Treatment for male hypogonadism mainly focusses on replacing the low testosterone levels.

Hormone replacement therapy

Hormone replacement therapy is the main treatment for both types of hypogonadism. The goal of hormone replacement therapy (often referred to as testosterone therapy in the case of male hypogonadism) is to help you feel better, improve your mood, boost your energy, and making your muscles and bones stronger.

There are different types of testosterone therapy, and each one is absorbed by the body in its own way, with different possible side effects.

If side effects are a concern, you might want to start with a treatment that’s easy to stop. Ask you doctor which treatment would be right for you in this case.

Not all types of testosterone therapy may be available, so it's important to work closely with your doctor to find the treatment that is right for you.

For men with low testosterone because of problems with the testicles (primary hypogonadism), replacing testosterone can bring levels back to normal.
If the problem comes from the brain, the pituitary gland (secondary hypogonadism), replacing pituitary hormones can help boys develop normally and support their growth. In men, these hormones can boost sperm production and improve the ability to have children.

Types of testosterone therapy and delivery method:

Taken by mouth:
- Testosterone undecanoate pills: Taken by mouth.
- Sublingual testosterone: A small tablet that dissolves under the tongue.
- Buccal testosterone: A tablet placed against the inside of the cheek and swallowed.
Side effects: These forms are commonly used, safe, and have little to no side effects when taken for a short time. However, they work quickly but need to be taken regularly to keep testosterone levels steady.
Injected into the Buttock or Arm:
- Testosterone cypionate and testosterone enanthate: Given as injections every 2–3 weeks.
- Testosterone undecanoate: Given as an injection every 3 months.
- Subdermal depot: A patch placed under the skin that slowly releases medicine for 5–7 months.
Side effects:
- Testosterone cypionate and testosterone enanthate can cause your testosterone levels to vary, sometimes going too high or too low. This can lead to symptoms that come and go during treatment.
- With the depot, there’s a small risk of infection or the implant coming out.
Applied to the Skin:
- Transdermal testosterone gel: Applied directly to the skin (usually on the shoulders, upper arms, or abdomen). The testosterone is absorbed through the skin into the bloodstream.
Side effects:
- Transdermal testosterone gel is a simple, easy-to-use option that delivers a steady release of testosterone throughout the day.
- However, it can sometimes cause skin irritation. You need to be careful to avoid skin contact with others after applying it to prevent transferring the testosterone to them.

Risks of testosterone treatment

While testosterone treatment can help, it also comes with some risks. These include possible side effects, as well as changes in hormone levels that may lead to problems like prostate tumours (both cancerous and non-cancerous), enlarged breasts, infertility (not being able to have children), and blood clots.

Do not use testosterone replacement treatment if you have:

Heart problems.
Prostate cancer.
An enlarged prostate that causes problems urinating.
Male breast cancer.
High red blood cell count.
Serious sleep apnoea (a condition where your breathing stops and starts repeatedly during sleep, leading to poor sleep quality and low oxygen levels in the body. It can cause loud snoring and daytime tiredness).
Infertility and want to have children.

It’s important to discuss these risks with your doctor to make sure testosterone treatment is safe for you.

Follow-up

You should get regular check-ups during your treatment. Your doctor will plan visits with you to check if the treatment is safe and working and if you are noticing any side effects. Your testosterone will be tested over time to help decide on the right dosage. Follow-up may include blood tests, checking your prostate and your heart, and scans to find out how weak or strong your bones are.

With treatment, your symptoms will go away gradually. For example, your sex drive might improve first, then your mood might improve, and then erectile function (getting and keeping an erection) might return.

Hypogonadism and wanting to have children

Men who want to have children should stay clear from testosterone replacement treatment because it can lower or stop sperm production, leading to infertility (not being able to have children).

Testosterone replacement treatment tells the body it has enough testosterone, which causes the brain to slow down or stop the natural production of both testosterone and sperm. For men with low testosterone who still want to have children, other treatments like clomiphene citrate or hCG can help boost natural testosterone levels without affecting fertility. Talk to your doctor about these alternative treatments to see if either one could be right for you.