Hypogonadism

Male gonads, called the testes, produce the hormone testosterone and sperm. When the testes do not function properly, a man can experience a deficiency of testosterone (low testosterone level), reduced sperm development, or infertility. Hypogonadism can be present at birth, or it can be caused by a defect of the testicles, hypothalamus, or pituitary gland. It can also be induced by chronic use of anabolic/androgenic steroids.

As many as 1 in 5 men have low testosterone levels, with only 10 percent of them knowing they have the condition. Sometimes this condition is known as andropause. A low testosterone level can result in fatigue, decreased sex drive, difficulty concentrating, hot flashes, irritability, depression, erectile dysfunction, dry skin, and male infertility.

Evaluation
Hypogonadism is diagnosed by a detailed history by urologist David Shin, M.D.; use of the ADAM questionnaire; and blood tests to check leutinizing hormone (LH), follicle stimulating hormone (FSH), and total and free testosterone levels.

Treatments
Treatment is based upon whether the patient is young and concerned about fertility or over the age of 60. If preserving male fertility is not an issue, then there are several treatment methods, all of which involve giving testosterone supplementation to the patient:

• Testosterone replacement gel
• Testosterone injection therapy
• Implantable Testopel® testosterone pellets, the only testosterone pellets approved by the FDA. Testopel® is implanted under the skin during a simple office visit every three to six months.

If preserving male fertility is important, please refer to the treatment section on male infertility.