Information for healthcare professionals

What are Symptoms of hypogonadism?

Symptoms, physical examination, and blood testsThe symptom most associated with hypogonadism is reduced libido, however other manifestations can also be associated with low testosterone, and a diagnosis of hypogonadism is made on the basis of low serum testosterone levels occurring in association with one or more of the symptoms and signs listed in the Table.1,2 However, please consult guidelines relevant to your country of practice as country-specific differences in the diagnosis and treatment of hypogonadism exist.

General Signs and Symptoms for Hypogonadism:

Signs and symptoms suggestive of hypogonadism in men Other, less specific symptoms and signs associated with hypogonadism
Incomplete sexual development, eunuchoidism, aspermia Decreased energy, motivation, initiative, aggressiveness, self-confidence
Reduced sexual desire (libido) and activity Feeling sad or blue, depressed mood, dysthymia
Decreased spontaneous erections Diminished physical or work performance
Reduced muscle bulk and strength Poor concentration and memory
Hot flushes, night sweats Increased body fat, body mass index
Loss of body (axillary and pubic) hair, reduced shaving Insulin resistance
Breast discomfort, gynecomastia Sleep disturbance, increased sleepiness
Very small or shrinking testes Mild anemia
Inability to father children, low or zero sperm counts  
Height loss, low trauma fracture, low bone mineral density (osteoporosis)  

Symptoms for Hypogonadism based on onset of hypogonadism:

Organ/ ­affected function Onset of hypogonadism before completion of puberty Onset of hypogonadism after completion of puberty
Larynx No voice mutation No change
Hair Horizontal pubic hair line; straight frontal hair line; diminished beard growth Diminished secondary body hair; decreased beard growth
Skin Absent sebum production; lack of acne; pallor; fine skin wrinkling Decreased sebum production; pallor; fine skin wrinkling
Bone Eunuchoid tall stature; osteoporosis Osteoporosis
Haematopoiesis Anaemia Anaemia
Breast Sometimes gynaecomastia Sometimes gynaecomastia
Muscles Underdeveloped Atrophia
Penis Infantile No change/atrophy
Prostate Underdeveloped Atrophy
Testes Small volume; often maldescensus Decrease of volume
Spermatogenesis Not initiated Arrest
Mood Reduced Reduced
Erectile function and libido Not developed Loss

Symptoms typically met in late-onset hypogonadism (LOH)

Sexual Other
  • Diminished sexual desire and arousability (libido)
  • Loss of erectile quality and frequenc
  • Loss of particularly nocturnal erections
  • Depression, fatigue, lack of vigor, irritability
  • Decreased intellectual activity: cognitive functions, spatial orientation
  • Sleep disturbances
  • Decrease in lean body mass, diminution of muscle volume, and strength
  • Increase in visceral fat
  • Decrease in body hair and skin alterations
  • Osteopenia, osteoporosis, and increased risk of bone fractures

References

1 Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006; 91(6): 1995-2010.

2 Wang, C., E. Nieschlag, R. Swerdloff, et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 2008, 159(5): 507-514.

Last updated: 2018
G.MKT.GM.MH.01.2018.0500