Hypogonadism is when the body doesn’t produce enough sex hormones, causing low libido, fatigue, and muscle weakness. Hypogonadism can be caused by aging or other conditions that affect hormone production. There is no cure for hypogonadism, but there are treatments that can help manage symptoms.
If you think you may have hypogonadism, it’s important to seek a diagnosis from a qualified healthcare provider. A good place to start is by talking with your primary care doctor or endocrinologist, who will likely take an extensive medical history and perform a physical examination. Your doctor will also likely order blood tests, which will help determine if there are any issues with testosterone production or other hormones related to sex development.
You may also get blood samples of your pituitary gland (the part of the brain that regulates sex hormones) and nerve endings in various parts of your body (including the scrotum). Tests like these help diagnose hypogonadism when there are no clear symptoms but can also reveal other conditions, such as diabetes or prostate cancer, that may be causing low levels of testosterone production.
Hypogonadism Treatment: Hormone Replacement Therapy (HRT)
One of the most effective treatments for hypogonadism is hormone replacement therapy (HRT). This treatment option can be taken by mouth, injection, or gel.
HRT works by restoring testosterone levels to normal. It may also increase sperm production in men and sometimes restore fertility. Doctors typically recommend waiting until you reach your mid-20s before starting this treatment, if possible.
Hormone replacement therapy is not a permanent solution. It only increases testosterone levels to normal, so you’ll need to be on it for life. The treatment can also have side effects, including breast growth in men and women.
You should talk with your doctor about HRT and other treatment options if you have hypogonadism. You’ll likely need to take testosterone for life to maintain normal hormone levels.
If you decide to try the gel, here’s what you can expect:
- How it’s applied: The gel comes in a small bottle and is applied to the skin of your upper arm or abdomen once a day. It takes about an hour before it starts working and will remain effective for around 24 hours. You can apply the gel more than once a day if needed—but do not use it more often than every four hours (or thrice in one day).
- Side effects: Some people may initially experience mild itching; this should go away after a few days. Other possible side effects include acne-like breakouts on your face or body, tender breasts, flu-like symptoms such as fatigue or fever, headaches, and nausea/vomiting. The most serious side effects are an allergic reaction and swelling of your face or throat, which could be life-threatening.
You can inject testosterone into your muscles, typically in the thigh or buttocks. Your doctor will give you specific instructions on how to do this. You should not inject testosterone directly into your veins or arteries.
Testosterone injections come in several different forms:
- Long-acting formulations (testosterone undecanoate injection) are injected into a muscle every two to three weeks and can be stored at room temperature for up to 10 years.
- Short-acting formulations (testosterone enanthate, methyltestosterone) must be refrigerated and used within three months of their manufacture date. They’re usually injected every two to three weeks, but they may cause pain at the injection site when injected too frequently (more than once per week).
Hormones are absorbed through your skin and enter your bloodstream. The patch is a type of hormone replacement therapy that comes in the form of a small sticky disc called a “patch,” which is changed every three to seven days. This method has several benefits:
- Because it’s applied to the skin, not swallowed or injected into muscles, it may be easier on your body.
- The hormones are delivered directly to where they need to go—your bloodstream—so there’s no chance for them to get lost along the way and end up in other parts of your body where they don’t belong.
- Since you only need one patch per week (except if you’re using testosterone), this means fewer appointments with your doctor than oral forms of treatment would require.
Gum and cheek (buccal cavity)
One of the most common ways to replace testosterone is taking a pill. But you can also get it from places like your gum and cheek (buccal cavity), which is a good option if you don’t like swallowing pills.
- You won’t have to swallow any pills, so it’s easier to take than other replacement therapy.
- This method only lasts as short as other replacement therapy, so you’ll need to take another dose every few hours or days. This makes it hard if you’re on the go all day long!
Nasal sprays can be helpful for some men. One nasal spray that has been well-studied is testosterone gel, which you apply to your upper lip every morning. This treatment can restore your testosterone levels to normal, as well as your fertility and sex drive.
However, it’s important to understand that no studies show that low testosterone levels or hypogonadism cause a decline in these areas. In many cases, doctors prescribe topical gels because they’re still trying to determine what’s causing low T levels in the first place. As long as you’re receiving treatment for this condition and have received a diagnosis from a doctor, you should see positive results over time (though there may be some short-term side effects).
Implantable pellets, placed under the skin, are a newer option for treating hypogonadism. They contain testosterone or human chorionic gonadotropin, which releases hormones over time. This can be used to treat infertility caused by hypogonadism because there’s no need for daily injections, and it lasts longer than hormone replacement therapy (HRT).
Treatment of infertility due to hypogonadism
Testosterone replacement therapy is the main treatment for hypogonadism. Testosterone is the male hormone important for sexual function, muscle mass and strength, bone density, and more.
Testosterone replacement therapy can help treat infertility in men. It can also help men with hypogonadism feel better about themselves and improve their moods by increasing their energy levels, sex drive, and overall self-esteem.
Risks of Hormone Replacement Therapy
Now that we’ve covered the basics, let’s talk about some precautions you should take before starting hormone replacement therapy (HRT). First, if you’re taking testosterone or another androgenic hormone-like DHEA, which can be converted into testosterone in men—you should have a baseline PSA test done. Any additional androgens could cause further inflammation and possibly cancer if your prostate is enlarged or inflamed.
If you decide to go with HRT for hypogonadism, keep in mind that it increases your risk of cardiovascular disease by three times what it was before treatment. This means there’s an increased chance of heart attacks, strokes, and even death from other causes.
HRT also increases blood clotting factors which can lead to thrombosis (blood clots) in whatever part of your body is being exposed most often:
- Breast tissue for women who take estrogen.
- Lower limbs for men who take testosterone.
- Brain tissue for anyone who takes progesterone or estradiol pills (also known as “birth control”).
It’s important not only that you don’t smoke while on HRT but also that you make sure all doctors are aware if they prescribe blood thinners like Coumadin® (warfarin) because these drugs may interact negatively with other medications on board at any given time!
If you have hypogonadism, there are treatment options available to you. The first step is to make an appointment with your doctor so they can determine if there is a cause for your symptoms. After that, they can prescribe testosterone therapy or other treatments based on their diagnosis results.
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