Overview

What is hypogonadism?

Hypogonadism occurs when sex glands called gonads produce little, if any, sex hormones. It affects teenagers and adults of all genders. The condition causes a low sex drive or libido. Hypogonadism is sometimes called gonad deficiency.

What are the sex glands and sex hormones?

Testicles (testes) in the male reproductive system produce testosterone, the main male hormone. Hypogonadism in men is the result of low testosterone.

Ovaries in the female reproductive system produce estrogen, progesterone and testosterone. Women with hypogonadism are often low in estrogen and progesterone.

What are the types of hypogonadism?

Two glands in your brain, the hypothalamus and pituitary, send signals to sex glands. These signals tell your body to make sex hormones. When you have hypogonadism, something within the brain or sex glands interferes with hormone production.

Healthcare providers look at the cause to determine if hypogonadism is:

Primary hypogonadism: A problem within the sex glands slows or stops hormone production.
Secondary (central) hypogonadism: A problem with brain signals affects hormone production.

Who might have hypogonadism?

Starting in their late 40s or 50s, everyone has lower amounts of sex hormones. As a result, sex drives decrease. These changes are expected. They aren’t necessarily a sign of hypogonadism. Younger people who have little to no interest in sex may have hypogonadism.

Conditions and treatments that raise the risk of primary hypogonadism include:

Endocrine (adrenal gland) disorders, such as diabetes or Addison’s disease.
Cancer treatments, including radiation therapy and chemotherapy.
Genetic disorders, such as Turner syndrome (in females) or Klinefelter syndrome (in males).
Excess iron (hemochromatosis).
Undescended testicles.
Liver disease or kidney disease.
Surgery on reproductive organs.

Risk factors for secondary hypogonadism include:

Anabolic steroids or opioid use.
Brain surgery.
Cancer treatments.
Genetic disorders that affect brain development, such as Prader-Willi syndrome.
Infections, including HIV.
Inflammatory diseases, such as sarcoidosis.
Obesity.
Pituitary tumors (adenomas) and disorders.

Symptoms and Causes

What causes hypogonadism?

It isn’t clear why some people develop hypogonadism. For unknown reasons, a problem with the sex glands or brain affects the body’s production of sex hormones.

What are the symptoms of hypogonadism?

Hypogonadism symptoms vary depending on the cause and a person’s gender. Teenagers may get a diagnosis of secondary hypogonadism when they don’t start puberty on time. For example, teen girls with hypogonadism may not get their periods or develop breasts. Boys might not grow facial hair or have underdeveloped testicles.

Adults may experience a low sex drive (sexual dysfunction), as well as hair loss and hot flashes. Other common complaints include fatigue and difficulty concentrating.

Signs of hypogonadism in females include:

Abnormal menstruation.
Milky nipple discharge.

Signs of hypogonadism in males include:

Enlarged breasts (gynecomastia).
Erectile dysfunction.
Infertility due to low sperm count.
Muscle loss.

Diagnosis and Tests

How is hypogonadism diagnosed?

Your healthcare provider will assess your symptoms and perform a physical exam. Women may also have a pelvic exam.

You may get one or more of these tests:

Blood test: A blood test can check levels of sex hormones, thyroid hormones, prolactin (pituitary gland hormone) and iron. You’ll get this test in the morning, when hormone levels are at their highest.
Imaging tests: An MRI or CT scan can identify tumors in the pituitary gland or brain. An ultrasound can check for problems like ovarian cysts or polycystic ovary syndrome (PCOS).
Semen analysis: This test measures sperm count.

Management and Treatment

What are the complications of hypogonadism?

Hypogonadism can cause:

Anxiety or depression.
Infertility.
Osteoporosis.
Relationship problems.

How is hypogonadism managed or treated?

Hypogonadism treatments vary depending on the cause. For primary hypogonadism, hormone replacement therapy can raise hormone levels. Men may have testosterone therapy, while women may have estrogen and progesterone hormone therapy. These treatments come in gels, implants, pills, shots and skin patches. Female hormone therapy may slightly increase a woman’s risk of uterine (endometrial) cancer, blood clots and strokes.

If a pituitary gland problem like a tumor causes secondary hypogonadism, you may need medication, radiation therapy or surgery.

Outlook / Prognosis

What is the prognosis (outlook) for people who have hypogonadism?

Primary hypogonadism can be a chronic condition that requires ongoing treatment. If you stop hormone replacement therapy, hormone levels can plummet, causing symptoms to return.

If a treatable condition like a pituitary gland tumor causes hypogonadism, hormone levels should return to normal after your healthcare provider treats the tumor.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

Erectile dysfunction or enlarged breasts (in males).
Low sex drive.
Menstruation changes (in females).
Nipple discharge.
Slow onset of puberty (in teens).
Unexplained hot flashes.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

Why did I get hypogonadism?
What type of hypogonadism do I have?
What is the best treatment for this type of hypogonadism?
What are the treatment risks and side effects?
What type of follow-up care do I need after treatment?
Should I look out for signs of complications?

A note from Cleveland Clinic

Low sex hormone levels can negatively affect your physical and mental health. Teenagers may be self-conscious about their underdeveloped appearance. Many adults experience some disinterest in sex as they get older. But a sudden drop or complete halt to any sexual desire may indicate hypogonadism. Don’t be embarrassed to tell your healthcare provider what’s going on (or not going on) in the bedroom. Treatments can get hormone levels back in the normal range.

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Low Sex Drive (Hypogonadism)