At a glance
- Primary causes begin in the testicles
- Secondary causes involve pituitary or hypothalamic signaling
- Medication, illness, sleep, weight, and substance use can contribute
- Identifying the cause changes the treatment conversation
Primary hypogonadism
In a primary pattern, the testicles do not produce adequate testosterone despite signaling from the pituitary. Causes can include genetic conditions, injury, infection, chemotherapy or radiation, and other testicular damage.
Secondary hypogonadism
In a secondary pattern, the hypothalamus or pituitary does not provide adequate stimulation. Pituitary conditions, elevated prolactin, prior head injury, some medications, severe illness, and other factors may be involved.
Functional and mixed contributors
Obesity, poorly controlled diabetes, sleep apnea, chronic illness, opioid or glucocorticoid use, heavy alcohol use, overtraining, undernutrition, and acute illness can affect hormone levels or symptoms. These factors may coexist with primary or secondary disease.
The right response may be to address a contributor, repeat testing under better conditions, involve another specialist, support fertility, or discuss hormone therapy. That is why the cause matters.