Hypogonadism in Males & ED

Testosterone has long been associated with male virility, big muscles, and a strong urge to punch other men, but this sex hormone has so much more to offer.

While it’s true testosterone drives the development of your male characteristics from a young age, including your penis size, muscle size, and body hair, this androgen also plays a key role in sexual function, mood, and general well-being.

Hypogonadism in males refers to a medical condition in which your testosterone levels are too low, resulting in symptoms like weight gain, fatigue, and low libido.

But is there a link between male hypogonadism and erectile dysfunction (ED)? While the exact link between low testosterone levels and ED isn’t completely understood, weak erections — or difficulty getting an erection at all — are a known symptom of hypogonadism.

The good news is that both low testosterone production and erectile dysfunction can be treated, usually with a combination of medication and lifestyle changes.

Below, we’ve discussed what hypogonadism is and the key differences between primary and secondary hypogonadism. We’ve also explained the link between the levels of testosterone in your blood (serum testosterone levels) and your risk of sexual dysfunction, including erectile dysfunction.

Finally, we’ve shared treatment options that you can use to treat testosterone deficiency caused by hypogonadism, as well as the erectile dysfunction it can potentially cause.

Male hypogonadism is a condition in which your body doesn’t produce enough testosterone. It’s often referred to as low testosterone, androgen deficiency, or low-T.

The term “hypogonadism” refers to the activity of the gonads — in men, the testes, or balls. The prefix “hypo” means “below normal,” with the term hypogonadism referring to lower-than-normal testicular function.

Your body produces testosterone through a complex process that involves your testes and parts of your brain called the hypothalamus and pituitary gland.

In men, the normal range for testosterone is between 300 and 1,000 nanograms per deciliter of blood (ng/dL) or 10 to 35 nanomoles per liter (nmol/L).

If you have hypogonadism, your testes may still produce some testosterone, but not enough to put your serum testosterone concentration within this range.

There are two types of hypogonadism in males:

• Primary hypogonadism

• Secondary hypogonadism

Primary Hypogonadism

Also known as testicular failure, primary hypogonadism can develop when there’s a specific problem with your testicles, such as a congenital problem or a physical injury that damages your testicles (oof).

The condition is typically characterized by low testosterone levels in combination with elevated levels of pituitary hormones, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).

When this type of hypogonadism develops early in your life, it may cause delayed puberty and issues related to your secondary sex characteristics, such as your bone structure, pubic hair, genital size, facial hair, and voice.

Secondary Hypogonadism

Secondary hypogonadism, or hypogonadotropic hypogonadism, can develop when a problem occurs elsewhere in the body, such as in the areas of the brain responsible for controlling the function of the testes.

With this type of hypogonadism, you may have absent or inadequate secretion of gonadotropin-releasing hormone (GnRH) or luteinizing hormone (LH).

A congenital disease, pituitary disorder, or certain medications may all contribute to this type of hypogonadism by affecting parts of your brain that are involved in testosterone production.

The main causes of hypogonadism depend on the type you have. From genetic conditions to lifestyle habits, there are many different contributing factors to hypogonadism.

Let’s break them down by type.

Primary hypogonadism causes:

• Klinefelter syndrome. A common genetic condition in which a man is born with one or more extra X chromosomes.

• Undescended testicles. A condition in which one or more testicles fail to descend into the scrotum.

• Cancer treatments. Radiation and chemotherapy for prostate cancer may alter testosterone production.

• Testicular injuries. Physical trauma to both testes may affect your testosterone.

• Infections like mumps orchitis. A condition characterized by inflamed testicles.

Secondary hypogonadism causes:

• Aging. Males of any age can have low testosterone, but older men have an increased risk.

• Kallmann syndrome. A genetic condition in which your hypothalamus is underdeveloped.

• Metabolic disorders. Certain metabolic disorders like type 2 diabetes and hemochromatosis (iron overload) can contribute to low T.

• Obesity. Obesity can contribute to low testosterone by suppressing the hypothalamic-pituitary-testicular axis.

• Pituitary disorders. Pituitary tumors or infections can interfere with brain signaling to the testes.

• Obstructive sleep apnea. A condition in which there is airflow blockage during sleep.

Hypogonadism can cause a range of symptoms, including several that could affect your sexual performance and general sexual satisfaction.

Common clinical symptoms of male hypogonadism include:

• Sexual dysfunction. Testosterone plays a key role in regulating your sex drive and your erections. If you’re affected by low testosterone levels, you may notice that you feel less interested in sex than normal. And even when you want to have sex, you may have difficulty getting an erection.

• Reduced sperm count. Your testicles are responsible for sperm production. If you have hypogonadism, you may have a lower-than-normal sperm count, which can lead to infertility in severe cases.

• Reduced muscle mass and strength. Testosterone is an important anabolic hormone that plays a major role in producing muscle. If you have subnormal testosterone levels, you may feel weaker than normal and find it difficult to put on muscle.

• Increased body fat levels. In addition to losing muscle strength, you may find that you gain fat more easily. This could result in a general increase in body fat or extra fat in certain areas, such as around your waist or on your breasts (gynecomastia).

• Reduced bone density. Testosterone is involved in ensuring your bones stay healthy and strong. If you have hypogonadism, you may notice that your bones are weaker and more at risk of fracturing (osteoporosis).

• Difficulty falling asleep or staying asleep. Suboptimal testosterone levels could affect sleep, causing sleep disorders like insomnia (difficulty falling asleep, staying asleep, or getting high-quality sleep throughout the entire night).

• Poor concentration. You may find focusing on specific tasks, remembering information, or getting things done more difficult. While the association isn’t perfectly clear, research has linked hypogonadism to lower cognitive function in some men.

• Mood changes and/or depression. Testosterone helps to boost your energy levels and regulate your moods. If you have low endogenous testosterone, you may be more at risk of developing depression.

Not all hypogonadal males display all of these symptoms. You may have one or two more obvious symptoms or a combination of symptoms that affect your well-being and general quality of life.

In addition to potentially affecting your sex drive, strength, and general health, there’s also a link between male hypogonadism and erectile dysfunction. Testosterone is heavily involved in maintaining your sex drive and producing erections — ED is one of several known symptoms of low testosterone levels.

While the link between hypogonadism and ED isn’t fully understood, there appears to be an overlap between low testosterone and factors that can cause ED in men.

For example, common physical causes of ED include cardiovascular disease, hypertension, diabetes, and metabolic syndrome. These conditions may affect blood flow and nerve function, resulting in erections that aren’t hard enough for satisfying sex. Low testosterone is also linked to these conditions.

Psychological causes of ED include sexual performance anxiety, depression, feelings of guilt related to sex, and low self-esteem.

Low testosterone can affect your level of sexual desire, which may make it harder for you to get hard in response to sexual stimulation. It’s also linked with depression, which can have a significant effect on your response to sexual contact.

Our guide to low testosterone and its role in erectile dysfunction covers this relationship in more detail, including how normal testosterone levels aren’t necessarily essential for having sex.

Hypogonadism is a treatable condition. For adult men, the most common form of testosterone treatment is testosterone replacement therapy or TRT.

This type of treatment involves using synthetic testosterone to supplement the small amounts of testosterone your body produces naturally. You can think of it as “topping up” the testosterone that’s produced in your testes to help you reach a healthy level of the hormone.

Testosterone is available in several forms, including a topical testosterone gel, transdermal patch, implant, pill, and intramuscular injection. Your healthcare provider will work with you to select the best form of testosterone for your needs and work out a dosage that helps you maintain a normal testosterone level.

TRT is effective for most men. Many men with hypogonadism report beneficial effects after they start treatment with testosterone, including a stronger sex drive and improved physical function.

However, TRT also has potential risks and side effects, including changes in your fertility, a higher risk of blood clots, prostate enlargement, sleep problems, and increases in your cholesterol levels.

We’ve talked about these effects in our guide to testosterone replacement therapy. If you’re prescribed testosterone, your healthcare provider will likely ask you to come in for checkups to assess your health and well-being.

Much like hypogonadism, erectile dysfunction is also a treatable condition. If you’re affected by ED, you can improve your erections and sexual performance by using medication and making changes to your lifestyle to promote better general health.

Currently, the most effective way to treat erectile dysfunction is by using medications called PDE5 inhibitors. These medications, which come in oral form, work by increasing blood flow to the erectile tissue inside your penis.

Popular PDE5 inhibitors include sildenafil (the active ingredient in Viagra^®), tadalafil (Cialis^®), vardenafil (Levitra^®), and avanafil (Stendra^®).

We offer access to several of these medications online as part of our range of ED treatments, following a consultation with a healthcare provider who will determine if a prescription is appropriate.

In addition to using medication to improve your erections, making small changes to your habits can often have a real impact on your sexual function and physical performance, including your ability to get and maintain an erection.

Try to eat a balanced diet, stay physically active, limit your alcohol consumption, and maintain a healthy body weight to improve blood flow and reduce your risk of ED.

If you smoke, quitting can have a positive impact on your erections and your general health, as smoking is associated with an elevated risk of experiencing erection problems.

Our guide to maintaining an erection goes into more detail on these tips, as well as other tactics that you can use to improve your erections and sexual function.

Male hypogonadism is a serious condition that can have a significant impact on your health and quality of life. Remember:

• If you have hypogonadism, it may impact your sexual performance. Symptoms of low T include reduced sexual desire and ED.

• If you’re worried that you might have hypogonadism, talk to your healthcare provider ASAP. They’ll be able to evaluate blood tests to check your testosterone levels and, if they’re low, give a diagnosis of hypogonadism.

• Treatments for low T and ED are available. In some cases of hypogonadism, you may be prescribed testosterone replacement therapy to bring your levels of testosterone back up to normal. If you have ED, medications like PDE5 inhibitors can make getting hard and enjoying sex easier.

Want to learn more before taking action? Our guide to the signs of low testosterone in men goes into more detail about what to look out for if you’re worried about hypogonadism.

When you’re ready for changes, schedule an online consultation.