Male Hypogonadism

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Organic Hypogonadism: this is due to testicular pathology (primary hypogonadism) or impaired testicular function due to deficient pituitary signal hormones e.g. gonadotrophins LH, FSH hormones from-

· Pituitary tumour (adenoma)- A pituitary tumour (usually non-cancerous) can cause low testosterone level known as secondary hypogonadism. 

· Hyperprolactinaemia- high prolactin hormone from the pituitary gland due to an adenoma or due to medications e.g. Sertraline, SSRI group of drugs can cause low testosterone by suppressing the action of testosterone simulating pituitary signal hormones LH. 

Functional Hypogonadism: this is due to

Obesity

Being overweight or obese can increase the risk of low testosterone. In one study, 30% of people who were overweight had low testosterone, compared to 6% of those with a normal weight. 

Diabetes

People with Type 2 diabetes are more likely to have low testosterone. In one study, 25% of people with Type 2 diabetes had low testosterone, compared to 13% of those without diabetes. 

Long term exposure to Opioid medications e.g. Morphine, Oramorph, Codeine 

Use of anabolic steroid and testosterone hormones

Aging

As men age, the function of the hypothalamus and pituitary gland declines, which can lead to a decrease in testosterone production. This is known as late-onset hypogonadism (LOH). 

Severe illness including COVID-19

Mental health issues- stress or anxiety can cause low testosterone. 

Sleep apnoea- People with obstructive sleep apnoea don't reach REM sleep, when testosterone is produced.

Smoking- Smoking increases carbon monoxide levels in the body, which can reduce testosterone production.

Other conditions

Other causes include testicular injury, genetic disorders, and some cancer treatments.