November 13th, 2015
Low testosterone can be caused by problems in the organs that produce testosterone, the testicles and the adrenal glands, or it can be caused by a problem with either the hypothalamus or pituitary gland in the brain, which regulate testosterone production in the gonads. Low T is known as “hypogonadism” and when it is due to a problem in the testicles, it is known as “primary hypogonadism.” In this case, your testicles are receiving a message from the hypothalamus and pituitary to produce testosterone, but the testicles are unable to respond. If a problem with the hypothalamus or pituitary gland is the reason for low testosterone, this is known as “central hypogonadism.”
When treating hypogonadism, your doctor will consider whether or not your disorder is primary, which may be caused by radiation exposure, surgery on the testes, infection, some genetic disorders, some autoimmune disorders, and liver or kidney disease. These problems will be addressed to restore your ability to maintain an adequate level of testosterone, although in many cases a testosterone supplement will be necessary.
In the case of central hypogonadism, causes can include genetic disorders, infections (AIDS), inflammation from sarcoidosis or other inflammatory diseases; nutritional deficiencies, use of steroids, and use of opioid drugs; brain surgery, bleeding, or a pituitary tumor; obesity, rapid weight loss; and a number of pituitary disorders. These problems should be addressed, if possible, when treating low T.
When evaluating and treating low T, your physician will check your blood levels of several reproductive hormones released by the pituitary gland, including follicle stimulating hormone and luteinizing hormone. In addition to testing your serum testosterone level, a semen analysis may be ordered by your physician to check your sperm count. Other blood tests may be needed to rule out a variety of possible causes. Prolactin and thyroid hormone disorders can cause problems that may appear similar to low T. If you have an iron deficiency, your blood count will reflect this potential cause of low T.
Imaging studies can be helpful in evaluation of low T, in order to determine the best treatment. This may include an MRI or CT scan to rule out tumors of the pituitary gland.
Treatment for low T is primarily testosterone replacement therapy in men. Testosterone can be supplemented by injection, gel, patch, or lozenge. In younger men with low T and delayed puberty, gonadotropin-releasing hormone injections are sometimes utilized to trigger puberty. These injections are sometimes used to increase sperm production.
If the low T is the result of a pituitary gland tumor, treatment may include radiation, medication, or surgery.
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