Hypogonadism is when your body does not produce enough sex hormones. Treatment options will depend, in part, on whether you’re trying to conceive.

Hypogonadism occurs when the sex glands produce little to no sex hormones.

The sex glands, also called gonads, are primarily the ovaries in people assigned female at birth (AFAB) and the testes are in people assigned male at birth (AMAB).

The sex hormones help control secondary sex characteristics, such as breast development in people AFAB, testicular development in people AMAB, and pubic hair growth. Sex hormones also play a role in the menstrual cycle and sperm production.

Hypogonadism is also known as gonadal deficiency. It may be called andropause or low serum testosterone when it occurs in people AMAB.

There are three types of hypogonadism: primary, secondary, and eugonadotropic.

Primary hypogonadism

Primary hypogonadism means that you do not have enough sex hormones in your body due to a problem in your gonads.

Your gonads are still receiving the message to produce hormones from your brain, but they can’t produce the hormones.

It’s also known as hypergonadotropic hypogonadism.

Secondary hypogonadism

In secondary hypogonadism, the issue originates in your brain.

Your hypothalamus or pituitary gland, found in or near the brain, are not working properly. These areas control your gonads.

If you have secondary hypogonadism, your gonads aren’t being stimulated.

Secondary hypogonadism is also known as hypogonadotropic or central hypogonadism.

Eugonadotropic hypogonadism

In eugonadotropic hypogonadism, you experience the effects of hypogonadism even though your pituitary gland is functioning as expected.

It’s also known as normogonadotropic hypogonadism. It only affects people AFAB as it is caused by issues affecting the ovaries, such as polycystic ovarian syndrome (PCOS).

The causes of primary hypogonadism include:

Secondary hypogonadism may be the result of the following:

  • genetic disorders such as Kallmann syndrome (abnormal hypothalamic development)
  • injury to your hypothalamus or pituitary gland
  • a tumor in or near your pituitary gland
  • pituitary disorders
  • infections, including HIV
  • inflammatory diseases such as sarcoidosis and tuberculosis
  • obesity
  • rapid weight loss
  • nutritional deficiencies
  • use of steroids or opioids
  • brain surgery
  • radiation exposure
  • hemochromatosis, which occurs when your body absorbs too much iron

Eugonadotropic hypogonadism may be caused by:

Symptoms that may affect people AFAB include:

Symptoms that may affect people AMAB include:

A doctor will conduct a physical exam to confirm your sexual development is typical for a person your age. They may examine your muscle mass, body hair, and sexual organs.

Laboratory tests

If the doctor thinks you might have hypogonadism, they’ll first check the levels of your sex hormones.

You’ll need a blood test so that they can check your level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Your pituitary gland makes these reproductive hormones, which are also known as gonadotropins.

If you’re AFAB, you’ll have your estrogen levels tested. The doctor may also evaluate your egg count by performing a test such as the anti-Mullerian hormone (AMH) test.

If you’re AMAB, you’ll have your testosterone levels tested. Testosterone tests are usually performed in the morning when your hormone levels are highest. The doctor may also order a semen analysis to check your sperm count. Hypogonadism can reduce your sperm count.

In addition, the doctor may order additional blood tests to help confirm a diagnosis and rule out any underlying causes. These include:

  • Prolactin tests: The hormone prolactin promotes breast development and breast milk production in people AFAB, but it’s present in people AMAB too.
  • Thyroid function tests: The doctor may also check your thyroid hormone levels. Thyroid problems can cause symptoms similar to hypogonadism.
  • Iron tests: Iron levels can affect your sex hormones. For this reason, the doctor may perform an iron test to check for high blood iron levels.
  • Genetic tests: The doctor may perform genetic testing, especially if they suspect you have a chromosomal irregularity such as Turner syndrome.

Imaging tests

Imaging tests can also be useful in diagnosis.

An ultrasound can be used to create an image of the ovaries and check for any problems, including ovarian cysts and PCOS.

The doctor may order MRIs or CT scans to check for tumors in or near your pituitary gland.

Treatment for all genders is similar if the hypogonadism is due to a tumor affecting the pituitary gland. Treatment to shrink or remove the tumor may include medication, radiation, or surgery.

Treatments that are specific to female or male hypogonadism are described below.

Treatment for female hypogonadism

Your treatment will involve increasing your amount of female sex hormones. Treatments will vary depending on the type of hypogonadism you have and whether you’re trying to conceive.

If you have primary hypogonadism and true ovarian failure, you’ll typically need to explore alternative forms of family building. Options include:

If you have secondary hypogonadism and low FSH levels, you’ll typically need FSH injections. Some people will need injections of both FSH and the hormone human choriogonadotropin (hCG) to trigger ovulation.

Some people will also require estrogen therapy. Supplemental estrogen can be administered via a patch or pill.

If you’ve had a hysterectomy, estrogen therapy will probably be your first line of treatment.

Because increased estrogen levels can increase your risk for endometrial cancer, you’ll be given a combination of estrogen and progesterone if you have not had a hysterectomy. Progesterone can lower your risk for endometrial cancer if you’re taking estrogen.

Other treatments can target specific symptoms. For eugonadotropic hypogonadism, a doctor will usually treat the underlying cause, such as PCOS.

Treatment for male hypogonadism

Injections of a gonadotropin-releasing hormone (GnRH) or gonadotropins (such as hCG or FSH) may trigger puberty or increase sperm production. These treatments are appropriate if you’re interested in conceiving and have primary hypogonadism.

If you have primary hypogonadism, you can explore sperm harvesting and sperm donation as options for conception, as well as intracytoplasmic sperm injection (ICSI).

If fertility isn’t a concern, you may receive testosterone replacement therapy (TRT. Testosterone is available in many forms, including:

Unless a treatable condition causes it, hypogonadism is chronic and may require lifelong treatment. Your levels of sex hormones may decrease if you stop hormone therapy.

Most cases of hypogonadism respond well to appropriate medical treatment, though.

Seeking support through therapy or support groups can help you before, during, and after treatment.