Symptoms

of hypogonadism can be both physical and sexual

What are the symptoms of hypogonadism (low testosterone)?

Symptoms and signs of testosterone deficiency occur as a result of low testosterone levels and hence, may benefit from testosterone therapy (regardless of whether there is an identified underlying aetiology).^1,6

Insufficient testosterone action (even at normal testosterone levels) can be caused by less sensitive androgen receptors (which is genetically determined)⁷ or elevated SHBG levels (which bind to testosterone and reduce the free “active” serum fraction of testosterone.⁸

Due to the multiple effects of testosterone, the health consequences of hypogonadism are wide-ranging with signs and symptoms affecting sexual, physical, metabolic and psychological domains.

Figure: Common symptoms and signs of hypogonadism (low testosterone) in men.^1,3-6

Metabolic
symptoms / signs

Obesity (BMI 30 or higher)
Abdominal obesity (waist circumference 94-102 cm or higher)
Metabolic syndrome
Insulin resistance, prediabetes or type 2 diabetes

Sexual symptoms

Decreased sexual desire and activity
Decreased frequency of sexual thoughts
Erectile dysfunction
Delayed ejaculation
Decreased volume of ejaculate
Decreased frequency or absent morning or night-time erections
Small testes
Infertility

Psychological symptoms

Depressed mood
Loss of energy
Reduced motivation
Poor concentration
Decreased well-being and/or poor self-rated health
Irritability
Sadness
Impaired memory
Decreased cognitive function (including impaired concentration, verbal memory, and spatial performance)

Physical symptoms

Decreased muscle mass and strength
Reduced physical performance
Hot flushes or sweats
Sleep disturbances
Fatigue
Reduced bone mineral density, osteoporosis, low trauma fractures
Decreased body hair
Gynecomastia

Recommendations

About hypogonadism

How to diagnose hypogonadism

Related topics

Tools Treatment Online learning

References

Dean JD, McMahon CG, Guay AT, et al. The International Society for Sexual Medicine's Process of Care for the Assessment and Management of Testosterone Deficiency in Adult Men. The journal of sexual medicine. 2015;12(8):1660-1686. Return to content
Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Mayo Clin Proc. 2016;91(7):881-896. Return to content
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432. Return to content
Hackett G, Kirby M, Edwards D, et al. British Society for Sexual Medicine Guidelines on Adult Testosterone Deficiency, With Statements for UK Practice. The journal of sexual medicine. 2017;14(12):1504-1523. Return to content
Dohle GR, Arver S, Bettocchi C, Jones TH, Kliesch S. 2018 European Association of Urology (EAU) Guidelines on Male Hypogonadism. Available at https://uroweb.org/guideline/ male-hypogonadism Return to content
Morales A, Bebb RA, Manjoo P, et al. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline. Appendix available at: http://www.cmaj.ca/content/suppl/2015/10/26/cmaj.150033.DC1/15-0033-1-at.pdf (accessed September 2020). CMAJ. 2015;187(18):1369-1377. Return to content
Zitzmann M. Mechanisms of disease: pharmacogenetics of testosterone therapy in hypogonadal men. Nature clinical practice Urology. 2007;4(3):161-166. Return to content
Krakowsky Y, Conners W, Morgentaler A. Serum Concentrations of Sex Hormone-binding Globulin Vary Widely in Younger and Older Men: Clinical Data from a Men's Health Practice. Eur Urol Focus. 2019;5(2):273-279. Return to content

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