A testosterone level below 200 is called hypogonadism, and can lead to several medical conditions, including fatigue, low sex drive and reduced muscle mass. Risk for developing hypogonadism increases with excess weight gain, trauma and severe illness. Both men and women can develop low levels of testosterone, and treatment is usually in the form of hormone replacement therapy. If you think you suffer from hypogonadism, speak with your doctor for a proper diagnosis and treatment plan.
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Hypogonadism occurs when the primary sex organs fail to produce testosterone, or when the hypothalamus or pituitary glands fail to release appropriate levels of gonadotropin-releasing hormone, luteinizing hormone or follicle stimulating hormone. Hypogonadism can occur in both men and women. A testosterone level above 200 nanograms per deciliter (ng/dL) in men is considered the low end of normal. In women, normal testosterone levels may be above 15 ng/dL, but a clear lower limit has yet to be determined.
Causes and Symptoms
Decreased libido, erectile dysfunction and inability to achieve meaningful orgasm are strong indicators of hypogonadism. Anemia, depression, fatigue, low energy, impaired cognition and diminished bone density, muscle mass or strength may also point to low levels of testosterone.
Strong risk factors for hypogonadism include genetic predispositions like Klinefelter or Kallmann syndrome, use of alkylating agents like cyclophosphamide or chlorambucil, or the use of opioids or glucocorticoids. Infection, severe illness, liver or kidney disease or direct trauma to the testes may also increase the risk of low testosterone levels. Obesity can also cause hypogonadism. The increased adipose fat elevates estradiol levels and inhibits gonadotropin secretion in the pituitary.
Always seek council from a licensed physician for proper diagnosis and treatment.
The differential for hypogonadism is broad, with many symptoms overlapping other conditions. A serum total testosterone test is usually ordered first, along with a complete blood count. Results are positive if serum total testosterone is below 300 ng/dL or if complete blood count indicates normochromic normocytic anemia. Other tests may include checking thyroid function, sperm count or prolactin levels. Computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered, if warranted.
Restoring serum total testosterone levels to a normal range is the primary goal of treatment, and is usually done with hormone replacement therapy using a transdermal patch, oral pill or injection. Patient compliance is vital to the success of treatment, and requires careful follow-up by a doctor to ensure effectiveness and to monitor for side effects.
There is a high correlation between testosterone deficiency, body composition and mental well-being. Maintaining a healthy weight and managing stress may be an effective way to reduce the risk of hypogonadism and its associated co-conditions.
REFERENCES & RESOURCES
- Epocrates Online: Hypogonadism in Males
- MedlinePlus: Hypogonadism
- American Academy of Family Physicians: Testosterone Treatments: Why, When, and How?
- Medscape: Treatment of Male Infertility Secondary to Morbid Obesity
- Medscape: Body Composition, Metabolic Syndrome and Testosterone in Aging Men
- Medscape: Clinical Hypogonadism and Androgen Replacement Therapy
- Exercise Is Medicine
- The Obesity Society