Testosterone Deficiency - Hypogonadism

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Testosterone Deficiency - Hypogonadism
Testosterone Deficiency - Hypogonadism
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Video: Low Testosterone (Hypogonadism): Dietary Causes (Deficiencies & Dietary Selections) 2023, February

Testosterone deficiency in men

The sex hormone testosterone is important for normal male development and a healthy organism. Testosterone influences, among other things, reproductive ability, sexual functions, muscle growth, bone density and it regulates fat metabolism. In the embryo, testosterone controls, among other things, the development of the male genitals. During puberty, the hormones begin to activate the production of sperm cells and increase testosterone production. This results in secondary male sexual characteristics (e.g. deep voice, facial hair, muscle mass, bone size, etc.) and sexual maturity occurs.


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  • The sex hormone testosterone
  • What affects testosterone levels?
  • What are the causes of a testosterone deficiency?
  • What are the symptoms?
  • How is the diagnosis made?
  • How is hypogonadism treated?
  • Dangerous doping
  • Whom can I ask?
  • How are the costs going to be covered?

The sex hormone testosterone

Testosterone is made by the Leydig cells in the testes. The production of testosterone and the formation of sperm (spermatogenesis) are controlled by other hormones, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH) and gonadotropin-releasing hormone (GnRH). These hormones are made in the hypothalamic-pituitary system. In the blood testosterone is bound and transported by a blood protein - sex hormone-binding globulin (SHBG).

What affects testosterone levels?

The testosterone level fluctuates even in healthy men and varies from man to man. During the day, the testosterone level is highest in the morning and in the morning. In addition, various factors can contribute to temporarily low testosterone levels. These include:

  • very overweight - mostly caused by a lack of exercise and an unbalanced diet,
  • high alcohol consumption, drugs, drug abuse,
  • long fasting,
  • very strenuous physical activity,
  • psychological stress,
  • severe infections and chronic diseases such as type 2 diabetes.

Physical changes in old age also cause testosterone levels to slowly decrease. A healthy lifestyle avoids additional negative influences on the production and effects of testosterone and helps to prevent a testosterone deficiency.

What are the causes of a testosterone deficiency?

A testosterone deficiency can have various causes. Depending on whether the disorder is in the testes or in the hypothalamus-pituitary system, two main forms are distinguished: primary and secondary hypogonadism.

  • Disorders or diseases of the testes (primary hypogonadism): The Leydig cells of the testes cannot produce testosterone. Possible causes are, for example:

    • Absence or loss of function of the testicles (anorchia)
    • Inflammation of the testicles (orchitis), e.g. as a result of mumps,
    • Testicular injuries, testicular cancer,
    • Klinefelter Syndrome as well
    • Systemic diseases, e.g. cirrhosis of the liver.
  • Disorders of the hypothalamus or the pituitary gland (secondary hypogonadism): The formation of hormones for the central control of testosterone production (LH, FSH, GnRH) can be disturbed due to various diseases. These include:

    • Pituitary insufficiency (lack of function or failure of the pituitary gland),
    • Pituitary adenoma (benign growth in the pituitary gland)
    • Lack of gonadotropin releasing hormone, which can be triggered by systemic disease, adverse drug effects, drug use, or toxins,
    • Kallmann syndrome as well
    • Brain injuries.
  • Androgen resistance due to genetic diseases.
  • Age hypogonadism: The mixed form of primary and secondary hypogonadism is often associated with excess abdominal fat and the metabolic syndrome. You can find more information under Testosterone Deficiency in Old Age.

What are the symptoms?

A lack of testosterone can cause many different symptoms, which can vary in severity. A distinction is made between clinical symptoms, sexual symptoms and cognitive symptoms. Depending on the cause and form, the signs develop slowly over weeks, months, or years. They usually last for a long time, at least several weeks. Testosterone deficiency during or after puberty can sometimes be seen in different symptoms.

Symptoms of testosterone deficiency during puberty include:

  • No change in voice (voice break),
  • Paleness,
  • underdeveloped muscles,
  • childlike penis,
  • small testicles,
  • no development of erectile function and libido (sexual desire) as well
  • Disorders of spermatogenesis (formation of sperm).

Symptoms of testosterone deficiency after puberty include:

  • Decrease in sexual desire (loss of libido),
  • Erectile dysfunction,
  • Decrease in sexual activity,
  • Mood swings, depressed moods and loss of drive,
  • Sleep disorders,
  • Muscle decline,
  • Shrinkage of the testicles,
  • Increase in belly fat,
  • Male breast enlargement (gynecomastia),
  • Signs of metabolic syndrome, as well
  • cognitive disorders, especially a reduction in spatial awareness.

The various sexual, psychological, cognitive, physical-organic symptoms of a testosterone deficiency can also be caused by other diseases. Therefore, the doctor tries to determine the cause by means of precise diagnostics.

How is the diagnosis made?

The diagnosis of a suspected testosterone deficiency in men includes at least the medical history, physical examination and laboratory examination. The doctor first checks whether there are clinical symptoms of a testosterone deficiency.

In the laboratory test, the total testosterone is determined, among other things. The blood sample to measure the testosterone must be done in the morning, as the testosterone level is increased in men in the morning. The results must be confirmed by a second measurement. Information on the reference values ​​can be found under testosterone laboratory value.

The measurement of free testosterone can also be important for the diagnosis, especially if the measurements of the total testosterone do not allow a clear diagnosis. Testosterone is for the most part (approx. 97 percent) bound to proteins, e.g. SHBG, in the blood, and only a small proportion (approx. One to three percent) is available as free hormone. In order to narrow down the causes further, the serum levels of SHBG, LH and FSH are measured. From this the doctor can conclude whether there is primary or secondary hypogonadism or age hypogonadism. Further examinations may be necessary to diagnose the underlying disease, e.g. a sonographic examination of the testicles and prostate.

How is hypogonadism treated?

Testosterone should only be used in adult men with a clear diagnosis of hypogonadism, ie if clinical symptoms are present and testosterone concentrations are too low, as determined in at least two laboratory tests in the morning.

Precondition for the choice of the hormone replacement product (e.g. testosterone, GnRH) is the exact knowledge of the cause that is responsible for the testosterone deficiency. Before the treatment, the doctor clarifies possible risks or illnesses that exclude testosterone replacement therapy, for example. Contraindications for testosterone replacement therapy are, for example, prostate cancer, elevated PSA levels, male breast cancer, polycythemia, severe sleep apnea, severe heart failure or male infertility (or desire to have children).

The aim of testosterone replacement therapy is to restore normal testosterone levels. The aim is to treat complaints or illnesses caused by a lack of testosterone. These include:

  • delayed puberty,
  • Klinefelter syndrome,
  • Disorders of sexual functions,
  • low bone mass,
  • Metabolic Syndrome as well
  • mental changes.

Short-acting and long-acting preparations in different dosage forms are available for testosterone replacement therapy, for example oral drugs, intramuscular injections or gels and plasters for use on the skin. The treating doctor decides together with the patient which preparation is most suitable.

The doctor provides information about the prognosis and the likely success of the therapy and explains possible risks and side effects. Dosage and preparation are chosen so that testosterone levels settle in the normal range. If this is the case, side effects are very rare.

unwanted effects

Testosterone replacement therapy can cause acne in some men. Testosterone replacement therapy can temporarily suppress spermatogenesis. If the patient wants to have children, the doctor can suggest other hormone preparations. Rare side effects of testosterone replacement therapy are, for example, swelling of the mammary glands (gynecomastia), a reduction in the size of the testicles, an increase in the number of red blood cells (erythrocythosis), which can be associated with a deterioration in the flow properties of the blood and possibly with an increased tendency to thrombosis. Testosterone can make sleep apnea worse.

Therapy control

Regular laboratory tests of the patient's testosterone levels enable the doctor to check the success of the therapy. Medical guidelines also recommend the following check-ups for testosterone replacement therapy: laboratory values ​​for hematocrit, hemoglobin, PSA, rectal examination of the prostate and breast examination.

Dangerous doping

Testosterone supplements are prescription drugs. They are used by the doctor to treat a patient with testosterone deficiency in certain indications. The abuse of testosterone, for example to promote muscle growth or doping, can lead to dangerous damage to health.

Whom can I ask?

You can contact the following offices to clarify complaints related to sexual development or sexual functions:

  • General Practitioner,
  • Pediatrician,
  • Specialist in urology,
  • Specialist in andrology,
  • Specialist in internal medicine specializing in endocrinology.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • Prescription fee: This is how drug costs are covered
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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