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Last updated: May 13, 2022
4 min read

Hypogonadism: types, symptoms, causes, treatments



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.

Your sex drive isn’t constant. It’s normal to experience fluctuations and have periods of higher or lower libido. But if your sex drive suddenly decreases and doesn’t return, or if it’s accompanied by symptoms like weight gain, depression, or erectile dysfunction, it may be a symptom of a condition called hypogonadism. 

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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 the condition or develop it later in life. 

Biological males with hypogonadism have decreased testosterone production and low testosterone levels. In biological females, there are low estrogen levels (Sizar, 2021).  

What are the types of hypogonadism?

There are two types of hypogonadism: primary and secondary. The type someone has is based on which part of the body is causing the low hormone levels. 

Primary hypogonadism

In primary hypogonadism, sex hormone levels are low because of a problem in the organs that make them: the ovaries or testes. The brain sends signals to the sex organs, but they’re not able to respond by producing hormones. 

Secondary hypogonadism (central hypogonadism)

In secondary hypogonadism, the problem occurs outside of the sex organs. 

It’s usually related to areas of the brain (central nervous system) called the pituitary gland and the hypothalamus. These regions help regulate sex hormone production, so conditions that affect them can cause hypogonadism. Secondary hypogonadism is also called hypogonadotropic hypogonadism or central hypogonadism (Fraietta, 2013). 

Causes and risk factors of hypogonadism

Hypogonadism’s risk factors and causes differ based on whether the condition is primary or secondary.

Causes and risk factors of primary hypogonadism include (Richard-Eaglin, 2018; Sizar, 2021):

  • Genetic conditions: Certain conditions that you inherit in your genes or chromosomes can affect ovarian and testicular development and decrease sex hormone production. This includes conditions like Klinefelter syndrome, which affects the testes, and Turner syndrome, which affects the ovaries. 
  • Cancer treatments: Chemotherapy and radiation can damage the ovaries and testes and lead to low sex hormone levels. 
  • Iron exposure: A condition called hemochromatosis raises the iron levels in the body and can damage the testicles or ovaries. 
  • Infections: Infections like the mumps virus can cause inflammation of the testes (orchitis) and hypogonadism. 
  • Immune system disease: Conditions that affect the immune system (autoimmune disease), such as Addison’s disease, may lead to hypogonadism. 
  • Testicle or ovary injuries
  • Kidney disease
  • Liver disease

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 (Richard-Eaglin, 2018; Sizar, 2021):

  • Brain conditions, including brain tumors, brain surgery, or genetic disorders like Kallmann syndrome 
  • Recreational drugs, including marijuana, anabolic steroids, and opioids 
  • Infections like HIV
  • Hormone conditions, including diabetes and underactive thyroid (hypothyroidism) 
  • Inflammation from a recent illness
  • Cancer treatments
  • Obesity

What are the symptoms of hypogonadism?

Symptoms of hypogonadism may vary based on the cause and whether an individual has testes or ovaries, but common symptoms include (Grinspon, 2020; Sizar, 2021): 

  • Delayed puberty: This occurs when puberty starts later than the expected age. 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): When hypogonadism decreases estrogen and testosterone levels, you may feel less interested in sex.  
  • Difficulty becoming pregnant
  • Erectile dysfunction
  • Low sperm count
  • Weight gain
  • Depressed mood
  • Decreased armpit (axillary) and pubic hair
  • Hot flashes  
  • Tiredness and fatigue

What are the complications of hypogonadism?

Besides causing symptoms in the short-term, untreated hypogonadism may cause long-term complications, including (Bassil, 2011):

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 common tests for diagnosing hypogonadism include (Salonia, 2019):

  • 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 (semen analysis): Hypogonadism can cause a low sperm count, so a sperm test may be performed to see whether your sperm count is within the normal range.

What are the treatments for hypogonadism?

There are different treatments for hypogonadism, depending on what’s causing it. 

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).

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 people with secondary hypogonadism caused by tumors, treating the tumor treats the hypogonadism.

Long-term outlook for people with hypogonadism

The long-term outlook for people with hypogonadism also varies based on the type and cause. 

Primary hypogonadism may be a life-long condition and may require long-term hormone replacement therapy. In secondary hypothyroidism, the symptoms usually resolve when you treat the underlying cause.

Hypogonadism has many different causes, but there are different treatment options that can relieve symptoms and, in some cases, reverse the condition entirely. If you have symptoms of hypogonadism or have questions about this condition, speak to your healthcare provider. 


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