Types of Hypogonadism:
There are two types of Hypogonadism: Primary and Secondary. Primary means your testicles are not functioning properly. Secondary often means your pituitary is not functioning properly. It can also be due to problems with your thyroid, hypothalamus, and/or adrenals. Now that you have your blood work indicating Hypogonadism, you need to see what your Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) are. LH is produced in the pituitary gland and acts as a signal to the Leydig Cells in your testicles that tells them to produce testosterone. FSH is also produced in the pituitary gland and acts as a signal (along with testosterone) to the Sertoli Cells in your testicles that tells them to produce sperm. LH and FSH work together synergistically.
If you have high LH and FSH in combination with low testosterone you have Primary Hypogonadism. This means your pituitary is yelling at your testicles to produce more testosterone but they are not responding. If you have low or normal LH and FSH in combination with low testosterone you have Secondary Hypogonadism. This means that your pituitary is not recognizing that your body is deficient in testosterone so it is not sending a loud signal to your testicles to produce more testosterone. You will often hear this system referred to as the Hypothalamic-Pituitary-Testicular Axis or HPTA and I encourage you to spend more time learning about it.
Causes of Hypogonadism:
Possible causes of Primary Hypogonadism include: physical trauma to the testicles, aging, toxins (e.g. alcohol or heavy metals), Klinefelters Syndrome, XYY Syndrome, anorchia, orhitis, varicocele, hemochromatosis, mumps, certain prescription drugs and radiation treatment or chemotherapy. There are other possibilities as well that you can discuss with your doctor. If you are Primary you should consult with an urologist to see if you can determine what is wrong with your testicles.
Possible causes of Secondary Hypogonadism include: physical trauma to the head, aging, pituitary and/or hypothalamus tumor (usually benign), Hyperprolactinemia, Kallmans Syndrome, HIV, obesity. Again, there are other possibilities as well that you can discuss with your doctor. If you are secondary you should consult with an endocrinologist and probably have an MRI done. Sometimes it is possible to get your pituitary gland working again by attempting a restart. This option should be considered especially if you are in your 20s or early 30s. I wont go into details here, but it often involves using Clomid or other similar medications. I would strongly encourage you to work with a doctor that is very knowledgeable in restart protocols.
Unfortunately, the truth is that many guys never determine what is causing their Hypogonadism. The good news is that means one of the serious illnesses listed above is not causing it. It likely comes down to getting old, being over-weight or being unlucky.
There are other health problems that can lower your testosterone and should be looked into with your doctor before starting treatment. These include: sleep apnea/hypopnea, thyroid problems, poor diet, and drug use including certain pain medication. I highly encourage you to have a sleep study done to rule this possibility out and have a full thyroid panel run. Take a look at your diet, drug use and lifestyle as well.
