Hypogonadism: types, symptoms, causes, and treatments

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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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. 

Biological males with hypogonadism experience decreased testosterone production and low testosterone levels. Biological females experience low estrogen and progesterone levels (Sizar, 2022).   

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). 

Primary hypogonadism

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. 

Secondary hypogonadism

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). 

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

• Obesity

• Stress

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

Untreated hypogonadism may cause long-term complications, including (Bassil, 2011):

• Infertility 

• Osteoporosis

• Depression

• Loss of muscle mass and strength

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.

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. 

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

September 23, 2022

Written by

Gina Allegretti, MD

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.