Medicines for Hypogonadism

What it is

Hypogonadism means the sex glands (the testes in men, the ovaries in women) produce too little of the sex hormones. In men, this usually means low testosterone, which can cause reduced sex drive, erectile difficulties, tiredness, low mood, reduced muscle and body hair, and, over time, effects on bone strength; in younger people it can affect puberty and development. It can be caused by a problem with the testes or ovaries themselves, or with the pituitary gland or brain that controls them, and can be present from birth or develop later (for example from certain conditions, treatments, or as part of ageing in men, though "age-related" low testosterone is assessed carefully). In women, reduced sex hormones occur around and after the menopause, or earlier in conditions such as premature ovarian insufficiency. Diagnosis involves symptoms plus blood tests measuring hormone levels, often repeated, and looking for the cause.

How it is treated

Treatment depends on the cause, the person's age and symptoms, and whether fertility is a consideration. Where hypogonadism is confirmed and causing symptoms, hormone replacement — such as testosterone for men, or oestrogen (and sometimes other hormones) for women — can relieve symptoms and protect bone and general health, with the decision individualised and benefits weighed against any risks. Any underlying cause (such as a pituitary problem) is treated in its own right. Where fertility is desired, specific treatments may be used, as standard testosterone replacement can reduce fertility in men. Monitoring checks the response and safety of treatment. Lifestyle measures (healthy weight, exercise, good sleep, limiting alcohol) support hormone health. Care is guided by a GP and, where needed, a hormone specialist (endocrinologist). The reassuring message is that, where truly present, hypogonadism is treatable and symptoms often improve.