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Testosterone is an essential sex hormone in the human body. Male hypogonadism or Testosterone deficiency syndrome is when the testes don’t produce an adequate amount of hormone that plays a crucial role in masculine growth and development during puberty.  Male hypogonadism may prevent puberty or cause lack of normal development. Some men may have low testosterone all their lives, while others may develop it later in life.

Testosterone naturally drops after age 30 and continues throughout life. As a man ages, slowly and gradually, the volume of testosterone declines.According to the American Urological Association, about 2 out of 10 men older than 60 have low testosterone. But it starts to decrease each year after age 30. It is difficult to define normal testosterone levels because levels vary every day and are affected by age, nutrition, body mass index, alcohol consumption, certain medications, and illness.

There are two main types of hypogonadism: Primary and Secondary hypogonadism.

Primary hypogonadism

Primary hypogonadism is either inherited, underactive testes, or occurs after an injury or illness. That’s because the body doesn’t produce sufficient levels of testosterone for optimal health and growth.  Inherited conditions include undescended testicles (Testicles that fail to descend at birth), Klinefelter’s syndrome (A situation in which a man is born with three sex chromosomes: X, X, and Y), and Hemochromatosis (High levels of iron).

Secondary hypogonadism

Secondary hypogonadism is caused by the damage to the hypothalamus or pituitary gland.

Factors related to secondary hypogonadism are-age, autoimmune diseases, high levels of body fat. 

Other factors or conditions that can cause low testosterone:

  • Genetic conditions
  • Testicular injuries or infections
  • Excessive alcohol use
  • Dysfunction or tumors of the pituitary gland
  • Untreated Type 2 diabetes
  • Problems with the pituitary gland
  • Inflammatory conditions such as sarcoidosis (a disease that causes inflammation of the lungs and other organs)
  • Opioid use
  • Obesity or extreme weight loss
  • Cirrhosis of the liver
  • Any cancer treatment involving chemotherapy
  • Mumps orchitis
  • Steroid abuse
  • Kidney failure
  • Severe hypothyroidism
  • Radiation exposure or prior surgery of the brain
  • Abnormal development of the hypothalamus
  • Various medications, including steroids and hormones that are commonly used to treat prostate cancer

Hypogonadism can begin during fetal development.

If hypogonadism starts during fetal development, the immediate result is undermined external sex organs’ growth. Depending on when hypogonadism begins and the level of testosterone present during fetal development, a male child may develop:

  • Genitals that are neither male nor female (ambiguous genitals)
  • underdeveloped male genitals
  • female genitals

How Common is Low Testosterone?

As low testosterone is a part of the natural aging process, it’s very common. Low T is more common in men who are overweight or have diabetes.  From or after the age of 30, a man starts decreasing testosterone levels and continues to reduce by about 1 percent every year for the rest of his life. Therefore, low testosterone affects almost 40 percent of 45 and older men, according to information from the Cleveland Clinic. In one research study, 30% of fat men had low T, compared to only 6.4% of those with average weight. The same survey found diabetes a risk factor for low T. In another study, 24.5% of men with diabetes had low T, compared to 12.6% of those without diabetes.

 Remarkable symptoms of testosterone deficiency or low testosterone include:

  • Low sex drive(libido)
  • Depression
  • Erectile dysfunction(ED)
  • Irritability
  • Fatigue
  • Hair loss
  • Decreased bone mass
  • Reduced lean muscle mass
  • Low semen volume
  • Mood swings
  • Increased body fat
  • Difficulty sleeping(sleep apnea)
  • Low blood counts
  • Affected memory
  • Smaller testicle size
  • Hot flashes
  • Decreased body hair

Low t treatment

The most common and beneficial treatment is Testosterone Replacement Therapy (TRT). If you have several low testosterone symptoms and your blood test results show a deficiency of testosterone, your doctor will typically prescribe TRT.There are several delivery methods or options for TRT, including:

  • Gels
  • Skin patches
  • Pellets
  • Tablets that dissolve in the mouth
  • Injections