Secondary hypogonadism: what it is and why it matters

If you feel low on energy, have a low sex drive, or trouble with fertility, the cause might be secondary hypogonadism. That’s when the testes make too little testosterone because the brain — the pituitary or hypothalamus — isn’t sending the right signals. It’s different from primary hypogonadism, where the problem is in the testes themselves.

This condition can creep up slowly. You may notice tiredness, mood changes, loss of muscle, less body hair, or trouble with erections. For men trying to father a child, low sperm count or poor sperm quality can be a big red flag. Women can also get secondary hypogonadism, with irregular periods or infertility being common signs.

How doctors diagnose it

Diagnosis starts with simple blood tests. A morning total testosterone level is the first step. If testosterone is low, your doctor checks LH and FSH. Low or normal LH/FSH with low testosterone points to secondary hypogonadism. Other useful tests include prolactin, morning cortisol, and thyroid function to catch other causes.

If labs suggest a pituitary issue, an MRI of the pituitary gland is usually next. Pituitary tumors, past head trauma, radiation, or infections can disrupt hormone signals. Some medicines — long-term opioids, high-dose steroids, or certain psychiatric drugs — can also cause secondary hypogonadism, so review your meds with your clinician.

Treatment options and what to expect

Treatment depends on the cause and your goals. If a pituitary tumor is found, treating it (medication, surgery, or radiation) can restore normal hormone signals. If a medication is the culprit, switching or stopping it under medical supervision often helps.

For symptom relief, testosterone replacement therapy (TRT) is common in men who don’t need fertility. TRT comes as gels, injections, patches, or implants. It improves energy, mood, muscle mass, and libido in many men, but it’s not the fix for fertility — in fact, TRT can lower sperm production.

If having children matters, doctors use different approaches: injectable hCG, combined hCG with FSH, or oral agents like clomiphene citrate to stimulate the body’s own hormone chain and boost sperm production. These treatments aim to restore fertility rather than just raise testosterone numbers.

Watch for side effects of any therapy. TRT needs monitoring of hematocrit, liver function, and prostate health in older men. Pituitary treatments may require hormone replacement if other pituitary hormones are affected.

Simple lifestyle moves help too: lose excess weight, get regular exercise, limit alcohol, and avoid opioids when possible. These steps don’t replace medical care but can improve outcomes.

If you have persistent symptoms, trouble conceiving, sudden headaches or vision changes, see a doctor. Those signs can point to a treatable pituitary problem that deserves prompt attention.