, the ovaries or testes are unable to respond to signals sent by the brain, resulting in low levels of sex hormones, and subsequently, low sex drive.
In secondary hypogonadism (also called central hypogonadism or hypogonadotropic hypogonadism), the problem occurs outside of the sex organs.
The issue usually occurs in the pituitary gland (a gland located at the base of the brain) and the hypothalamus (a region of the brain that coordinates the activity of the pituitary gland and the central nervous system). The pituitary gland and the hypothalamus both help regulate sex hormone production, so conditions that affect them can cause hypogonadism (Sizar, 2022).
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Risk factors and causes of hypogonadism
Risk factors and causes for hypogonadism differ based on whether the condition is primary or secondary. Causes and risk factors of primary hypogonadism include (Sizar, 2022):
- Genetic conditions, including Klinefelter syndrome and Turner syndrome
- Cancer treatments, including chemotherapy and radiation, can damage the ovaries and testes.
- High iron levels, including a condition called hemochromatosis, which can damage the testicles or ovaries
- Infections like the mumps virus, which can cause inflammation of the testes (orchitis) and hypogonadism
- Certain autoimmune diseases
- Testicle or ovary injuries
Causes of secondary hypogonadism are usually conditions that affect the pituitary gland and hypothalamus or interfere with the brain’s ability to send signals to the testes and ovaries. They include (Sizar, 2022):
- Brain conditions, including brain tumors, brain surgery, or genetic disorders like Kallmann syndrome
- Certain drugs, including anabolic steroids
- Infections like HIV
- Hormone conditions, including diabetes and underactive thyroid (hypothyroidism)
- Inflammation from a recent illness
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What are the symptoms of hypogonadism?
Symptoms of hypogonadism may vary based on the cause and whether an individual has testes or ovaries. However, common symptoms include (Grinspon, 2020; Sizar, 2022):
- Delayed puberty: In people with ovaries, signs of delayed puberty include delayed breast growth and menstruation, while people with testes may experience enlarged breast tissue (gynecomastia) or delayed penis growth.
- Low sex drive (decreased libido)
- Difficulty becoming pregnant
- Erectile dysfunction
- Low sperm count
- Weight gain
- Depressed mood
- Decreased armpit (axillary) and pubic hair
- Hot flashes
- Tiredness and fatigue
Complications of hypogonadism
Untreated hypogonadism may cause long-term complications, including (Bassil, 2011):
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How is hypogonadism diagnosed?
A healthcare professional’s diagnosis of hypogonadism is based on an individual’s symptoms, a physical examination, and test results. Some of the standard tests for diagnosing hypogonadism include (Salonia, 2019; Sizar, 2022):
- Blood test: Sex hormone levels (estrogen and testosterone levels) are low in both primary and secondary hypogonadism, so a blood test is used to measure them. Blood tests can also check the levels of hormones from the pituitary gland and hypothalamus, which may be low in people with secondary hypogonadism.
- Imaging tests: Hypogonadism may be due to tumors, and imaging tests may be used to detect them. For example, an ultrasound can look at the testes or ovaries, and a CT scan or MRI can visualize the pituitary gland and hypothalamus.
- Sperm test: Hypogonadism can cause a low sperm count, so a sperm test (semen analysis) may be performed to see whether your sperm count is within the normal range.
There are different hypogonadism treatments depending on the cause of the condition.
In people with primary hypogonadism, the testes or ovaries don’t produce adequate sex hormones, so the treatment involves hormone replacement therapy like estrogen therapy or testosterone replacement therapy (TRT) (Sizar, 2022).
Sometimes, hormonal therapy may improve sperm production or restore fertility in people with hypogonadism. If it doesn’t, assisted reproductive techniques like IVF and ICSI may be an option (Papanikolaou, 2022).
In secondary hypogonadism, the symptoms usually resolve when the underlying cause is treated. For example, in people with secondary hypogonadism caused by tumors, treating the tumor treats the hypogonadism.
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Long-term outlook for people with hypogonadism
The long-term outlook for people with hypogonadism varies based on the type and cause of the condition.
Primary hypogonadism may be a life-long condition and may require long-term hormone replacement therapy.
Low sex drive is a frustrating symptom, but many treatment options are available to relieve the symptoms of hypogonadism, increase sex drive, and (in some cases) reverse the condition entirely. If you experience symptoms of hypogonadism, speak to a healthcare provider to find a treatment plan that’s right for you.
- Bassil, N. (2011). Late-onset hypogonadism. The Medical Clinics of North America, 95(3), 507–x. doi:10.1016/j.mcna.2011.03.001. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21549875/
- Fraietta, R., Zylberstejn, D. S., & Esteves, S. (2013). Hypogonadotropic hypogonadism revisited. Clinics, 68(1), 81–88. doi:10.6061/clinics/2013(sup01)09. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583156/
- Grinspon, R. P., Bergadá, I., & Rey, R. A. (2020). Male hypogonadism and disorders of sex development. Frontiers in Endocrinology, 11, 211. doi:10.3389/fendo.2020.00211. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7174651/
- Papanikolaou, N., Luo, R., & Jayasena, C. N. (2022). Fertility considerations in hypogonadal men. Endocrinology and Metabolism Clinics of North America, 51(1), 133–148. doi:10.1016/j.ecl.2021.11.009. Retrieved from https://pubmed.ncbi.nlm.nih.gov/35216712/
- Richard-Eaglin, A. (2018). Male and female hypogonadism. The Nursing Clinics of North America, 53(3), 395–405. doi:10.1016/j.cnur.2018.04.006. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30100005/
- Salonia, A., Rastrelli, G., Hackett, G., et al. (2019). Paediatric and adult-onset male hypogonadism. Nature Reviews. Disease Primers, 5(1), 38. doi:10.1038/s41572-019-0087-y. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944317/
- Sizar, O. & Schwartz, J. (2022). Hypogonadism. StatPearls. Retrieved on Sept. 23, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK532933/