Low testosterone, also known as hypogonadism, can significantly impact energy levels, mood, muscle mass, and fertility in both men
What is Low Testosterone / Hypogonadism?
Low testosterone, or male hypogonadism, occurs when the body does not produce enough testosterone, which is a hormone crucial for sexual development, reproductive function, muscle growth, fat distribution, and overall metabolic health. While commonly associated with men, testosterone can also play a key role in women’s health.
This hormonal deficiency can arise at any age, and may be temporary or permanent depending on its cause. As such, prompt diagnosis and finding the route cause, followed by tailored treatment can help restore hormonal balance, and improve quality of life.
What are the types of Hypogonadism?
Hypogonadism is categorised based on its origin:
Primary hypogonadism – the problem lies within the testes (in men) which fail to produce adequate testosterone despite normal stimulation.
Secondary hypogonadism – the pituitary gland does not release enough luteinising hormone (LH) and/or follicle-stimulating hormone (FSH) to stimulate the testes.
Tertiary hypogonadism – a rare form of hypogonadism, occurs when the hypothalamus fails to produce gonadotropin-releasing hormone (GnRH), disrupting the hormonal cascade.
Testosterone Levels
It is important to note that testosterone levels can vary based on age, sex, time of day, and health status. A blood test, should be taken while fasted, in the morning, will determine if your testosterone levels are within a healthy range. Dr. Dinesh mentions that testosterone levels fluctuate and therefore two abnormal tests are required to diagnose male hypogonadism.
With aging, men lose about 1 percent of testosterone every year after the age of 40. Still no male should ever have low testosterone (age-specific levels).
What causes Low Testosterone / Hypogonadism?
Low testosterone or hypogonadism can stem from a wide range of causes. These include both congenital conditions, and acquired factors that disrupt the body’s ability to produce or regulate testosterone.
Some of the common causes may include:
Age-related decline– testosterone levels naturally decrease by about 1% per year after the age of 40.
Chronic diseases – diabetes, obesity, kidney or liver disease, and HIV/AIDS can disrupt hormonal balance.
Excess alcohol use or substance abuse – can impair testicular function, and reduce testosterone levels.
Genetic conditions– such as Klinefelter syndrome (XXY karyotype), which impairs testicular function.This is the most common cause of primary hypogonadism
Medications – opioids, glucocorticoids, anabolic steroids, and certain psychiatric drugs can suppress testosterone production.
Pituitary or hypothalamic dysfunction – Pituitary tumours, inflammation or trauma can impair signalling to the testes or ovaries.
Radiation or chemotherapy– especially treatments targeting the neck/ mouth/ nose or brain region.
Severe stress or sleep deprivation– these can disrupt the hypothalamic-pituitary-gonadal (HPG) axis.
Testicular or ovarian injury – trauma, torsion or surgical removal can impair hormone production.
Testicular infection such as Mumps
Obesity -- This causes a low testosterone level that may or may not be symptomatic and responds well to weight loss.
Symptoms of Low Testosterone / Hypogonadism
Mood swings is one of the common symptoms of low testosterone.
The signs of low testosterone are often gradual, and may be mistaken for normal ageing or stress. It is important to understand that symptoms differ between individuals, and may vary depending on the severity, and duration of hormone deficiency.
Thinning or decreased growth of body or facial hair.
Weight gain, especially around the abdomen (visceral fat which is metabolically harmful).
Reduced libido, and erectile dysfunction (in men).
In adolescents:
Delayed or incomplete puberty.
Lack of secondary sexual characteristics.
Slower growth or shorter stature.
Underdeveloped genitals (in boys).
Dr. Dinesh notes that the more specific symptoms that are more highly indicative of hypogonadism are decreased libido, decreased hair growth and a loss of early morning erections.
Who is at risk of Low Testosterone / Hypogonadism in Singapore?
In Singapore, awareness of these risk groups is crucial for early detection, and intervention. This is especially crucial since symptoms may be subtle or mistaken for ageing, burnout or stress-related issues.
Some individuals with higher risk of developing low testosterone include:
Age– testosterone production gradually declines with age. Men over 40 years old are particularly vulnerable, especially if they also lead sedentary lifestyles or have coexisting chronic conditions.
Obesity– Increased leptin, insulin, oestrogen and inflammation suppresses pituitary function and can cause hypogonadism.
Type 2 diabetes– insulin resistance interferes with the hypothalamic-pituitary-gonadal axis, reducing testosterone production. Nearly one-third of men with diabetes have low testosterone.
Previous testicular or ovarian injury– surgical procedures, trauma or infections affecting reproductive organs can impair hormone production.
Substance abuse or steroid use– long-term use of anabolic steroids, opioids or alcohol can suppress testosterone production permanently.
How does Low Testosterone / Hypogonadism impact fertility?
Unfortunately, low testosterone has a direct impact on fertility.
Low testosterone can have a profound effect on fertility in men. These may include:
In men
Erectile dysfunction and low libido– these issues may interfere with the ability to conceive naturally.
Poor sperm quality– low testosterone can reduce sperm motility, and morphology.
Reduced sperm production – low testosterone limits spermatogenesis in the testes, often leading to low sperm count (oligospermia) or absence of sperm (azoospermia).
Reduced libido– sexual dysfunction can affect frequency of intercourse, and family planning.
How is Low Testosterone / Hypogonadism diagnosed?
As mentioned earlier, diagnosing low testosterone requires more than a single blood test. It involves a comprehensive clinical evaluation, multiple hormone measurements, and sometimes imaging or fertility tests.
As testosterone levels naturally fluctuate throughout the day, and can be influenced by factors like stress, illness or medication, Dr Dinesh will look at both your symptoms, and critically analyse lab results to confirm a diagnosis. Establishing the correct diagnosis and subsequent testing to reveal the cause is crucial.
Some of the key diagnostic methods include:
How is Low Testosterone / Hypogonadism treated?
Treatment for low testosterone focuses on restoring normal testosterone levels, relieving symptoms, and addressing the underlying cause.
However, the approach depends on age, fertility goals, and whether the condition is reversible. While some individuals benefit from testosterone replacement, others may respond to medications that stimulate natural hormone production.
TREATMENT
HOW IT WORKS
NOTES
Testosterone Replacement Therapy (TRT)
Provides testosterone via injections or gels.
Effective for symptomatic men. Requires regular monitoring of red blood cell count, prostate, and hormone levels.
Clomiphene Citrate
Stimulates the brain to boost natural testosterone production.
Can be used off-labet in men seeking to preserve fertility.
Human Chorionic Gonadotropin (hCG)
Mimics LH to stimulate testosterone, and sperm production.
Often used in fertility-focused treatments.
Aromatase inhibitors
Reduce conversion of testosterone to oestrogen.
Off-labet use in obese men or those with high oestrogen levels.
Lifestyle interventions
Weight loss, improved sleep, stress reduction, and resistance training.
Can enhance natural testosterone levels, especially in mild cases.
Management of underlying conditions
Treating diabetes, thyroid disorders or pituitary tumours.
Hormonal balance may improve without direct testosterone replacement.
Summary
Low testosterone, or hypogonadism, is more than just a number. It can impact your energy, mood, libido, muscle strength, and even your long-term health and fertility. Fortunately, with early detection, and the right treatment, you can restore hormonal balance, reclaim vitality, and improve your quality of life.
At The Metabolic Clinic, we offer comprehensive assessments, and personalised care plans tailored to your needs. Whether you are noticing symptoms or simply want peace of mind, our experienced team is here to support you every step of the way. Book a consultation with us today for a detailed diagnosis and personalised treatment plan.
Frequently Asked Questions
Is hypogonadism permanent? It depends on the cause. Some cases, such as those due to medication or temporary illness, may resolve over time. Others, like genetic or age-related causes, may require long-term management.
What can I expect if I have low testosterone? You may notice changes in mood, energy, strength or sexual function. With appropriate treatment, many people see significant improvements in symptoms, including enhanced energy, libido, better mood, and improved physical strength.
How does low testosterone affect mental health? Low testosterone can lead to mood swings, irritability, depression, and difficulty concentrating. Restoring balanced hormone levels can significantly improve mood, and mental clarity.
How does testosterone affect muscle growth? Testosterone plays a key role in muscle development, and strength. Low levels can lead to reduced muscle mass, making it harder to gain strength or maintain physical fitness. This can lead to a condtion called sarcopenia with aging which results in frailty in old age. Testosterone replacement therapy can help improve muscle function and strength.
Can low testosterone affect bone health? Yes, low testosterone levels can lead to decreased bone density, increasing the risk of osteoporosis and fractures. Treatment can help maintain bone health by improving testosterone levels.
Can low testosterone cause weight gain? Yes, low testosterone can contribute to weight gain, particularly around the abdomen, by causing fat redistribution, reducing muscle mass, and slowing metabolism. Rest assured that a proper treatment plan can help manage weight, and improve body composition.
Can low testosterone affect my sexual health? Yes, low testosterone is commonly associated with reduced libido, erectile dysfunction, and difficulty achieving orgasm. However, treatment can help restore sexual function, and improve overall quality of life.
Can low testosterone be prevented? Not always, but healthy lifestyle habits like regular exercise, sufficient sleep, managing stress, and maintaining a healthy weight can support hormone levels. Additionally, avoid excessive alcohol consumption and untested testosterone supplementation or stimulation can reduce your risk.
Is testosterone replacement therapy safe? Testosterone replacement therapy is generally safe when prescribed, and monitored by a healthcare professional. However, it may not be suitable for everyone, especially those with certain health conditions. So, it is essential to discuss your options thoroughly with our doctor.
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