Secondary Hypogonadism: What It Is and How to Manage It

If you’ve heard that your testosterone is low but the testicles look fine, you might be dealing with secondary hypogonadism. Unlike primary hypogonadism, where the testicles themselves can’t make enough hormone, secondary forms stem from problems higher up in the hormonal chain—usually the brain’s pituitary or hypothalamus.

Common Causes and Symptoms

Things that can disrupt the signal from the brain include pituitary tumors, head injuries, chronic opioid use, and certain medications like glucocorticoids. Even extreme stress or severe weight loss can mute the hormonal “start button.” When the signal is off, you’ll notice classic low‑testosterone signs: reduced libido, fatigue, loss of muscle mass, mood swings, and sometimes mild anemia.

Diagnosis and Treatment Options

Your doctor will start with a blood test that checks both testosterone and the pituitary hormones (LH and FSH). If those upstream hormones are low, it points straight to secondary hypogonadism. Imaging—usually an MRI of the pituitary—helps spot a tumor or structural issue.

Treatment focuses on two fronts. First, fix the underlying cause: surgery for a tumor, tapering off offending meds, or managing stress and nutrition. Second, replace the missing hormone. Many clinicians prescribe testosterone gels, patches, or injections, adjusting the dose to your body weight for a safer, more effective result. Lifestyle tweaks—regular strength training, balanced diet, adequate sleep—also boost natural hormone production.

Monitoring is key. After starting therapy, check hormone levels every 3‑6 months and watch for side effects like acne, sleep apnea, or changes in blood counts. If you notice any new symptoms, reach out quickly.

Bottom line: secondary hypogonadism is a treatable condition that starts with a clear diagnosis and ends with a personalized plan. Whether you need a small hormone patch or a bigger medical intervention, the goal is to get your energy, mood, and strength back on track.