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Low testosterone (hypogonadism)

In medicine, the insufficient production of male hormones (including testosterone) by the testicle is called hypogonadism, although the word 'andropause' is often used colloquially, somewhat inappropriately.


Hypogonadism is characterised by:

  • reduced production of male sex hormones, of which the main one is testosterone, which plays a vital role in the growth of the testicles and the maintenance of their functions

  • a deficit in sperm production, which can in turn cause infertility

  • both conditions

Hypogonadism can be congenital (from birth) or secondary (therefore acquired over life), followed by injury or infection.
There are two forms of hypogonadism:

  • Primary or hypogonadotropic hypogonadism: This form, also known as a primary testicular failure, originates from a testicular problem.

  • Secondary or hypogonadotropic hypogonadism: this form is due to a problem with the hypothalamus-pituitary axis, a structure located in the brain, at the base of the skull and which releases messages (gonadotropins) that stimulate the production of testosterone in the testicles.

Both forms can be caused by hereditary (congenital) factors or arise later (acquired). Sometimes primary and secondary hypogonadism coexist.


Is there a cure for hypogonadism?


Hypogonadism can have adverse effects on the health of males and cause various problems resulting from insufficient testosterone production.
Effective therapy must have three goals:

  • Restore the correct levels of testosterone through hormone replacement therapy.

  • Treat pre-existing conditions that triggered hypogonadism

  • Improve the symptoms caused by hypogonadism, such as erectile dysfunction, decreased libido, etc.


I believe I have low testosterone levels. What can I do?


If you think you have symptoms attributable to low testosterone levels, we recommend seeing a specialist.
Our team is highly specialised in diagnosing and treating hypogonadism and treating related problems, such as erectile dysfunction or infertility. A detailed medical history will be collected during the first visit to arrive at a correct diagnosis and choose the best treatment to restore adequate testosterone levels.

What are the symptoms of low testosterone



Hypogonadism can occur before birth (at the fetal level), during puberty or in adulthood. Symptoms vary depending on the time of onset.

Fetal development

Insufficient testosterone production during fetal development can compromise the proper formation of the external and internal genitalia (in particular, the differentiation of male genitalia compared to female genitalia). Depending on when hypogonadism originates and based on testosterone levels, a genetically male baby can be born with:

  • Underdeveloped male genitalia

  • Female genitals

  • Ambiguous genitals: genitals that are neither male nor female



Hypogonadism can delay puberty or impair proper development. It can cause:

  • Failure to lower the timbre of the voice

  • Reduced or no growth of body hair

  • Insufficient growth of the penis and testicles

  • Reduced muscle mass development

  • The disproportionate increase of the limbs (arms and legs) compared to the torso

  • Breast tissue growth (gynecomastia)



Hypogonadism can change some male-specific physical characteristics in adult males and decrease fertility. Symptoms can include:

  • Erectile dysfunction

  • Poor sexual desire

  • Infertility

  • Reduction of beard and body hair growth

  • Reduction of muscle mass

  • Bone loss (osteoporosis)

  • Breast tissue development (gynecomastia)

  • Difficulty concentrating

  • Fatigue

Dottore ' s Appuntamento

How is the diagnosis made?

The specialist will perform a visit to assess whether your sexual development is in accordance with your age, by evaluating your pubic hair, muscle mass and the size of your testicles.

It is important to promptly identify hypogonadism in boys in order to prevent the problems associated with delayed puberty. In fact, early diagnosis and treatment ensure greater protection against osteoporosis and other associated problems.

The diagnosis of hypogonadism is based on the symptoms, the visit, and the blood levels of testosterone. Blood tests are usually done early in the morning, around 8 am, as testosterone levels vary throughout the day and generally peak in the morning.

If tests confirm low testosterone levels, further tests will be required to determine if it is a testicular or pituitary disorder.

Some of these exams are:

  • Hormonal dosage

  • Spermiogram

  • Pituitary imaging

  • Genetic tests

  • Testicular biopsy

Testosterone dosage plays an important role in the management of hypogonadism, helping the doctor determine the correct dose of the drug, both at the start of therapy and over time.

Therapy for hypogonadism

Treatment for male hypogonadism depends on the underlying cause (primary vs secondary) and the desire to preserve one's fertility.

For hypogonadism caused by testicular dysfunction (primary hypogonadism), your specialist will recommend hormone replacement therapy (testosterone replacement therapy). Testosterone replacement therapy can restore sexual function and muscle strength and prevent bone loss (osteoporosis). Additionally, people undergoing testosterone replacement therapy often report increased levels of energy, libido, and well-being.

If the cause is a problem in the hypothalamus-pituitary axis (secondary hypogonadism), gonadotropin therapy can be used to stimulate sperm production and restore fertility. Testosterone replacement therapy is a possible therapeutic approach but can impair fertility. A pituitary tumor, on the other hand, may require removal through surgery or radiotherapy or another type of hormone replacement therapy.

It is very important to carry out a preliminary evaluation of the prostate, as the possible presence of prostate cancer is an absolute contraindication to testosterone replacement therapy.

There are several methods of administering testosterone. The choice of different methods of administration depends on the patient's preferences, side effects and costs. It is found, in fact, in the following formulations:

Testosterone injections are safe and effective. The drug is injected intra-muscularly.

A testosterone-releasing patch is applied to the back, abdomen, forearm or thigh every evening. The patch is applied in rotation to different areas of the body to minimize the risk of allergic skin reactions.

Different formulations are available in the form of gels, with different methods of application. The gel formulation causes fewer skin reactions than patches. A potential side effect of the gel is the ability to transfer the drug to another person (with physical contact with bare skin) and therefore patients should avoid skin contact until the gel is completely resorbed or otherwise cover the skin. affected area.

Mucoadhesive tablets for cheek and gum
These small gelatinous looking tablets quickly attach to the gum allowing the drug to be absorbed.

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