Androgen Deficiency – Causes, Symptoms and Treatment
Androgen deficiency refers to abnormally low levels of male sex hormones in the body. It can cause fatigue, loss of libido, and muscle loss, and affects both men and women.
Things worth knowing about "Androgen Deficiency"
Androgen deficiency refers to abnormally low levels of male sex hormones in the body. It can cause fatigue, loss of libido, and muscle loss, and affects both men and women.
What is Androgen Deficiency?
Androgen deficiency is a condition in which the body does not produce sufficient male sex hormones, known as androgens. The most important androgen is testosterone, which is present in both men and women but at very different levels. In men, testosterone is primarily produced in the testes; in women, in the ovaries and adrenal cortex. A deficiency can occur at any age and has wide-ranging effects on health and quality of life.
Causes
Androgen deficiency can be divided into primary and secondary forms depending on its origin:
Primary Androgen Deficiency
In primary androgen deficiency, the cause lies directly in the gonads (testes or ovaries). Common causes include:
- Genetic conditions such as Klinefelter syndrome
- Testicular inflammation (orchitis), e.g. following mumps infection
- Testicular torsion or injury
- Chemotherapy or radiation therapy to the pelvic region
- Surgical removal of the testes (orchiectomy)
Secondary Androgen Deficiency
Secondary androgen deficiency arises from impaired signaling from the brain. The hypothalamic-pituitary axis produces insufficient levels of the regulating hormones LH and FSH, reducing androgen production. Causes include:
- Tumors or injuries of the pituitary gland or hypothalamus
- Hyperprolactinemia (elevated prolactin levels)
- Chronic stress or malnutrition
- Obesity and metabolic syndrome
Age-Related Androgen Deficiency
From around age 40 onwards, testosterone levels in men decline by approximately 1–2% per year. This gradual process is known as the andropause or late-onset hypogonadism.
Symptoms
Symptoms of androgen deficiency are diverse and often develop gradually:
- Reduced sexual drive (loss of libido)
- Erectile dysfunction in men
- Persistent fatigue and lack of motivation
- Mood swings, depression, and irritability
- Loss of muscle mass and physical strength
- Increased body fat, particularly around the abdomen
- Reduced bone density (increased risk of osteoporosis)
- Hair loss or reduced body and facial hair
- Difficulty concentrating and memory problems
- Reduced testicular size and sperm production in men
Diagnosis
Diagnosis of androgen deficiency involves a combination of clinical evaluation and laboratory tests:
- Blood test: Measurement of total testosterone, free testosterone, LH, FSH, and SHBG (sex hormone-binding globulin)
- Blood samples should ideally be taken in the morning between 7 and 11 a.m., as testosterone levels follow a diurnal pattern
- Exclusion of other conditions (e.g. thyroid disorders, diabetes)
- MRI of the pituitary gland if secondary hypogonadism is suspected
- Bone densitometry (DXA scan) to assess bone mineral density
Treatment
Treatment depends on the underlying cause and severity of the deficiency:
Testosterone Replacement Therapy (TRT)
The most common treatment is testosterone replacement therapy (TRT), which is available in the following forms:
- Daily topical gel applied to the skin
- Injections (every 2–12 weeks depending on the preparation)
- Transdermal patches
- Subcutaneous implants (pellets)
TRT improves libido, energy levels, muscle mass, and bone density. Regular monitoring (blood count, PSA levels, hematocrit) is essential during therapy.
Lifestyle Modifications
For mild or functional androgen deficiency, the following measures may help:
- Regular strength training and physical activity
- Weight loss in cases of obesity
- Stress reduction and adequate sleep
- A balanced diet rich in zinc, vitamin D, and healthy fats
Treatment of the Underlying Condition
If a specific cause is identified (e.g. a pituitary tumor or hyperprolactinemia), treating that condition directly often leads to normalization of androgen levels.
References
- Bhasin S. et al. - Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism, 2018.
- World Health Organization (WHO) - Reproductive Health and Androgen Deficiency. Available at: https://www.who.int
- Nieschlag E., Behre H.M., Nieschlag S. - Andrology: Male Reproductive Health and Dysfunction. 3rd Edition, Springer, 2010.
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