Hypogonadism is a medical term that describes when the body does not produce sufficient sex hormones. “Hypo” means low or below normal levels, while “gonads” refers to the sex glands.

Hypogonadism, also known as gonadal deficiency, refers to when the sex glands produce little to no sex hormones. Generally, the ovaries are the sex glands in people assigned female at birth (AFAB), while the testes are the sex glands in those assigned male at birth (AMAB).

The gonads, also known as the primary reproductive organs, are responsible for releasing sex hormones. These hormones help control secondary sex characteristics. This refers to physical features that people may relate to sex, such as breast and testicular development, as well as pubic hair growth. Sex hormones also play a role in menstruation and sperm production.

Treatment options may vary but typically involve treating the responsible underlying health condition or receiving hormone injections.

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Health experts typically refer to two main types of hypogonadism: Primary and secondary.

Primary hypogonadism

Primary hypogonadism refers to when a deficiency in sex hormones occurs due to a problem in the ovaries or testes.

This is also known as hypergonadotropic hypogonadism. It refers to hypogonadism while the body produces high levels of gonadotropins. These are hormones that regulate ovarian and testicular function. As such, the gonads still receive signals from the brain to produce sex hormones but are unable to produce them.

Secondary hypogonadism

With secondary hypogonadism, also known as central hypogonadism, the problem instead occurs in the brain. It happens due to the hypothalamus or pituitary gland not functioning correctly.

This type of hypogonadism is also known as hypogonadotropic hypogonadism. This is because problems with the hypothalamus or pituitary gland result in low levels of gonadotropins — which means that the gonads do not receive stimulation to release sex hormones.

Generally, hypogonadism can be either congenital or acquired. This means a person may be born with a genetic alteration or develop hypogonadism after birth.

Potential causes of primary hypogonadism include:

Possible causes of secondary hypogonadism include:

As hypogonadism affects puberty, it may not cause noticeable symptoms in children who have not yet reached puberty. In teenagers, it can delay or prevent sexual development.

Potential symptoms of hypogonadism in those AFAB include:

The complications of hypogonadism may include a higher risk of osteoporosis and cardiovascular disease.

In people AMAB, the symptoms of hypogonadism may include:

  • small or ambiguous genitals
  • young appearance
  • lack of body and pubic hair
  • high voice
  • difficulty gaining muscle
  • low sex drive
  • erectile dysfunction
  • osteoporosis
  • depression
  • breast development
  • dry, thin skin
  • infertility

Typically, a diagnosis of hypogonadism will begin with a physical exam. A doctor will check for signs of sexual development in line with a person’s age. This may involve examining muscle mass, body hair, and sexual organs.

If a doctor suspects hypogonadism, they will request blood tests to measure hormone levels.

For those AFAB, this will involve measuring estrogen levels. A doctor may also evaluate egg count by performing a sonogram or measuring anti-Mullerian hormones. For those AMAB, it will involve measuring testosterone levels. The doctor may also request a semen analysis to check the person’s sperm count.

Additionally, a doctor may measure other hormone levels, such as luteinizing hormone (LH) and follicle stimulating hormone (FSH). LH and FSH are pituitary hormones that stimulate the gonads. Other tests may also measure thyroid hormones and prolactin levels, as well as testing for anemia and possible genetic causes of symptoms.

A doctor may also request imaging tests. For example, an ultrasound may be able to identify problems with the ovaries, while MRI or CT scans can check for pituitary tumors.

Treating hypogonadism will generally involve managing the underlying cause, or treatment with hormone replacement therapy (HRT).

For example, if a pituitary tumor is causing hypogonadism, treatment will usually involve surgery to remove the tumor.

HRT uses medications to replace hormones that a person is not producing. People AFAB will require estrogen replacement therapy, and those AMAB will require testosterone replacement therapy. A person can administer HRT as an injection, oral pill, transdermal patch, topical gels, buccal tablets, or vaginal ring.

Both males and females may also receive hormone injections, such as FSH, gonadotropin-releasing hormone (GnRH), or human chorionic gonadotropin (HCG), to help induce fertility.

Hypogonadism refers to when a person produces little to no sex hormones. This can prevent or delay puberty and may mean that a person does not develop secondary sex characteristics, such as breast or testicular development and pubic hair growth.

Generally, it occurs due to problems with the gonads (the ovaries in those assigned female at birth and the testes in those assigned male at birth), or issues with the hypothalamus or pituitary gland.

Treatment will typically involve treating the underlying cause, or hormone replacement therapy to replace the sex hormones a person is not producing.