Some men can be born with male hypogonadism, and in some, it can develop later in life, often caused by injury or infection.

Male hypogonadism is a condition in which the body doesn’t produce enough of the hormone that plays a key role in masculine growth and development during puberty (testosterone) or enough sperm or both.

You can be born with male hypogonadism, or it can develop later in life, often from injury or infection. The effects — and what you can do about them — depend on the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.


In adult males, hypogonadism can alter certain masculine physical characteristics and impair normal reproductive function. Early signs and symptoms might include:

  • decreased sex drive;
  • decreased energy;
  • depression.

Over time, men with hypogonadism can develop:

  • erectile dysfunction;
  • infertility;
  • decrease in hair growth on the face and body;
  • decrease in muscle mass;
  • development of breast tissue (gynecomastia);
  • loss of bone mass (osteoporosis).

Severe hypogonadism can also cause mental and emotional changes. As testosterone decreases, some men have symptoms similar to those of menopause in women. These can include:

  • difficulty concentrating;
  • hot flashes.

When to seek help

See a healthcare provider if you have symptoms of male hypogonadism. Finding the cause of hypogonadism is an important first step to getting appropriate treatment.


Male hypogonadism means the testicles don’t produce enough of the male sex hormone testosterone. There are two basic types of hypogonadism:

  • Primary. This type of hypogonadism — also known as primary testicular failure — originates from a problem in the testicles.
  • Secondary. This type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone. The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to make a follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then signals the testes to produce testosterone.

Either type of hypogonadism can be caused by an inherited (congenital) trait or something that happens later in life (acquired), such as an injury or an infection. At times, primary and secondary hypogonadism occur together.

Types of testosterone replacement therapy

One Food and Drug Administration-approved oral testosterone replacement preparation, testosterone undecanoate (Jatenzo), is absorbed by the lymph system. It might avoid liver problems seen with other oral forms of testosterone.

Other preparations you might choose, depending on convenience, cost, and your insurance coverage, include:

  • Gel. There are several gels and solutions available, with different ways of applying them. Depending on the brand, you rub the testosterone into the skin on your upper arm or shoulder (AndroGel, Testim, Vogelxo) or apply it to the front and inner thigh (Fortesta).Your body absorbs testosterone through your skin. Don’t shower or bathe for several hours after a gel application, to be sure it gets absorbed.

    Side effects include skin irritation and the possibility of transferring the medication to another person. Avoid skin-to-skin contact until the gel is completely dry, or cover the area after an application.

  • Injection. Testosterone cypionate (Depo-Testosterone) and testosterone enanthate are given in a muscle or under the skin. Your symptoms might waver between doses depending on the frequency of injections.You or a family member can learn to give testosterone injections at home. If you’re uncomfortable giving yourself injections, a member of your care team can give the injections.

    Testosterone undecanoate (Aveed) is given by deep intramuscular injection, typically every 10 weeks. It must be given at your provider’s office and can have serious side effects.

  • Patch. A patch containing testosterone (Androderm) is applied each night to your thighs or torso. A possible side effect is severe skin reactions.
  • Gum and cheek (buccal cavity). A small putty-like substance, gum-and-cheek testosterone replacement delivers testosterone through the natural depression above your top teeth where your gum meets your upper lip (buccal cavity).This product, taken three times a day, sticks to your gumline and allows testosterone to be absorbed into your bloodstream. It can cause gum irritation.
  • Nasal. This testosterone gel (Natesto) can be pumped into the nostrils. This option reduces the risk that medication will be transferred to another person through skin contact. Nasal-delivered testosterone must be applied twice in each nostril, three times daily, which might be more inconvenient than other delivery methods.
  • Implantable pellets. Testosterone-containing pellets (Testopel) are surgically implanted under the skin every three to six months. This requires an incision.

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