Living Well with Hypogonadism

Caused by insufficient production of the sex hormones, testosterone and estrogen, hypogonadism can be challenging to live with. Among a broad range of symptoms, it leads to developmental delays in adolescents, erectile dysfunction, muscle weakness, gynecomastia (breast swelling), and low libido (low sex drive) in males, while affecting female menstruation, energy levels, and mood, among other symptoms.

While this condition can be medically managed with hormone replacement therapy, it can have a serious impact on mental health and quality of life.

Living with hypogonadism, often a chronic condition, also means doing your own work to help manage physical effects, as well as the associated emotional and social challenges. Finding community—in social media groups and online forums, in support groups, and through patient advocacy organizations—can also play a crucial role in coping.

Getting a diagnosis of hypogonadism can be challenging, but if you’re proactive and engaged, there’s no doubt you can thrive despite this condition.   

Emotional

Both directly, and indirectly, hypogonadism causes mood disorders and can lead to significant mental health challenges, including major depressive disorder, with some symptoms overlapping, and lower overall quality of life. These and other issues are compounded by the fact that this condition often goes undiagnosed.

The specific mental health challenges faced by those with hypogonadism vary based on age and assigned sex:  

• Adolescents with delayed puberty due to insufficient hormone production experience higher levels of bullying and stigmatization because of their condition. This leads to body image concerns, low self-esteem, depression, and social isolation.
• Adult females with hypogonadism experience a significantly reduced quality of life, especially if they face associated infertility or libido problems. In addition, this condition directly causes mood disorders in women, and they experience a high degree of stigma.
• Adult males, especially those experiencing low libido and erectile dysfunction, can feel socially isolated, ashamed, and alienated due to their condition. Many patients experience a vicious cycle, as they cope with problems with sexual and psychological issues that reinforce each other.

Because of these associations, mental health assessment is a standard part of treatment. You may be advised to seek out individualized counseling or group work to help you manage the associated emotional and psychological fallout. However, it’s important to remember that these issues are normal and expected and that managing them is part of the process.    

Physical

While therapies for hypogonadism can reverse or at least manage most of its symptoms, lifestyle changes aid in this work and can help spur production of sex hormones. Things like incorporating more exercise into your routine and altering diet also help with complications, such as osteoporosis (a weakening of the bones) and metabolic syndrome (a set of physical signs that raise cardiac risk), among others.

Along with standard treatments, it’s important to think about what else you can do to manage this condition. A well-rounded plan will increase the likelihood of treatment success and reduce the impact of complications.  

Diet

Dietary changes focus on managing the complications and associated conditions of hypogonadism. They’re a necessary step in the treatment of metabolic and can help with osteoporosis. Furthermore, diet helps manage obesity and type 2 diabetes, which can lead to underproduction of testosterone, causing hypogonadism. Losing weight can help rebalance hormone levels. 

So what would a dietary intervention look like? To supplement testosterone levels:

• Eat healthy fats, as in seeds, nuts, and plant-based oils.
• Choose healthy proteins from lean meats like chicken (with no fat) and fish.
• Minimize the number of processed foods you eat.
• Reduce salt and sugar intake.
• Have multiple servings of fresh vegetables and fruit daily.
• Avoid animal fats and red meats.

What you eat can also directly affect hormone levels. In a 2018 study published in the journal Nutrients, diets high in carbohydrates (as in bread and pastries), dairy products, added sugars and low in leafy green vegetables were associated with lower testosterone levels.

Certain foods may boost testosterone levels, making nutritional assessment and counseling an integral aspect of treatment. These include:

• Green tea
• High fiber foods
• Different-colored fruits and vegetables
• Nuts (especially Brazil nuts)
• Flaxseed

Low estrogen levels associated with female hypogonadism and menopause also call for dietary changes, as does osteoporosis. Along with the types of changes you’d make for weight loss, you’d also need to find dietary sources of magnesium and calcium. This means foods like:

• Nuts
• Whole grains
• Dairy (whole milk, cheese)
• Broccoli, spinach, and leafy greens
• Avocados
• Sardines

Exercise

Related to diet, ensuring that you’re getting enough physical activity can be another way to manage hypogonadism and its associated conditions. For low testosterone, regular strengthening exercises help boost production. Furthermore, these exercises help strengthen bones and prevent injury associated with osteoporosis.

Exercises that can help with hypogonadism include:

• Regular activity: At minimum, you should get 150 minutes a week of light-to-moderate exercise. As little as 30 minutes a day, five days a week walking, swimming, or cycling can be an excellent starting point.  
• Strengthening: Strengthening helps counter disrupted muscle development and bones. Start with at least two sessions a week of strengthening exercises, like weightlifting, squats, and push-ups.
• Scale up gradually: If you’re newly adopting an exercise program, don’t push it. The idea is to gradually scale up, increasing the intensity or duration of exercise as you progress. Varying your routine by focusing on different muscle groups or activities on different days can also help.  

Lifestyle Adjustments

Other changes that can help with hypogonadism include:

• Quitting tobacco
• Avoiding or minimizing alcohol consumption
• Stopping the use of opioid drugs
• Ensuring that you get enough sleep

Social

One of the biggest challenges associated with hypogonadism is the extent to which the condition can be alienating. Poorly understood, and not widely known, patients may struggle with socialization.

In light of that, there’s great value in finding community and seeking out support if you’re living with this condition. Here’s what you can do:

• Build up informal networks: Talk to your family, loved ones, and friends about what you’re going through. Reducing social isolation—by keeping up with friends or getting involved in the community—drastically improves outcomes.
• Seek out support groups: Sharing experiences and exchanging information with others living with the condition can be invaluable.
• Try online communities: Social media groups and online discussion boards connecting you to hypogonadism patients around the world can also help. Considering how stigmatizing and alienating this condition can be, it helps to know that there are others going through similar challenges.  
• Connect with advocacy organizations: Organizations promoting patient, caregiver, and public education about hypogonadism and related disorders include the Endocrine Society’s Hormone Health Network and the Pituitary Network Association.  

Practical

An additional challenge associated with hypogonadism is that, in many cases, therapy is a continual process. Typically, this involves hormone replacement therapy, restoring progesterone, estrogen, or testosterone levels as needed. You may need either regular injections (performed in a clinic or hospital) or daily medications.

Staying on top of prescriptions and appointments requires careful attention and coordination, as does dealing with the financial realities of having a chronic condition. Keep in mind:

• Medication management: Use a calendar, pill organizer, or phone app, to help you remember when to take medications. Learn as much as you can about what you’re taking, and let your doctor know if you feel side effects or miss a dose.
• Appointments: As with medications, you’ll need to stay on top of appointments. In addition to ongoing evaluations, therapy may require clinical visits. Make sure you keep your appointments, and don’t hesitate to enlist loved ones to help.
• Communicate: Good communication between patient and medical staff is essential. Don’t hesitate to call your doctor if you’re feeling depression, anxiety, or have other issues. Keep notes on your own progress, attending appointments with prepared questions.

Despite the challenges, hypogonadism, can be effectively managed. Talk to your doctor about what you can do to help you live well with this condition.