Low testosterone (male hypogonadism) is a condition in which your testicles don’t produce enough testosterone. It has several possible causes, including conditions or injuries affecting your testicles, pituitary gland or hypothalamus. It’s treatable with testosterone replacement therapy.
Low testosterone (male hypogonadism) is a condition in which your testicles don’t produce enough testosterone (the male sex hormone). Testicles are the gonads (sex organs) in people assigned male at birth (AMAB). More specifically, the Leydig cells in your testicles make testosterone.
Low testosterone causes different symptoms at different ages. Testosterone levels in adults AMAB naturally decline as they age. This includes cisgender men, non-binary people AMAB and transgender women who aren’t undergoing feminizing hormone therapy.
Other names for low testosterone and male hypogonadism include:
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Testosterone is the main androgen. It stimulates the development of male characteristics and is essential for sperm production (spermatogenesis). Levels of testosterone are naturally much higher in people assigned AMAB than in people assigned female at birth (AFAB).
In people assigned AMAB, testosterone helps maintain and develop:
Your body usually tightly controls the levels of testosterone in your blood. Levels are typically highest in the morning and decline through the day.
Your hypothalamus releases gonadotropin-releasing hormone (GnRH), which triggers your pituitary gland to release luteinizing hormone (LH). LH then travels to your gonads (testicles or ovaries) and stimulates the production and release of testosterone. Your pituitary also releases follicle-stimulating hormone (FSH) to cause sperm production.
Any issue with your testicles, hypothalamus or pituitary gland can cause low testosterone (male hypogonadism).
The American Urology Association (AUA) considers low blood testosterone to be less than 300 nanograms per deciliter (ng/dL) for adults.
However, some researchers and healthcare providers disagree with this and feel that levels below 250 ng/dL are low. Providers also take symptoms into consideration when diagnosing low testosterone.
Male hypogonadism is a medical condition that can affect people with testicles at any age from birth through adulthood.
Low testosterone is more likely to affect people who:
It’s difficult for researchers to estimate how common low testosterone is since different studies have different definitions for low testosterone.
Data suggest that about 2% of people AMAB may have low testosterone. And other studies have estimated that more than 8% of people AMAB aged 50 to 79 years have low testosterone.
Symptoms of low testosterone can vary considerably, particularly by age.
Symptoms that highly suggest low testosterone in adults assigned male at birth include:
Other symptoms of low testosterone in adults AMAB include:
Low testosterone before or during puberty for children assigned male at birth can result in:
There are several possible causes of low testosterone. The two types of male hypogonadism are:
Causes of primary and secondary hypogonadism are also divided into either congenital (at birth) or acquired (developed later in childhood or adulthood).
Primary hypogonadism happens when something is wrong with your testicles that doesn’t allow them to make normal levels of testosterone.
Another name for primary hypogonadism is hypergonadotropic hypogonadism. In this type, your pituitary gland produces more luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (known as gonadotropins) in response to low testosterone levels. The high levels of these hormones would normally tell your testicles to produce more testosterone and sperm. However, if you have damaged (most commonly related to prior chemotherapy) or missing testicles, they can’t respond to the increased levels of gonadotropins. As a result, your testicles make too little or no testosterone and sperm.
Sometimes in primary hypogonadism testosterone levels are within the normal range and gonadotropins are high. Your specialist will help you understand if you need treatment, even with normal testosterone levels.
Congenital conditions that affect your testicles and can lead to primary hypogonadism include:
Acquired conditions that affect your testicles and can lead to primary hypogonadism include:
Conditions that affect how your hypothalamus and/or pituitary gland cause secondary hypogonadism. This is known as hypogonadotropic hypogonadism because there are low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Those low levels cause decreased testosterone and sperm production.
Congenital conditions that can lead to secondary hypogonadism include:
Acquired conditions that can lead to secondary hypogonadism include:
Late-onset hypogonadism (LOH) is a type of secondary male hypogonadism that results from normal aging. As males age they have a deterioration of hypothalamic-pituitary function and Leydig cell function that decrease testosterone and/or sperm production.
LOH and low testosterone are more common in people AMAB who have Type 2 diabetes, overweight and/or obesity.
In one study, 30% of people AMAB who were overweight had low testosterone, compared to only 6% of those with weight in the normal range. In another study, 25% of people AMAB with Type 2 diabetes had low testosterone, compared to 13% of those without diabetes.
If you have signs and symptoms of low testosterone, a healthcare provider will perform a physical exam. They’ll also ask questions about your medical history, medications you take or have taken, smoking history and any symptoms you currently have. Blood tests may be ordered.
To make a diagnosis, a provider will consider your specific signs, symptoms and any blood test results.
The following tests can help confirm low testosterone and determine the cause:
Healthcare providers treat low testosterone (male hypogonadism) with testosterone replacement therapy. Testosterone replacement therapy has several different forms, including:
You may not be able to receive testosterone replacement therapy if you have a history of the following:
The side effects of testosterone replacement therapy include:
Laboratory abnormalities that can occur with testosterone replacement therapy include:
Healthcare providers and medical researchers don’t know how to prevent low testosterone from genetic conditions or damage to your testicles, hypothalamus or pituitary gland.
Lifestyle habits that may help keep testosterone levels normal include:
There’s no one-time fix for low testosterone. However, consistent hormone replacement therapy helps improve sex drive, ease symptoms of depression and increase energy levels for many people assigned male at birth (AMAB) experiencing low testosterone. Treatment may also boost muscle mass and bone density.
The mortality of people AMAB with testosterone deficiency is significantly higher than among people AMAB with normal testosterone levels. But, it is unclear whether replacing testosterone to a normal level reduces that increased mortality. Treatment is largely focused on the treatment of symptoms, not the specific testosterone level.
For congenital hypogonadism in children assigned male at birth, testosterone replacement therapy often helps prevent problems related to delayed puberty.
If you’re taking hormone replacement therapy, regular follow-up appointments with a healthcare provider are important.
If you’re experiencing symptoms of low testosterone, such as a decrease in sex drive and hot flashes, talk to a healthcare provider. They will evaluate you and may order blood tests.
If your child assigned male at birth isn’t showing signs of puberty by the age of 14, talk to their pediatrician.
A note from Cleveland Clinic
Many people shrug off the symptoms associated with low testosterone as an unpleasant part of getting older. But you should address symptoms that interfere with your quality of life. If you’re noticing bothersome signs of low testosterone, see a provider and discuss your options for treatment.
Last reviewed by a Cleveland Clinic medical professional on 09/02/2022.
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