What are the symptoms of hypogonadism (low testosterone)?

Symptoms and signs of testosterone deficiency occur as a result of low testosterone levels or insufficient testosterone action, and hence benefit from testosterone therapy (regardless of whether there is an identified underlying etiology).1,6

Insufficient testosterone action (even at normal testosterone levels) can be caused by less sensitive androgen receptors (which is genetically determined)7 or elevated SHBG levels (which bind to testosterone and reduce the free “active” serum fraction of testosterone.8

Due to the multiple effects of testosterone, the health consequences of hypogonadism are wide-ranging with signs and symptoms affecting sexual, physical, metabolic and psychological domains.

Figure: Common symptoms and signs of hypogonadism (low testosterone) in men.1,3,6

 

Cardiometabolic
symptoms / signs

  • Obesity (BMI 30 or higher)
  • Abdominal (belly) obesity (waist circumference 102 cm or higher)
  • Metabolic syndrome
  • Insulin resistance, prediabetes or type 2 diabetes

Sexual symptoms

  • Small testes
  • Infertility
  • Decreased sexual desire and activity
  • Decreased frequency of sexual thoughts
  • Erectile dysfunction
  • Delayed ejaculation
  • Decreased volume of ejaculate
  • Decreased frequency or absent morning or night-time erections
symptoms of hypogonadism

Psychological symptoms

  • Irritability
  • Sadness
  • Depressive symptoms
  • Loss of energy
  • Reduced motivation
  • Poor concentration
  • Impaired memory
  • Decreased well-being and/or poor self-rated health
  • Decreased cognitive function (including impaired concentration, verbal memory, and spatial performance)

Physical symptoms

  • Decreased body hair
  • Gynecomastia (female breasts)
  • Decreased muscle mass and strength
  • Reduced physical performance
  • Hot flushes or sweats
  • Sleep disturbances
  • Fatigue
  • Reduced bone mineral density, osteoporosis, low trauma fractures

References

  • Dean JD, McMahon CG, Guay AT, et al. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. The journal of sexual medicine. 2015;12(8):1660-1686. Return to content
  • Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Mayo Clin Proc. 2016;91(7):881-896. Return to content
  • Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432. Return to content
  • Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The journal of sexual medicine. 2017;14(12):1504-1523. Return to content
  • Dohle GR, Arver S, Bettocchi C, Jones TH, Kliesch S. 2018 European Association of Urology (EAU) Guidelines on Male Hypogonadism. Available at https://uroweb.org/guideline/ male-hypogonadism Return to content
  • Morales A, Bebb RA, Manjoo P, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. Appendix available at: http:// www.cmaj.ca/content/suppl/2015/10/26/cmaj.150033.DC1/15-0033-1-at.pdf (accessed Sept 17, 2019). CMAJ. 2015;187(18):1369-1377. Return to content
  • Zitzmann M. Mechanisms of disease: pharmacogenetics of testosterone therapy in hypogonadal men. Nature clinical practice Urology. 2007;4(3):161-166. Return to content
  • Krakowsky Y, Conners W, Morgentaler A. Serum Concentrations of Sex Hormone-binding Globulin Vary Widely in Younger and Older Men: Clinical Data from a Men's Health Practice. Eur Urol Focus. 2019;5(2):273-279. Return to content