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Hypogonadism: Signs, Symptoms, and Complications – Verywell Health

Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.
Ana Maria Kausel, MD, is double board-certified in internal medicine and endocrinology/diabetes and metabolism. She works in private practice and is affiliated with Mount Sinai St. Luke's/Mount Sinai West.
People experience hypogonadism when their sex glands, or gonads, produce insufficient levels of sex hormones. In adult women, the ovaries don’t secrete enough estrogen, leading to hot flashes, changes in mood and energy levels, and irregular or stopped menstruation.
In men, an absence or lack of testosterone manufactured in the testicles causes low sex drive and loss of muscle tone, as well as gynecomastia (the development of breasts) in rare cases. Furthermore, hypogonadism before puberty significantly affects sexual and physical development.
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Since hypogonadism is defined by a lack of or low levels of sex hormones, the symptoms of the condition vary based on the sex at birth and stages of development. Significantly, hypogonadism delays the onset of puberty. In children and teenagers, this affects:
Hypogonadism is actually very common in adult women. It’s usually the result of menopause, which marks the end of menstrual cycles. The associated changes in estrogen levels cause:
Symptoms in adult men arise due to insufficient testosterone levels, either due to advanced age or other health conditions. Common signs are:
When hypogonadism is caused by a tumor in the pituitary gland (prolactinoma) or the brain (craniopharyngioma), additional complications may arise. These cases of central hypogonadism lead to a range of symptoms, including:
In addition, Kallmann syndrome, a genetic type of hypogonadism, has the same symptoms as other types, but there are also reductions in the senses of taste and smell (anosmia).
Most hypogonadism cases occur in older adults: women in their late 40s and early 50s and men in their 50s and 60s. As you age, there are natural fluctuations in your sex hormone levels. Menopausal women no longer produce estrogen, and older men naturally secrete less testosterone. Given the effects of hypogonadism—and since some therapies, medications, and chronic conditions can affect hormone production—these levels are often monitored in older people.
Left untreated and given time, hypogonadism can lead to additional, potentially debilitating health issues. The most common are:
In addition, the presence of comorbid (simultaneously occurring) conditions can increase the burden of hypogonadism. Of particular concern are:
Since hypogonadism is a hormonal disorder, it presents differently in children than it does in adults. As such, the signs that medical attention is needed among age groups.
For children or teenagers, delayed onset of puberty is the most obvious sign of an issue. The absence of breast buds and lack of periods in girls 13 and up, as well as lack of facial hair development and voice changes in teenage boys, may signal the need for medical intervention.
For adults with the condition, seek help if:
Since the symptoms of hypogonadism can mimic those of other conditions, it’s important that your doctor determine what’s causing your symptoms. The sooner you have a complete understanding of what’s happening, the sooner you can get proper treatment. Importantly, therapies and medications can help manage this condition.
Hormonal problems like hypogonadism are particularly challenging because they have a pervasive and persistent impact on your health. Though there are therapies that can manage symptoms, there’s no cure for hypogonadism, with treatment in many cases requiring an ongoing, sustained effort.
There’s also a good deal that the medical community still needs to learn about hypogonadism. With a firmer understanding of how it occurs, how it impacts other health conditions, and what therapies can do to help, treatment approaches will only improve. Certainly, the interventions used today are better than those of 20 years ago.
Integral in managing hypogonadism and its effects is patient awareness. If you have hypogonadism—or believe you might—become engaged and proactive. Seek timely medical help, ask questions, follow instructions, and learn as much as you can about the conditions. With the right help, you’ll no doubt join the many people who are successfully managing and even thriving with hypogonadism.
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National Institutes of Health. Hypogonadism. MedlinePlus. Updated August 29, 2020.
Bozzola M, Bozzola E, Montalbano C, Stamati F, Ferrara P, Villani A. Delayed puberty versus hypogonadism: a challenge for the pediatrician. Ann Pediatr Endocrinol Metab. 2018;23(2):57-61. doi:10.6065/apem.2018.23.2.57
Cleveland Clinic. Low sex drive (hypogonadism): symptoms, treatment. Updated November 20, 2020.
National Institutes of Health. Familial isolated pituitary adenoma. MedlinePlus Genetics. Updated August 18, 2020.
Yeo S, Holl K, Peñaherrera N, Wissinger U, Anstee K, Wyn R. Burden of male hypogonadism and major comorbidities, and the clinical, economic, and humanistic benefits of testosterone therapy: a narrative review. ClinicoEconomics and Outcomes Research. 2021;13:31-38. doi:10.2147/ceor.s285434

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