Hypogonadism (Low Testosterone)

Men with hypogonadism have low levels of testosterone (low T) and accompanying symptoms, which may include a decrease in sexual desire, erectile dysfunction, reduced muscle mass and strength, a reduction in bone density, changes in mood, and/or an increase in fat mass. If hypogonadism occurs in aging men, it is called late onset symptomatic hypogonadism or andropause. Hypogonadism can occur in younger men who have a testicular disorder (primary hypogonadism) or a disorder of the neuroendocrine system (secondary hypogonadism). These disorders can develop as a result of disease, heroin and cocaine abuse, or other factors.

Treatment for Hypogonadism

Doctors usually treat low testosterone with direct testosterone replacement therapy. For years testosterone therapy was available in only two forms, oral drugs and injections. But oral testosterone can be toxic to the liver, and testosterone injections, which are more effective and safer, produce peaks and valleys in testosterone levels. Transdermal testosterone patches met with limited success because they can irritate the skin. The topical gels (applied to the skin daily) are a very effective method of testosterone replacement therapy that most men tolerate well. This gel is applied daily to the skin of the upper arms and torso, and produces a constant level of testosterone. Testosterone replacement therapy is helpful for men suffering endocrine-related erectile dysfunction, but it also has several potential adverse effects. Doctors should monitor men on testosterone therapy regularly by checking blood levels of hormones and performing digital rectal exams. This monitoring is important because testosterone replacement therapy has a small risk of exacerbating a cancer that may already be present but not yet detected. There is no evidence that testosterone replacement causes prostate cancer.