Male Hypogonadism: Symptoms, Causes & Treatment Guide
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
Male hypogonadism is a condition in which the body does not make enough of the hormone testosterone, enough sperm, or both. It can begin in the womb, during childhood, or in adulthood, and its timing determines the symptoms — from unusual genital development at birth and delayed puberty to low sex drive, low energy, depression, erectile dysfunction, and bone loss in adults. There are two basic types: primary (a problem in the testicles) and secondary (a problem in the brain regions — the hypothalamus and pituitary gland — that signal the testicles to make testosterone). Diagnosis starts with a morning blood test between 8 and 10 a.m., followed by hormone testing, semen analysis, imaging, or genetic studies to find the cause. Testosterone replacement therapy — in gel, shot, patch, nasal, gum, or pellet form — treats many cases, and the condition is manageable with regular medical follow-up.
Quick Answer
What is male hypogonadism? A condition in which the body does not make enough testosterone, enough sperm, or both.
When can it start? In the womb, before puberty, or during adulthood — symptoms depend on when it begins.
Two types: Primary (a problem in the testicles) and secondary (a problem in the hypothalamus or pituitary gland that signals the testicles).
Most common adult symptoms: Low sex drive, low energy, and depression, progressing over time to erectile dysfunction, infertility, and bone loss.
How it's diagnosed: Morning blood test for testosterone (8–10 a.m.), plus hormone tests, semen analysis, pituitary imaging, and gene studies as needed.
How it's treated: Testosterone replacement in gel, shot, patch, nasal, gum, or pellet form, with regular follow-up blood tests to keep doses safe.
Is it treatable? Yes — testosterone replacement eases symptoms in many people, and treating the underlying cause (such as sleep apnea or a pituitary tumor) can restore function.
What Is Male Hypogonadism?
Male hypogonadism is a condition in which the body doesn't make enough of the hormone testosterone, enough sperm, or both. Testosterone plays a key role in male growth and maturing during puberty.
People can be born with male hypogonadism. Or it can start later in life, often from injury or infection. The cause of the condition and when it starts affect what can be done about it. Testosterone replacement therapy can treat some types of male hypogonadism.
What Are the Symptoms of Male Hypogonadism?
Hypogonadism can begin in the womb, before puberty, or during adulthood. Symptoms depend on when the condition starts.
In the Womb
If a baby's body doesn't make enough testosterone while in the womb, it can affect the outer sex organs. Depending on when hypogonadism starts and how much testosterone there is, a baby whose genes are male may be born with:
Female genitals.
Genitals that are neither clearly male nor clearly female, called ambiguous genitals.
Male genitals that don't develop fully.
During Puberty
Male hypogonadism that occurs in the first 10 years of life can delay puberty or cause incomplete development. It can get in the way of:
Muscle mass growth.
The voice getting deeper.
Growth of body and facial hair.
Growth of the penis and testicles.
And it can cause the arms and legs to grow more than the trunk of the body, as well as growth of breast tissue, called gynecomastia.
In Adulthood
In adults, hypogonadism can change certain physical traits and affect the ability to have children. Early symptoms might include:
Less sex drive.
Less energy.
Depression.
Over time, men with hypogonadism can have:
Difficulty getting and keeping an erection, called erectile dysfunction.
Problems having children, called infertility.
Less hair growth on the face and body.
Less muscle mass.
Growth of breast tissue (gynecomastia).
Loss of bone mass, called osteoporosis.
Severe hypogonadism also can cause mental and emotional changes. As testosterone decreases, some men have symptoms like those of menopause. These can include trouble focusing and hot flashes.
When to Seek Help
Make a medical appointment if you have symptoms of male hypogonadism. Finding the cause of hypogonadism is an important first step to getting the right treatment.
What Causes Male Hypogonadism?
Male hypogonadism means the testicles don't make enough of the male sex hormone testosterone. There are two basic types of hypogonadism:
Primary: this type comes from a problem in the testicles. It is also called primary testicular failure.
Secondary: this type means there is a problem in the parts of the brain that tell the testicles to make testosterone — the hypothalamus and the pituitary gland.
The hypothalamus makes gonadotropin-releasing hormone, which signals the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then tells the testes to make testosterone.
An inherited trait passed through families can cause either type. Something that happens later in life, such as an injury or infection, also can cause either type — this is called acquired hypogonadism. At times, primary and secondary hypogonadism occur together.
Causes of Primary Hypogonadism
Common causes of primary hypogonadism include:
Klinefelter syndrome: caused by a problem of the sex chromosomes X and Y, present at birth (congenital). A male typically has one X and one Y chromosome; in Klinefelter syndrome, there are two or more X chromosomes plus one Y chromosome. The extra X chromosome causes unusual growth of the testicles and results in too little testosterone.
Undescended testicles: before birth, the testicles develop inside the belly and move down into the scrotum. Sometimes one or both haven't moved into place by birth. This often fixes itself within the first few years of life. If not fixed in early childhood, it can cause the testicles not to work correctly or make enough testosterone.
Mumps orchitis: a mumps infection as a teenager or adult can harm the testicles.
Hemochromatosis: too much iron in the blood can cause the testicles to fail or the pituitary gland not to work as it should.
Injury to the testicles: because they are outside the belly, the testicles can be injured easily. Harm to both testicles can cause hypogonadism. If one testicle is harmed or removed, the other will take over and make the needed testosterone.
Cancer treatment: chemotherapy or radiation therapy can affect how well the body makes testosterone and sperm. The effects are often short-lived, but they can cause lifelong inability to have children. Many men regain fertility within a few months after treatment, and storing sperm before starting cancer therapy is an option for those who want to have children.
Causes of Secondary Hypogonadism
In secondary hypogonadism, the testicles look typical but don't work as they should due to a problem with the pituitary or hypothalamus:
Kallmann syndrome: unusual hypothalamus development; can affect smell (anosmia) and cause red-green color blindness.
Pituitary conditions or tumors: a pituitary tumor or brain tumor near the pituitary reduces the hormones that spur testosterone and sperm production; tumor treatment (surgery, radiation) can also affect the pituitary.
Inflammatory diseases: sarcoidosis, histiocytosis, and tuberculosis can affect testosterone production.
HIV/AIDS: lowers testosterone by affecting the hypothalamus, pituitary, and testes.
Medicines: opiates for pain and some hormones can affect testosterone levels.
Obstructive sleep apnea: untreated sleep-related breathing problems can cause hypogonadism; it may improve after treatment.
Obesity: being significantly overweight at any age may be linked to hypogonadism.
Aging: testosterone levels lessen with age; the rate varies from person to person.
What Increases Your Risk of Male Hypogonadism?
Risk factors for hypogonadism include:
HIV/AIDS.
Having had chemotherapy or radiation therapy.
Aging.
Obesity.
Not having a good diet, called malnutrition.
Obstructive sleep apnea.
Hypogonadism can also be inherited. If any of these risk factors appear in your family health history, tell a member of your healthcare team.
What Are the Complications of Male Hypogonadism?
The complications of untreated hypogonadism differ depending on whether it starts in the womb, at puberty, or in adulthood:
Unusual genitals: development differences when the condition starts in the womb.
Gynecomastia: growth of breast tissue.
Infertility: not being able to have children.
Erectile dysfunction: not being able to get or keep an erection.
Osteoporosis: the bone-weakening disease.
Poor self-image: emotional impact on how a person sees themselves.
Early diagnosis and treatment in men helps protect against osteoporosis and other conditions, and finding hypogonadism in childhood can prevent problems from delayed puberty.
How Is Male Hypogonadism Diagnosed?
A member of your healthcare team does a physical exam and looks at your sexual maturing — checking whether pubic hair, muscle mass, and the size of your testes are typical for your age.
Blood tests can show testosterone levels. Testosterone levels are most often highest in the morning, so blood testing is usually done between 8 and 10 a.m. It might be done on more than one day.
If tests show low testosterone, further testing can help find the cause:
Pituitary hormone testing: finds out whether the brain is signaling the testicles.
Semen analysis: checks whether enough sperm is being produced.
Pituitary imaging: looks for tumors or structural problems.
Gene studies: identifies inherited causes such as Klinefelter syndrome.
If your case needs deeper hormone expertise, you might be referred to an endocrinologist — a doctor who specializes in conditions involving the hormone-producing glands.
How Is Male Hypogonadism Treated?
Treatment for Adults
Testosterone replacement can raise testosterone levels and ease the symptoms of male hypogonadism — including less desire for sex, less energy, less facial and body hair, and loss of muscle mass and bone mass.
For older adults who have low testosterone and symptoms of hypogonadism due to aging, it is less clear how well testosterone replacement works.
Anyone taking testosterone replacement should have a medical checkup and blood tests several times during the first year of treatment and yearly after that — to see how well the treatment works and to watch for side effects.
Forms of Testosterone Replacement Therapy
Testosterone taken by mouth (oral) isn't often used for treatment because it can cause serious liver problems and doesn't keep levels even. One exception: the FDA has approved one oral testosterone replacement — testosterone undecanoate (Jatenzo, Tlando, Kyzatrex) — which the lymph system absorbs, so it may avoid the liver problems of other oral forms. It is not used for hypogonadism caused by aging.
Other forms depend on ease of use, cost, and insurance coverage:
Gels: rubbed onto the upper arm or shoulder, or applied to the thigh; absorbed through the skin. Don't shower for several hours after. Side effects: skin irritation and transfer to others by touch — wait until dry or cover the area.
Shots: injected into a muscle or under the skin, using testosterone cypionate or enanthate; levels may vary between doses. You can learn to inject at home. A deep-muscle form (undecanoate) is given by a medical team every 10 weeks and can have serious side effects.
Patch: worn on an arm or the torso each night. Possible mild or severe skin problems.
Buccal (gum and cheek): a small putty-like tablet stuck above the top teeth, three times a day, sends testosterone into the bloodstream; can irritate the gum.
Nasal gel: pumped into each nostril three times a day. Reduces the risk of transfer to others; slightly harder to use.
Pellets (implants): surgically placed under the skin every 3 to 6 months. A long-lasting option.
Risks of testosterone therapy include making too many red blood cells, acne, bigger breasts, sleep problems, growth of the prostate, and reduced sperm production. These risks are most often due to doses that are too high, and many side effects go away when the dose is lowered. Regular follow-up visits — with blood monitoring of testosterone levels — are essential.
Treatment for Infertility
If a pituitary problem is the cause, pituitary hormones can be given to help the body make more sperm and restore fertility. A pituitary tumor may need treatment with surgery, medicine, radiation, or replacement of other hormones.
There is often no way to help men with primary hypogonadism make sperm. But there are ways to help couples who haven't been able to have children — assisted reproductive technology offers options.
Treatment for Boys
Treatment of delayed puberty in boys depends on the cause. Three to six months of testosterone shots can help start puberty — increasing muscle mass, beard and pubic hair growth, and growth of the penis. This treatment is given only if the bones have matured enough.
Coping and Support: Living with Male Hypogonadism
Having male hypogonadism can affect how you see yourself, and it can also affect your relationships. Talk with a member of your healthcare team about reducing the anxiety and stress that often accompany this condition — counseling might help.
Support groups, whether in your area or online, put you in touch with other people who share similar concerns.
Preparing for Your Appointment
You are likely to start by seeing your primary healthcare provider, who may refer you to an endocrinologist. To prepare, make a list of:
Your symptoms: including any that may seem unrelated and when they began.
Key personal information: such as major stresses, recent life changes, and childhood illnesses or surgeries.
All medicines, vitamins, or supplements: with doses.
Questions to ask: such as: What's the most likely cause? What tests do I need? Is my condition temporary or long-lasting? What treatments are available? How do I manage other health conditions together?
Be prepared for your doctor to ask about your symptom patterns, when your puberty began, childhood growth problems, testicle injuries, whether you had the mumps with testicle pain, undescended testicles at birth, childhood genital or groin hernia surgery, and snoring or disrupted breathing at night.
Can Male Hypogonadism Be Prevented?
Some causes of hypogonadism — such as inherited chromosome conditions or congenital testicle problems — cannot be prevented. However, several acquired risk factors are within your control. Treating obstructive sleep apnea may reverse related hypogonadism. Maintaining a healthy weight, eating a nourishing diet, and reviewing medicines (such as long-term opiate use) with your healthcare team can all lower risk. For boys with undescended testicles, correction in early childhood helps the testicles work correctly.
Conclusion
Male hypogonadism is a hormone condition with a deceptively simple definition — too little testosterone, too little sperm, or both — but its impact reaches across an entire lifetime. When it begins in the womb or childhood, it shapes physical development. When it begins in adulthood, it quietly drains energy, mood, sexual function, and bone strength. The good news is that its two pathways — primary (testicle-based) and secondary (brain-signaling) — are well understood, and morning blood testing makes the diagnosis straightforward.
Treatment is equally clear: testosterone replacement in the form that fits your life — gel, shots, patch, nasal gel, gum tablet, or implant — backed by regular checkups that keep the dose in a safe, effective range. Whether you are a parent noticing delayed puberty in a son, or a man who has felt "off" for months without knowing why, the first step is the same: a simple appointment, a morning blood test, and a plan built on your specific cause.
The entire burden of this condition can be managed with two simple habits: notice the pattern of symptoms early (low drive, low energy, mood changes rarely appear alone) and keep follow-up blood tests on schedule once treatment begins.
Have you felt a lasting drop in energy, sex drive, or mood — or noticed delayed development in a son? Talk to a healthcare professional about a morning testosterone test. One lab visit can start a conversation that restores strength, mood, and confidence.
Frequently Asked Questions
What is male hypogonadism?
Male hypogonadism is a condition in which the body doesn't make enough of the hormone testosterone, enough sperm, or both. It can be present at birth or develop later in life, and testosterone replacement therapy can treat some types.
What are the symptoms of low testosterone in men?
Early adult symptoms include less sex drive, less energy, and depression. Over time, men can develop erectile dysfunction, infertility, less facial and body hair, less muscle mass, breast tissue growth, and bone loss. Severe cases can also cause trouble focusing and hot flashes.
Is male hypogonadism inherited?
It can be. An inherited trait can cause either the primary type (testicle problem) or the secondary type (brain signaling problem). Klinefelter syndrome and Kallmann syndrome are two inherited causes. Risk also increases with aging, obesity, malnutrition, sleep apnea, HIV/AIDS, and past chemotherapy or radiation.
How is low testosterone diagnosed?
With a blood test for testosterone, usually done between 8 and 10 a.m. when levels are highest, and possibly repeated on another day. If levels are low, further testing — pituitary hormones, semen analysis, pituitary imaging, and gene studies — finds the cause.
Can male hypogonadism be treated?
Yes. Testosterone replacement raises levels and eases symptoms such as low sex drive, low energy, and loss of muscle and bone mass. It comes as gels, shots, patches, nasal gel, gum tablets, or implanted pellets, and doses are adjusted through regular follow-up blood tests.
Does testosterone therapy have side effects?
Possible risks include too many red blood cells, acne, breast enlargement, sleep problems, prostate growth, and reduced sperm production. These are most often caused by doses that are too high and often resolve when the dose is lowered, which is why regular monitoring matters.
Can male hypogonadism cause infertility? Is it reversible?
Yes, it can cause infertility. When a pituitary problem is the cause, pituitary hormones can restore sperm production and fertility. With primary hypogonadism, there is often no way to help men make sperm, but assisted reproductive technology can help couples have children.
At what time should a testosterone blood test be done?
Usually between 8 and 10 a.m., because testosterone levels are most often highest in the morning. The test might be done on more than one day to confirm the result.
References
Symptoms & causes of male hypogonadism (updated Sep. 20, 2024)
Diagnosis & treatment of male hypogonadism (updated Sep. 20, 2024)
Rinnit.com provides general health information for educational purposes. This article is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare professional for guidance specific to your situation.
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