All In Your Head …. Or Further South?

Low testosterone (hypogonadism), can either have Primary or Secondary causes, or sometimes a combination of both. Primary means that something in the testes is not functioning correctly, secondary means that something is amiss in the Hypothalamus-Pituitary axis. It’s an important factor to consider because it affects your treatment options.

If you have primary low T, then basically your only option is going to be testosterone supplementation of some sort, either a gel, patch, pellets, or injections. Your doctor will probably also prescribe Clomid or HcG to keep your testes from shutting down what little production they’re currently making, but basically, you need an exogenous (external) source and that’s all there is to it. However, if your low T is secondary, that opens up a few options that don’t necessarily have to include testosterone therapy.

How do you determine whether your low T is primary or secondary? It’s not always possible to determine definitively what’s causing the low T, but there are sometimes indicators that can point the way. If LH and FSH values are high, indicating that the hypothalamus-pituitary axis is doing its job of telling the testes to produce more testosterone, but testosterone levels are still low, that’s typically a pretty good indicator that there’s a testicular disorder (primary cause).

Low LH and FSH values, on the other hand, mean that the hypothalamus-pituitary process is not working as it should (secondary hypogonadism). It’s important to note that even if LH and FSH values are within normal range, but T levels are low, then the LH and FSH levels are inappropriately  normal because they actually should  be elevated in response to low T levels. This would tend to indicate secondary hypogonadism.

There are other factors that can contribute to low T, both primary and secondary:

    • Sleep apnea,
    • Obesity
    • Heavy alcohol use
    • Varicocele (varicose vein in the testes)
    • Diabetes
    • Iron overload
    • Elevated estrogen
    • Elevated Prolactin levels
    • Hypothyroid

Often, correcting one of these issues will result in improvements to T levels without having to administer T therapy.

It’s important to determine whether your low T is primary or secondary, as this will affect your best course of action.