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What is Hypotestosteronism : Causes, Symptoms, Treatment, Prognosis, Prevention

What is Testosterone?

The adrenal gland of our body produce a hormone which define the sex characteristics of males called Testosterone, although females also have this hormone but the amount produced is much less than in males. In the females it is the ovaries and in males it is the testicles that have this hormone. The primary function of Testosterone is production and regulation of sex characteristics of males to include muscle development in males. Brain releases hormones to regulate the production of testosterone in humans. In males, the levels of testosterone increase when the individual attains puberty by pituitary gland and hypothalamus which leads to the development of distinct male characteristics like facial hair, penile enlargement, and sexual arousal.

What is Hypotestosteronism?

What is Hypotestosteronism?

Hypotestosteronism is a condition which is characterized by abnormal levels of the hormone testosterone. This condition is also known as hypogonadism or low testosterone (low T). When accurately measured, Hypotestosteronism is said to occur if the levels are below299 ng/dl in males, although some physicians believe the normal range to be between 269 – 1069 ng/dl. Even though majority of the cases of depleted testosterone levels are seen in males but this condition is at times also seen in females.

However, the incidences depleted testosterone levels in females are not that clear in the data available. Testosterone production begins in the endocrine system.

What Causes Hypotestosteronism?

Hypotestosteronism can occur due to various reasons and is broadly divided into three categories:

  • Primary Hypotestosteronism
  • Secondary Hypotestosteronism
  • Tertiary Hypotestosteronism.

Primary Causes of Hypotestosteronism: Primary hypotestosteronism or low-T refers to the failure or injury in the organs which primarily produce testosterone, i.e. in males testes and in females ovaries. Ageing, undescended testicles, injuries to the scrotum and testicles, orchitis, mumps, radiation or chemotherapy, failure of the ovaries to function or removal of the ovaries, chromosomal abnormalities are some of the factors, which cause primary hypotestosteronism.

Secondary & Tertiary Causes of Hypotestosteronism: Secondary hypotestosteronism or low T is linked to a dysfunction in regulating the testosterone by the pituitary gland. Tertiary hypotestosteronism or low T is related dysfunction in regulating testosterone by the hypothalamus. The causes are similar for cases of both secondary and tertiary Hypotestosteronism and involve both the hypothalamus and pituitary gland. These causes can affect both of them together as well.

Causes of hypotestosteronism of the secondary and tertiary types include tumors related to the hypothalamus or pituitary glands, treatment in the form of chemotherapy for tumors developing in the structures lose to these two glands in the brain, malformation of glands, reduced supply of blood to the glands, gland inflammation and intake of anabolic steroids.

Other Causes of Hypotestosteronism: Apart from the above mentioned categories, some other causes which reduce testosterone and cause hypotestosteronism are obesity, smoking, drug abuse, and diseases like COPD, hypertension, diabetes, and some renal conditions. Although rarely, but unusual cell mechanism and modified cell receptors can also lead to hypotestosteronism or low T.

What are the Symptoms of Hypotestosteronism?

Some of the common signs and symptoms of hypotestosteronism in males are erectile dysfunction, reduced libido, absence or decrease of spontaneous orgasm and erections, reduction in the size of testes, breast enlargement or discomfort, and loss or decrease of facial, armpit or pubic hair. Depression, memory reduction, sleep problems, sweating or hot flashes, decreased strength, infertility, decreased sperm production, conditions like anemia and osteoporosis, and increased BMI are other signs of hypotestosteronism. Most of the above mentioned symptoms, except those specific only for males, may be observed in females with hypotestosteronism too. An individual should get immediate medical attention on observing any symptoms associated with hypotestosteronism or low-T.

How is Hypotestosteronism Diagnosed?

Hypotestosteronism is diagnosed on the basis of a person’s history, the symptoms experienced, and a thorough physical evaluation. For males, a blood examination is conducted to measure the levels of testosterone and diagnose hypotestosteronism. For females, it is difficult to detect hypotestosteronism through a blood test and thus the diagnosis is dependent on physical findings and symptoms. To identify any underlying condition responsible for triggering hypotestosteronism, other blood and imaging tests may need to be conducted.

How is Hypotestosteronism Treated?

In males, the treatment for hypotestosteronism involves 2 approaches. Hypotestosteronism or low-T caused due to conditions like tumor, chemotherapy, HIV, diabetes, and obesity can be managed with specific treatment for each cause rendered separately. The hypotestosteronism levels can be replenished by prescriptive hormones. Prescribed testosterone therapy can be administered through pellet implant, an injection, dermal gel, oral gel, skin patch, or putty for the gums.

Although doctors prescribe certain form of testosterone supplement to females for treating hypotestosteronism but the safety and efficacy of this treatment is yet to be seen. Topical hormones should be administered with utmost care and caution. Females should avoid coming in contact with the area treated with absorbable testosterone since it can be absorbed by their skin and can lead to women developing male characteristics.

What is the Prognosis for Hypotestosteronism?

The overall prognosis for a male with hypotestosteronism can range from good to guarded and is depdent on the overall age and health status of the individual and the overall response to treatment. In cases where hypotestosteronism is diagnosed late and treatment begins after significant advancement of condition, the patient can suffer from osteoporosis and muscle loss. In women, the prognosis is less clear. Unless a treatment protocol or drug is approved by the Food and Drug Administration, testosterone treatments for hypotestosteronism would rely investigational therapies and off label use of medications.

Can Hypotestosteronism be Prevented?

One cannot prevent Hypotestosteronism caused due to genetic factors, chemotherapy, or inherited underlying condition. However, hypotestosteronism or low-T caused by obesity, drug abuse or smoking can be avoided, or its onset can be delayed, by making some lifestyle changes. Also, early diagnosis and prompt treatment of hypotestosteronism can help prevent its complications, such as bone and muscle loss.


  1. WebMD – Testosterone: https://www.webmd.com/men/what-is-testosterone#1
  2. Medscape – Hypogonadism: https://emedicine.medscape.com/article/122467-overview
  3. Healthline – Hypogonadism: https://www.healthline.com/health/hypogonadism
  4. Mayo Clinic – Male Hypogonadism: https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881
  5. Cleveland Clinic – Hypogonadism: https://my.clevelandclinic.org/health/diseases/15638-hypogonadism-low-testosterone
  6. Endocrine Society – Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes: https://www.endocrine.org/clinical-practice-guidelines/testosterone-therapy-in-adult-men-with-androgen-deficiency-syndromes

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 3, 2023

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