What testosterone level is considered hypogonadism?

Two morning fasted readings below the lab reference range, typically <8-10 nmol/L, alongside consistent symptoms. Borderline (8-12 nmol/L) with strong symptoms is a grey zone — clinician judgement applies.

Is hypogonadism reversible?

Secondary hypogonadism often is — fix the upstream cause (weight, sleep, opioids, prolactin). Primary is usually permanent and managed with TRT.

Hypogonadism in Men: The Working Guide

Hypogonadism is the clinical term for chronically low testosterone with symptoms. It's both over- and under-diagnosed: under, because most symptomatic men never get tested; over, because some clinics prescribe TRT for borderline numbers without confirming the diagnosis. Here's the working frame.

What is the difference between primary and secondary hypogonadism?

Primary hypogonadism: the testes themselves aren't producing enough testosterone. LH and FSH are high (the pituitary is shouting). Causes include Klinefelter, prior orchitis, trauma, chemotherapy, and undescended testes.

Secondary hypogonadism: the pituitary isn't signalling the testes properly. LH and FSH are low or inappropriately normal alongside low T. Causes include pituitary adenoma, hyperprolactinaemia, opioids, high-dose corticosteroids, obesity, and chronic illness.

The distinction matters because secondary hypogonadism often has a treatable upstream cause — fix the cause, the T comes back. Primary doesn't have that path.

What are the diagnostic criteria for hypogonadism?

Endocrine Society standard: two morning total testosterone readings below the lab reference range (typically <8-10 nmol/L), drawn fasted, with consistent symptoms (low libido, low energy, low morning erections, loss of muscle mass, depressed mood).

The full work-up adds LH, FSH (to classify primary vs secondary), SHBG and calculated free T, prolactin (rule out adenoma), and TSH (rule out thyroid). Iron studies are sometimes added to rule out haemochromatosis.

What are the treatment options for hypogonadism?

Testosterone replacement therapy (TRT) is the mainstay for primary and most secondary hypogonadism. Routes: intramuscular esters (enanthate, cypionate), subcutaneous, gels, pellets. Choice is preference and access.

For men trying to preserve fertility, clomiphene or hCG can be used as alternatives or adjuncts — they stimulate endogenous production rather than replacing it.

Lifestyle (sleep, weight loss if obese, stopping opioids/alcohol) can resolve secondary hypogonadism without medication in some cases. Always worth trying first if numbers are borderline.

FAQs

What testosterone level is considered hypogonadism?: Two morning fasted readings below the lab reference range, typically <8-10 nmol/L, alongside consistent symptoms. Borderline (8-12 nmol/L) with strong symptoms is a grey zone — clinician judgement applies.
Is hypogonadism reversible?: Secondary hypogonadism often is — fix the upstream cause (weight, sleep, opioids, prolactin). Primary is usually permanent and managed with TRT.

References

[1]Testosterone Therapy in Men with Hypogonadism: Endocrine Society Clinical Practice GuidelineEndocrine Society / JCEM (2018)
[2]Diagnosis and Management of Male Late-Onset HypogonadismPubMed / J Clin Endocrinol Metab
[3]Sex Hormone-Binding Globulin and Risk of Type 2 Diabetes in Women and MenNEJM (2009)

Get a proper hypogonadism work-up — full HPG axis, not just total T.

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