What is hypogonadism?

Hypogonadism can occur when the sex gland (gonads) doesn’t produce enough, or any, hormones. It causes a low sex drive, altered sexual characteristics, infertility, and other health conditions.

Hypogonadism can affect both male and female adults, and teenagers. In teenagers, it can cause late puberty. In men, hypogonadism is caused by low levels of the testosterone hormone. In women, it’s caused by low estrogen and progesterone hormone levels. 

There are two types: primary, caused by insufficient sex hormones, and secondary, usually caused by the brain or pituitary gland. Either type can also be caused by an inherited trait, or from an injury or infection. 

When does hypogonadism begin?

It can start before birth when the fetus is developing, before puberty, or in adulthood, including after an injury or infection.


What causes hypogonadism?

It is caused when either the brain or the sex glands change the production of sex hormones. The reason why this happens is unknown. 

Primary hypogonadism in men is caused when the testicles don’t produce enough testosterone. In women, primary hypogonadism is caused when the ovaries don’t produce enough estrogen, progesterone and testosterone.

Secondary hypogonadism is caused by hypothalamus or pituitary gland problems. These parts of the brain tell the testicles or ovaries to produce hormones. Primary and secondary hypogonadism can occur at the same time. 

It is normal for men’s and women’s sex hormones to decrease in their late 40s or 50s. This can decrease sex drive (libido), but it’s not a specific cause of hypogonadism. However, a young adult with no interest in sex should be checked for hypogonadism. 

What causes primary hypogonadism?

  • Klinefelter syndrome is an inherited condition that causes men to have an extra X chromosome. The extra X chromosome causes abnormal development of testicles, causing underproduction of testosterone. 
  • Undescended testicles can happen when, before birth, one or both testicles fail to move down into their permanent place in the scrotum. They usually move into place without treatment during the first year of life. If this doesn’t happen by early childhood, the testicles may not function correctly, causing low testosterone production. 
  • A mumps infection that damages the testicles can occur in teenagers or adult men, and limits testosterone production. 
  • Hemochromatosis (too much iron in the blood) can cause testicles not to produce testosterone. It can cause the pituitary gland to dysfunction and reduce testosterone production.
  • Injury to one or both testicles. Damage to only one testicle may permit some testosterone production.
  • Cancer treatment with chemotherapy or radiation can interfere with testosterone and sperm production. These effects can be temporary, or cause permanent infertility. 

What causes secondary hypogonadism?

With secondary hypogonadism the testicles are normal. However, they don’t function properly because of the pituitary gland or hypothalamus. Causes include:

  • Kallmann’s syndrome is an abnormal development of the hypothalamus, which controls the pituitary gland hormones.
  • Pituitary abnormalities can slow or stop the release of hormones from the pituitary gland to the testicles, and reduce testosterone.
  • Pituitary or brain tumors can cause hormone deficiencies.
  • Brain tumor treatment (surgery or radiation) can affect the pituitary gland.
  • Inflammatory diseases that affect the hypothalamus or pituitary gland can alter testosterone production.  
  • HIV/AIDS affects the hypothalamus, pituitary gland and testicles, causing lower levels of testosterone.
  • Medications (opiate pain meds and some hormones) will affect production of testosterone.
  • Significant obesity, at any age, is linked to hypogonadism.

What increases risk for hypogonadism?

You have a higher risk of developing primary hypogonadism if you have: 

  • Diabetes, Addison’s disease or other adrenal gland disorders
  • Cancer treatments
  • Genetic disorders 
  • Hemochromatosis 
  • Liver or kidney disease
  • Surgery on reproductive organs
  • Hypothyroidism reduces thyroid hormone and affects testosterone production

Your risk of developing secondary hypogonadism is higher if you have:

  • Used opioid medications or anabolic steroids
  • Cancer treatments
  • Genetic disorders affecting brain development
  • Infections, including HIV
  • Brain surgery
  • Inflammatory diseases
  • Obesity
  • Pituitary tumors or disorders


What are symptoms of hypogonadism?

Symptoms depend on gender and the age when it developed. 

Teenagers may have secondary hypogonadism if they don’t start puberty at the normal age. Boys may have underdeveloped testicles or delayed facial hair growth. Girls may be delayed in starting menstrual periods and developing breasts.

In adults, symptoms include a low libido, sexual dysfunction, hair loss, hot flashes, fatigue and difficulty concentrating. Adult men can have erectile dysfunction, infertility, enlarged breasts and loss of muscle. Adult women may have abnormal menstrual periods and a milky discharge from their nipples. 

Fetal development – If the body doesn’t produce enough testosterone during fetal development, the infant may have impaired growth of its external sex organs. A child born genetically male may have female genitals, underdeveloped male genitals, or genitals that are not clearly male or female.

Puberty – In males, hypogonadism can delay puberty or cause abnormal development. It can delay growth of the penis and testicles, body and facial hair, muscle mass, and delayed voice deepening. It can cause breast tissue to develop and excessive growth of arms and legs.Adult development – Males’ reproductive process and masculine physical characteristics can be impaired. This may cause a low libido, low energy, and depression. If left untreated, male hypogonadism can cause erectile dysfunction, infertility, less facial and body hair, breast tissue growth, and loss of muscle and bone mass (osteoporosis). Severe cases can cause difficulty concentrating, hot flashes, and emotional changes.


How is hypogonadism diagnosed?

Your doctor will start with a physical exam and listen to your symptoms. Blood tests can check hormone and iron levels. An MRI or CT scan can check for pituitary or brain tumors. 

Men may have a semen analysis to measure sperm count. Women may have a pelvic exam, and ultrasound to check for ovarian cysts or polycystic ovary syndrome.


Can hypogonadism be treated?

Treatment is determined by the type of hypogonadism. Primary hypogonadism responds well to hormone replacement therapy, which will likely be ongoing. To increase hormone levels, men will have supplemental testosterone; women will have estrogen and progesterone supplements. Stopping therapy can cause symptoms to return.

Secondary hypogonadism that’s caused by a tumor may require medication, radiation therapy or surgery. Hormone levels may return to normal after treatment. 

At Inland Endocrine, we have highly trained specialists who provide the individual care and attention that will speed your recovery from hypogonadism. Call today for an appointment with Inland Endocrine’s treatment team.


Mayo Clinic. 2019. Male Hypogonadism. Retrieved 7-6-2021, {https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881}

Cleveland Clinic. 2020. Low Sex Drive (Hypogonadism). Retrieved 7-6-2021, {https://my.clevelandclinic.org/health/diseases/15216-low-sex-drive-hypogonadism}


Medically reviewed by:

Jodi B. Nagelberg, MD, MHA

Dr. Jodi Nagelberg is an endocrinologist, with board certification in Internal Medicine. She also holds a masters in Health Administration and Policy. She joins TeleMed2U as Endocrinology Director and supports our mission to increase access to healthcare for patients everywhere.

Postgraduate: University of Southern California Sol Price School of Public Policy Los Angeles, CA  Masters, Health Administration and Policy, 2011