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Secondary Hypogonadism: causes & symptoms

Secondary Hypogonadism: causes & symptoms

By Mike Kocsis | 7 minutes read | Last updated: June 18, 2024
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  • Medically Reviewed by Dr. George Touliatos

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    Secondary hypogonadism occurs when the testes do not produce enough testosterone due to the dysfunction of the hypothalamic-pituitary-gonadal (HPG) axis.

    HPG controls the release of testosterone. The hypothalamus secretes a hormone that travels to the pituitary gland to stimulate the luteinising hormone (LH) and follicle-stimulating hormone (FSH) production. LH travels to the testes and stimulates Leydig cells located in the testes to synthesise testosterone.

    A negative feedback mechanism controls testosterone production. It means that high testosterone levels send signals to the pituitary gland and hypothalamus to stop the production of LH and FSH, resulting in low testosterone production.

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    What is the difference between primary and secondary hypogonadism?


    The following are the key differences between the two main types of hypogonadism.

    • In secondary hypogonadism, there is a similar reduction in sperm and testosterone production. Low LH and FSH levels negatively influence the production of testicular testosterone and intratesticular testosterone (which is required for sperm production). On the other hand, sometimes, in primary hypogonadism, sperm production is reduced more than testosterone production. It is because, here, seminiferous tubules (where sperms develop) are damaged to a greater extent than Leydig cells (that synthesise testosterone). That is why some men with primary hypogonadism may have normal testosterone levels but very low sperm counts.
    • Primary hypogonadism is linked to breast enlargement (gynecomastia) in men. It is because the high LH and FSH levels cause the conversion of testosterone into estradiol (a female hormone).


    Symptoms of secondary hypogonadism


    Men with secondary hypogonadism experience almost the same symptoms as men with primary hypogonadism experience. These symptoms include:


    Causes of secondary hypogonadism


    With secondary hypogonadism, the testicles are healthy, but there is a problem with either the pituitary gland or the hypothalamus. Enlisted below are the main acquired and congenital causes of secondary hypogonadism.

    Pituitary disorders

    Damage to the pituitary gland can reduce the production of LH, leading to low testosterone levels. 

    A pituitary tumour or injury commonly causes testosterone deficiency. Brain tumour treatment, including surgery, radiotherapy, and chemotherapy, can also impair pituitary gland hormone production.

    Kallmann’s syndrome

    It develops due to the underdevelopment of neurons that send signals to the hypothalamus for hormone production. Men with this condition experience delayed or absence of puberty, loss of smell, and red-green colour blindness.

    Inflammatory diseases

    Some inflammatory diseases also contribute to secondary hypogonadism development. Examples of these diseases include:

    • Sarcoidosis – The development of clumps of inflammatory cells/ swollen tissues
    • Histiocytosis – Increase in the production of white blood cells
    • Tuberculosis – A bacterial disease that mostly affects the lungs but can also affect other organs, including the brain and spine


    HIV infection may lead to testosterone deficiency by damaging the testes, pituitary gland, or hypothalamus.

    Certain medications

    Your testosterone levels may decline due to certain medications. However, it is a temporary issue and can be resolved by stopping medication usage. Examples of medication that decrease testosterone are:

    • Antidepressants
    • Anti-anxiety
    • Antihistamine
    • Opioids
    • Tranquilisers  


    Overweight men have high fat and plasma leptin levels, contributing to secondary hypogonadism development.

    Nutritional deficiency

    Your body needs a healthy dose of essential and nonessential nutrients to function normally. If you don’t take enough nutrients, you may develop certain problems, including secondary hypogonadism.

    The deficiency of the following nutrients is known to cause low T and hypogonadism.

    • Vitamin D
    • Vitamin B12
    • Riboflavin
    • Thiamin


    It occurs when your body absorbs too much iron from the food.


    Ageing increases the risk of secondary hypogonadism in men.


    Diagnosing secondary hypogonadism


    Early diagnosis of hypogonadism can help prevent associated problems. 

    If you have secondary hypogonadism symptoms, your doctor will perform a physical examination and ask you some questions about your medical history. They will check whether your sexual development is according to your age or if there is some abnormality.

    He will test your total testosterone levels. Testosterone levels are generally the highest in the morning in men. Therefore, your blood sample will be taken early in the morning and sent to the lab to measure the amount of your serum testosterone.

    If your serum testosterone is below 300 nanograms per deciliter (ng/dL), your doctor will request further testing to determine what kind of hypogonadism you have. You may have the following tests to rule out the underlying cause.

    Luteinizing hormone (LH) blood test: It will tell you whether your low testosterone is due to a pituitary disorder or some other reason.

    Prolactin blood test: Prolactin is a hormone secreted by the pituitary gland. Its high levels indicate pituitary gland problems.

    Pituitary imaging: A CT scan or MRI may be conducted to examine this gland in greater detail.

    Testicular biopsy: In this test, a small part of the testicles is removed and sent to the lab for examination. It is done to diagnose sperm problems.

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    Secondary hypogonadism treatment


    Its treatment depends on the actual cause of the problem. However, healthcare providers mostly prescribe testosterone replacement therapy (TRT) to their patients.

    There are different kinds of TRT. Each form has its unique benefits and disadvantages. You should discuss them with your healthcare provider to choose the one that can help you get the best possible results.


    Following are the popular types of TRT.


    There are different kinds of testosterone gels, including AndroGel, Vogelxo, and Fortesta that vary from each other based on their composition and method of application.

    Rub the gel into your skin and let it absorb fully. Don’t shower or swim for several hours after the gel application to ensure it gets absorbed. Avoid skin-to-skin contact and cover the area with a clean cloth such as a t-shirt to prevent testosterone transfer. Testosterone gels may cause skin irritation in some people.

    Nasal testosterone gels are also available. They are applied twice a day inside the nasal cavity. They help prevent testosterone transfer that may happen when using skin gels.


    A skin patch is applied to your skin to deliver a steady testosterone supply. You will have to replace it with a newer one after every 24 hours. You should always use a different patch application site to prevent skin irritation.


    They are surgically inserted into your skin every six months. This procedure requires an incision, which many people may not be comfortable with.


    Testosterone injections vary in composition and dose, which determines how many times you need them per month. You can give yourself injections on your own or ask a family member to do so. If you are not comfortable doing so, you can visit your healthcare provider to assist with testosterone administration.

    Testosterone undecanoate is given once after 10 weeks. It may cause serious side effects, so you should always have it at your provider’s clinic.


    Testosterone pills are also available for certain conditions, such as Kallmann’s syndrome. They are not suitable for all, as they may cause liver damage, bloating and diarrhoea.

    TRT also produces some side effects such as:

    • Acne
    • Breast enlargement
    • Reduction of testicle size
    • Prostate stimulation
    • Increase in red blood cell count
    • Infertility

    Due to these side effects, healthcare providers do not prescribe TRT to all. They conduct certain tests to ensure it is a completely safe procedure for you.


    Coping and support


    Secondary hypogonadism can affect your self-confidence and relationship with your partner. You should consult with your healthcare provider for psychological counselling and start a suitable treatment to improve your overall well-being.

    Join online support groups to share your thoughts with others experiencing the same issue. Get tips from men who have been managing the condition for years.



    Can secondary hypogonadism be reversed?

    It depends on what the cause of the problem is. If it is something like medication, obesity, or a poor lifestyle, getting rid of the cause may help reverse secondary hypogonadism.

    What is the late-onset hypogonadism (LOH)?

    It is a kind of secondary hypogonadism that occurs due to normal ageing. As men age, their hypothalamic-pituitary function declines, leading to low testosterone levels and sperm count.

    Can anyone have TRT?

    Your doctor will most likely never prescribe you TRT if you have any of the following conditions.

    • Obstructive sleep apnea
    • Prostate cancer
    • Breast cancer
    • A lump on your prostate


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    Summing it up

    When caused by an untreatable issue, secondary hypogonadism is a chronic condition and may require life-long treatment. Men often take doctor-prescribed testosterone replacement therapy (TRT) to prevent symptoms from interfering with their everyday life. It is a safe treatment used to boost serum testosterone levels and restore vitality.

    If you are experiencing hypogonadism symptoms, reach out to us by clicking the link button above. Our hormone-specialised doctors can assess your symptoms and devise a treatment plan tailored to your specific needs.  


    References/Scientific studies/Further reading/Bibliography 

    Saboor Aftab, S.A., Kumar, S. and Barber, T.M., 2013. The role of obesity and type 2 diabetes mellitus in the development of male obesity‐associated secondary hypogonadism. Clinical endocrinology78(3), pp.330-337.

    KORENMAN, S.G., MORLEY, J.E., MOORADIAN, A.D., DAVIS, S.S., KAISER, F.E., SILVER, A.J., VIOSCA, S.P. and GARZA, D., 1990. Secondary hypogonadism in older men: its relation to impotence. The Journal of Clinical Endocrinology & Metabolism71(4), pp.963-969.

    Santi, D. and Corona, G., 2017. Primary and Secondary Hypogonadism 23. Endocrinology of the testis and male reproduction1, p.687.

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    References, sources and studies used alongside our own in-house research have been cited below, most of which contain external clickable links to reviewed scientific paper that contain date stamped evidence.

    Our team of healthcare experts and GMC registered doctors are licensed to UK GMC standards. We strive to provide you with the latest evidence based, researched articles that are unbiased, honest and provide you with accurate insights, statistics and helpful information on the discussed topic to ensure you gain a better understanding of the subject. You can read more about our Editorial Process by clicking here.

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    About the Author: Mike Kocsis

    Mike KocsisMike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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    Last update: June 18th, 2024
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