Hypogonadism

At Montefiore Einstein Urology, you can access exceptional care for hypogonadism. As a global leader in Urology, we are an academic-based, national and international referral site for the most complex and high-risk cases. For more than a century, we have been at the forefront of innovation, research and clinical care for genitourinary (GU) conditions.

Ranked in the top one percent of all hospitals in the nation for Urology according to U.S. News & World Report, Montefiore Einstein continues to make advances in the diagnosis and treatment of GU conditions. Our multidisciplinary team of world-renowned specialists is passionate about uncovering the latest diagnostic approaches and treatments that can improve outcomes.

At Montefiore Einstein Urology, you can expect compassionate, personalized, research-based treatment plans that meet the highest standards for quality and safety. In addition, we offer patients a full range of support services, from nutritional guidance to rehabilitative therapies.

When you need hypogonadism care, turn to our dedicated providers who will develop a highly personalized treatment plan specific to you.

Congenital conditions that lead to primary hypogonadism include:

• Anorchia: absence of testicles at birth
• Cryptorchidism: undescended testicles 
• Klinefelter syndrome: a genetic disorder affecting males caused by an additional X chromosome
• Leydig cell hypoplasia: underdevelopment of Leydig cells in the testicles
• Myotonic dystrophy: a genetic disorder causing progressive muscle weakness and loss
• Noonan syndrome: a rare genetic condition that can cause delayed puberty, undescended testicles or infertility

Acquired conditions that lead to primary hypogonadism include:

• Anabolic steroid use
• Certain types of tumors
• Chemotherapy or radiation therapy of the testicles
• Inflammation of one or both testicles (orchitis)
• Testicle injury or removal

Conditions that affect the hypothalamus and/or pituitary gland cause secondary hypogonadism, resulting in low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These low levels cause decreased testosterone and sperm production.

Congenital conditions that can lead to secondary hypogonadism include:

• Isolated hypogonadotropic hypogonadism: a condition causing low levels of gonadotropin-releasing hormone
• Kallmann syndrome: a rare genetic condition that halts the development of the nerve cells in the hypothalamus that produce gonadotropin-releasing hormone
• Prader-Willi syndrome: a rare genetic multisystem condition that can cause hypothalamus dysfunction

Acquired conditions that can lead to secondary hypogonadism include:

• Brain or head injury
• Cirrhosis of the liver
• Cushing’s syndrome
• Hemochromatosis, or iron overload
• HIV/AIDS
• Hyperprolactinemia, or atypically high levels of prolactin (a hormone) in your blood
• Hypopituitarism, a rare condition in which the pituitary gland doesn’t make or makes insufficient quantities of one or more hormones
• Kidney failure
• Obesity
• Obstructive sleep apnea
• Poorly managed diabetes

Symptoms of male hypogonadism include:

• Decreased endurance
• Decreased muscle mass and strength
• Depression
• Difficulties concentrating or remembering
• Enlarged male breast tissue
• Erectile dysfunction
• Hot flashes
• Increased body fat
• Reduced sex drive
• Loss of armpit and pubic hair
• Low or zero sperm count
• Shrinking testicles

Hypogonadism is diagnosed based on a complete physical examination and a review of the patient’s personal and family medical histories. The following blood tests may be ordered to confirm levels of the following hormones:

• Total testosterone 
• Luteinizing hormone (LH), to determine if the cause of low testosterone is related to the pituitary gland
• Prolactin 

Hypogonadism is treated with testosterone replacement therapy, which can have several different forms:

• Buccal testosterone tablets 
• Intramuscular testosterone injections
• Oral testosterone
• Testosterone nasal gel
• Testosterone patches
• Testosterone pellets (implanted under the skin to provide consistent and long-term dosage)
• Testosterone skin gels