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What Causes Low Testosterone? (Male Hypogonadism)

Michael Garrico
Published by Michael Garrico
Fact checked by Donald Christman, BHSc FACT CHECKED
Last updated: March 16, 2022

Men’s testosterone levels decrease about 1-2% every year, but this decline is expected after the age of 30.

However, if the testicles don’t produce enough testosterone, this condition is known as male hypogonadism. It can happen at any age and should be treated.

After spending hundreds of hours researching hypogonadism and other causes of low testosterone, I consulted a urologist to double-check my findings so I can share them with you.

Read on to discover what causes low T and how you can treat it.

Summary

  • Low testosterone or hypogonadism can be caused by several factors, including inherited conditions, certain illnesses, accidents, and damage to the pituitary gland or hypothalamus. 
  • Symptoms of low testosterone or male hypogonadism vary depending on the age of an individual.
  • Low testosterone can start during fetal development, puberty, or adulthood. 
  • Men can treat hypogonadism with the help of lifestyle adjustments or testosterone replacement therapy (TRT).

What Is the Number One Cause of Low Testosterone?

man checking his crouch with a magnifying glas

There’s no number one cause for low testosterone, as different factors can bring about the condition.

You can develop hypogonadism if you experience an accident, illness, damage to the hypothalamus or the pituitary gland, or if you were born with certain medical conditions.

Low T affects around 4 to 5 million men in the United States [1]. Between 19% and 35% of older men have hypogonadism, but it’s not just them who can experience it [2].

It can affect young men, children, and teenagers as well.

Common Causes of Hypogonadism

Two types of low testosterone conditions are primary and secondary hypogonadism. Let's talk about the potential causes of these two types of hypogonadism.

Primary Hypogonadism

ill woman and a man covering his crouch

When the testes are not producing sufficient testosterone, it may cause primary hypogonadism, also known as “primary testicular failure.” This under-activity can be due to an inherited condition or acquired through an accident or illness.

Undescended Testicles

Before birth, testicles develop in the abdomen and descend into their permanent place in the scrotum. Sometimes, one or both testicles don’t move down [3].

This condition usually corrects itself within the first few years without treatment. However, it can lead to the malfunctioning of the testicles and decreased testosterone production if not corrected in early childhood.

Klinefelter Syndrome

A male usually has one X and one Y chromosome. But individuals with Klinefelter syndrome are born with three sex chromosomes: X, X, and Y.

The extra X chromosome causes abnormal development of the testicles, leading to a decline in testosterone production [4].

Hemochromatosis

Too much iron in the blood can lead to testicular failure or pituitary damage, both of which affect testosterone production.

Physical Injury to the Testicles

Injury in both testicles can impair total testosterone production and cause hypogonadism.

Mumps Orchitis

Mumps infection can damage the testes, affecting their function and the production of testosterone.

Cancer Treatment

Chemotherapy or radiation can impede testosterone and sperm production. Although the effects of both treatments are often temporary, permanent infertility is still possible [5].

Secondary Hypogonadism

aging man and a big stomach

This type of male hypogonadism is caused by damage to the hypothalamus or pituitary gland—the parts of your brain that control hormone production by the testicles.

Medical conditions that cause secondary hypogonadism include:

Pituitary Disorders

An abnormality in the pituitary gland can hinder the release of hormones from the pituitary gland to the testicles, hindering average testosterone production [6].

A pituitary tumor or other brain tumor near the pituitary gland may also cause deficiencies in testosterone and other hormones.

Kallmann Syndrome

This condition is associated with abnormal hypothalamus function, which can affect the production of testosterone.

Inflammatory Diseases

Inflammatory conditions such as tuberculosis, histiocytosis, and sarcoidosis involve the pituitary gland and the hypothalamus, negatively impacting testosterone production.

HIV/Aids

These diseases affect the hypothalamus, the pituitary, and the testes, causing low T levels.

Normal Aging

As men grow older, their testosterone production naturally decreases. However, the rate at which it does varies significantly per individual.

Obesity

Being significantly overweight can impact hormone production and response at any age.

Medications

Drugs such as opioid pain meds and anabolic steroids can affect the functioning of the pituitary and the hypothalamus and, ultimately, the production of testosterone [7].

Concurrent Illness

Extreme emotional or physical stress from an illness or surgery can cause a temporary shut down of the reproductive system.

Symptoms of Testosterone Deficiency Syndrome

shirtless man holding his chest and a man upset

Symptoms of hypogonadism depend on the age of the person. They can start during fetal development, puberty, or adulthood.

If the body doesn’t produce enough testosterone during fetal development, it may result in the impaired growth of external sex organs:

  • Underdeveloped male genitals
  • Female genitals
  • Ambiguous genitals (neither male nor female)

If hypogonadism happens during puberty, it can hamper average growth and cause problems with:

  • Voice deepening
  • Muscle development
  • Growth of body and facial hair
  • Development of the penis and testicles
  • Enlarged breasts (gynecomastia)
  • Overly long limbs

Hypogonadism in adult males can affect specific masculine physical characteristics and hinder normal reproductive function. Early signs and symptoms to look out for might include:

  • Low sex drive
  • Low energy levels
  • Depression

How Do You Fix Low Testosterone?

healthy men flexing muscles

You can fix low testosterone by making specific lifestyle changes or undergoing testosterone replacement therapy. However, an individual must consult their doctor before trying any of these options.

Lifestyle Changes

If you’re experiencing low testosterone symptoms, you might want to make a few changes to your lifestyle.

You can start with the basics- increasing physical activity and consuming a nutrient-dense diet. Doing these will help you reduce body fat, improve your overall health, and ultimately increase hormone production.

Testosterone Replacement Therapy

The above methods are only a first step in treating low levels of testosterone. Doctors often prescribe testosterone replacement therapy (TRT) in varying forms to treat male hypogonadism.

“Treatment can consist of different formulations of testosterone, including topical gels or patches, injections into the muscle or skin, nasal gels, long-acting pellet implants, and other options.” - Sriram Eleswarapu, MD, Ph.D., Urology Specialist 

This treatment helps address low T symptoms such as low libido and sexual function, poor muscle mass, and decreased energy. In teenagers, TRT can help them go through normal masculine development.

man with acne and another man covering his crouch

However, TRT can have some side effects, including:

  • Breast enlargement or tenderness
  • Acne
  • Skin irritation 
  • Sleep apnea
  • Swelling in the ankles caused by fluid retention
  • Smaller testicles
  • Difficulty urinating
  • Decreased sperm count

That said, not everyone is eligible for testosterone therapy. This includes men who have early prostate cancer, as there are some concerns that testosterone may encourage cancer's growth [8].

That's why anyone considering this treatment plan is recommended to undergo prostate screening first.

How To Prevent The Causes Of Low Testosterone?

Low testosterone levels caused by genetic conditions or damage to the testicles or pituitary gland can’t be prevented but can be cured with certain treatments.

However, maintaining a healthy diet, increasing exercise, weight management, and avoiding alcohol and other drugs may help maintain optimal T levels.

For men with severe cases of low T, there’s always the option of undergoing testosterone replacement therapy if your doctor recommends it.

TRT has some side effects, and specific individuals aren’t allowed to have it, so it’s vital to consult a doctor first before going through with this testosterone treatment option.


References:

  1. https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948422/
  3. https://my.clevelandclinic.org/health/diseases/17594-undescended-testicles
  4. https://my.clevelandclinic.org/health/articles/9126-testicular-disorders
  5. https://www.cancer.gov/about-cancer/treatment/side-effects/fertility-men
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255409/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571549/
  8. https://www.hopkinsmedicine.org/news/articles/testosterone-as-a-drug

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