Symptoms of Hypogonadism

People experience hypogonadism when their sex glands, or gonads, produce insufficient levels of sex hormones. In adult women, the ovaries don’t secrete enough estrogen, leading to hot flashes, changes in mood and energy levels, and irregular or stopped menstruation.

In men, an absence or lack of testosterone manufactured in the testicles causes low sex drive and loss of muscle tone, as well as gynecomastia (the development of breasts) in rare cases. Furthermore, hypogonadism before puberty significantly affects sexual and physical development.

Frequent Symptoms

Since hypogonadism is defined by a lack of or low levels of sex hormones, the symptoms of the condition vary based on the sex at birth and stages of development. Significantly, hypogonadism delays the onset of puberty. In children and teenagers, this affects:

• Menstruation: Girls who have reached puberty may not experience periods or will have irregular menstruation cycles.
• Testicle development: Boys with hypogonadism have reduced growth and development of the testicles during puberty.
• Breast development: Girls may not develop breast buds by age 13, in some cases leading to no breasts forming.
• Height: A lack of estrogen can stunt growth and affect overall height in girls.
• Facial hair: Boys undergoing puberty with this condition may not develop facial hair.

Hypogonadism is actually very common in adult women. It’s usually the result of menopause, which marks the end of menstrual cycles. The associated changes in estrogen levels cause:

• Irregular or abnormal menstruation
• Hot flashes
• Fatigue
• Changes in mood
• Difficulty concentrating
• Early menopause
• Milky discharges from the nipples
• Sleep problems

Symptoms in adult men arise due to insufficient testosterone levels, either due to advanced age or other health conditions. Common signs are:

• Low sexual drive (libido)
• Fatigue
• Gynecomastia (breast development)
• Erectile dysfunction
• Concentration problems
• Loss of muscle mass
• Loss of body/pubic hair (typically more noticeable as a decrease in the frequency of shaving)
• Hot flashes 
• Decrease in the frequency of nocturnal erections

Rare Symptoms

When hypogonadism is caused by a tumor in the pituitary gland (prolactinoma) or the brain (craniopharyngioma), additional complications may arise. These cases of central hypogonadism lead to a range of symptoms, including:

• Headaches
• Loss of vision
• Decreased libido and infertility in men and women
• Lactation in nonpregnant women and, rarely, in men
• Symptoms of hypothyroidism (underactive thyroid)

In addition, Kallmann syndrome, a genetic type of hypogonadism, has the same symptoms as other types, but there are also reductions in the senses of taste and smell (anosmia).

Complications and Subgroup Indications

Most hypogonadism cases occur in older adults: women in their late 40s and early 50s and men in their 50s and 60s. As you age, there are natural fluctuations in your sex hormone levels. Menopausal women no longer produce estrogen, and older men naturally secrete less testosterone. Given the effects of hypogonadism—and since some therapies, medications, and chronic conditions can affect hormone production—these levels are often monitored in older people.

Left untreated and given time, hypogonadism can lead to additional, potentially debilitating health issues. The most common are:

• Osteoporosis: Insufficient sex hormones can cause bones to become weaker, increasing the risk of fracture.
• Infertility: Lack of estrogen in women and reduced sperm counts due to insufficient testosterone in men can cause infertility and lead to difficulty becoming pregnant.
• Mood disorders: Living with the symptoms of hypogonadism may have a significant impact on mental health, leading to depression, anxiety, and other issues.
• Weight gain: Sometimes hypogonadism is linked to rapid weight gain, leading to obesity or being overweight. In turn, this can significantly impact cardiovascular health.

In addition, the presence of comorbid (simultaneously occurring) conditions can increase the burden of hypogonadism. Of particular concern are:

• Obesity: As noted, obesity and hypogonadism can be intimately related, with hypogonadism in obese individuals resulting in significantly worse outcomes than when obesity is not a concern. In addition, low testosterone in men is a risk factor for obesity.
• Cardiovascular conditions: Heart and circulation problems, such as heart failure, heart disease, or stroke, are also associated with this condition. Their impact can be worsened by insufficient sex hormone production.
• Type 2 diabetes mellitus: This common disease, in which the body doesn’t produce enough insulin, often occurs with hypogonadism. Studies have shown that hypogonadism can worsen the severity of diabetes.
• Metabolic syndrome: This is a group of conditions associated with increased risks of cardiovascular disease and characterized by weight gain, among other signs.

When to See a Doctor

Since hypogonadism is a hormonal disorder, it presents differently in children than it does in adults. As such, the signs that medical attention is needed among age groups.

For children or teenagers, delayed onset of puberty is the most obvious sign of an issue. The absence of breast buds and lack of periods in girls 13 and up, as well as lack of facial hair development and voice changes in teenage boys, may signal the need for medical intervention.

For adults with the condition, seek help if:

• You have a decreased urge for sex.
• You’re a man who is losing hair in his armpits.
• You’re a woman under 40, whose menstrual cycle has stopped.
• You experience hot flashes.
• You experience erectile dysfunction.
• You experience milky discharges from your nipples.

Since the symptoms of hypogonadism can mimic those of other conditions, it’s important that your doctor determine what’s causing your symptoms. The sooner you have a complete understanding of what’s happening, the sooner you can get proper treatment. Importantly, therapies and medications can help manage this condition.

A Word From Verywell

Hormonal problems like hypogonadism are particularly challenging because they have a pervasive and persistent impact on your health. Though there are therapies that can manage symptoms, there’s no cure for hypogonadism, with treatment in many cases requiring an ongoing, sustained effort.

There’s also a good deal that the medical community still needs to learn about hypogonadism. With a firmer understanding of how it occurs, how it impacts other health conditions, and what therapies can do to help, treatment approaches will only improve. Certainly, the interventions used today are better than those of 20 years ago.

Integral in managing hypogonadism and its effects is patient awareness. If you have hypogonadism—or believe you might—become engaged and proactive. Seek timely medical help, ask questions, follow instructions, and learn as much as you can about the conditions. With the right help, you’ll no doubt join the many people who are successfully managing and even thriving with hypogonadism.