How is hypogonadism treated?

Hypogonadism can be treated by giving the patient testosterone, or by increasing the signals from the brain that cause the testicle to produce testosterone and sperm. The best treatment for hypogonadism depends upon the type of hypogonadism and the patient’s goals.

Testosterone replacement: The symptoms of low testosterone can be treated with testosterone replacement.

There are many factors a man needs to consider before starting replacement testosterone therapy. Not all men with low testosterone will have symptoms that are severe enough to need medication.

Like any medication, testosterone replacement has side effects. The most important side effect is that testosterone replacement causes a decrease in sperm production in most men. Age is an important consideration; testosterone naturally declines as men age, and we don’t yet know what a “normal” testosterone level for older men is.

Fertility: Some men who have hypogonadism will want to father children. In patients with secondary hypogonadism, the testicle can usually be stimulated to make testosterone and sperm by injecting drugs that imitate the gonadotropin signals from the brain. Because it takes almost three months for mature sperm to reach the semen, men will need to continue these drugs for many months in order to have the best chance at fertility. In many cases, men will be able to cause a pregnancy on their own once their sperm production has increased.

Drugs to increase testicular function do not work in men with testicular failure. Men with testicular failure and low sperm numbers may still be able to cause a pregnancy on their own, or may need to consider assisted reproductive techniques such as intrauterine insemination or in vitro fertilization.

A biopsy (a small sample) of the testicle to retrieve sperm may be recommended in some men with hypogonadism. When sperm are found, they can be used to create a pregnancy using a technique called intracytoplasmic sperm injection.

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