The impaired production of testosterone is a condition known as androgen deficiency. Commonly referred to as hypogonadism, androgen deficiency may be congenital or acquired in its presentation. Complications are entirely dependent on the symptoms and the timing of their onset. Treatment for hypogonadism generally involves the administration of a form of hormone replacement therapy known as testosterone replacement therapy (TRT).
Testosterone production can become impaired when issues arise within the testicles, pituitary gland, or hypothalamus. Since these areas work together to play a pivotal role in hormone production, storage and regulation, injury or disease affecting any one area can adversely affect the stability of one’s testosterone levels. In addition to injury and disease, obesity and the regular use of certain prescription medications may also disrupt androgen, or male hormone, production, leading to a reduction in testosterone levels and the onset of an androgen deficiency.
A diagnosis of androgen deficiency is generally made with the administration of a variety of diagnostic tests. Boys and young men who exhibit signs of delayed puberty or other symptoms associated with suspected hypogonadism will generally undergo a blood test to evaluate their testosterone levels. Individuals whose test results confirm hypogonadism may undergo further testing to determine the possible cause and extent of the deficiency. It is not uncommon for additional examinations to include imaging and genetic testing as well as a semen analysis.
Considering an androgen deficiency can occur at any point during one’s development, from as early as in utero to during adulthood, symptom manifestation often varies by individual. Early presentations of an androgen deficiency often manifest as ambiguous or underdeveloped male genitalia. During puberty, young men may exhibit diminished muscle strength, pronounced breast development known as gynecomastia, and an absence of or impaired sexual development. Adult men who develop hypogonadism may experience symptoms that include erectile dysfunction (ED), loss of libido, and infertility.
When symptoms present during adolescence and treatment is inadequate or absent, permanent physiological signs may develop, such as underdeveloped genitalia. Congenital presentations of an untreated androgen deficiency may manifest as ambiguously formed genitalia, such as presenting with the external sex organs of a male but possessing the internal sex organs of a female. Adult males who acquire hypogonadism may also be at an increased risk for developing osteoporosis.
Treatment for an androgen deficiency is generally causal-based and includes the administration of testosterone replacement therapy (TRT). The use of hormone therapy can stimulate puberty in young boys and reverse the signs of hormone deficiency in adult men, including restoring libido and increasing muscle strength. Men who are infertile as a consequence of hypogonadism may undergo supplemental treatment to possibly restore fertility, though the effectiveness of treatment is not guaranteed.