Testosterone Deficiency
Testosterone deficiency, also referred to as hypogonadism, is a condition in which the male body doesn’t produce enough of the hormone responsible for masculine growth and development during puberty and sperm production. The condition can be congenital or it can be developed later in life, typically due to injury or injection.
Signs of Testosterone Deficiency
Low testosterone during fetal development may impair the growth of the external sex organs and cause genetic males to be born with:
Female genitals
Genitals that are not clearly male or clearly female (ambiguous genitals)
Underdeveloped male genitals
During puberty, low testosterone can inhibit normal development:
Muscle mass growth
Voice deepening
Growth of body and facial hair
Growth of the penis and testicles
As a result, boys can experience excessive growth of the arms and legs, compared to the trunk of the body, as well as development of breast tissue.
Low testosterone in adult males can cause the following symptoms:
- Infertility
- Decreased energy
- Erectile dysfunction
- Hot flashes
- Loss of bone mass (osteoporosis)
- Decrease in hair growth on the face and body
- Decreased sex drive
- Decrease in muscle mass
- Development of breast tissue (gynecomastia)
- Difficulty concentrating
The Two Types of Hypogonadism
Primary hypogonadism is also called primary testicular failure, which indicates the problem originates in the testicles. Secondary hypogonadism indicates a problem in the hypothalamus or the pituitary gland. These parts of the brain tell the testicles to produce testosterone.
The Causes of Low Testosterone
Causes of primary hypogonadism include:
Klinefelter syndrome
Undescended testicles
Anabolic steroid abuse
Injury to the testicles
Cancer treatment
Causes of secondary hypogonadism include:
Kallmann’s syndrome
Pituitary disorders
Aging
HIV/AIDS
Medications
Obesity
Testosterone Replacement Therapy
Patients with testosterone levels below 300 ng/dl may benefit from testosterone replacement therapy (TRT). This treatment may be an option for men also experiencing the following:
- Unexplained anemia
- Diabetes
- Radiation to the testicles
- Chronic narcotic use
- Pituitary gland disorders
- Insulin resistance
- History of chemotherapy treatment
- Low-trauma bone fracture
- Positive HIV/AIDS test results
- History of infertility
- Bone density loss
- History of corticosteroid use
Patients prescribed testosterone may take the hormone through the transdermal approach, which includes topical gels, creams, liquids, or patches.
Another option is to take testosterone as a dissolvable oral tablet. A buccal patch can also be placed above an incisor tooth to deliver testosterone.
Hormone replacement pellets can be placed under the skin, typically in the buttock or a hip. A healthcare professional will numb the patient’s skin, make a small incision, and insert the pellets. Depending on how many pellets the patient receives, treatment can last for three to six months.
Patients can also receive injections, which can be long-acting or short-acting. Intranasal testosterone can be delivered as a gel that is pumped into the nose through the nostrils. In this approach, patients have to pump the gel into the nose three times a day.
Potential Side Effects of Hormone Replacement Therapy
Testosterone that is applied to the skin or injected may cause redness or irritation at the application or injection site. Other side effects may include increased risk of erythrocytosis and negative impact on sperm production.
