Hypogonadism is a condition where your testes produce little or no testosterone, the main male sex hormone. It's not always about the testes themselves. Sometimes the problem sits further up the chain, in the signals your brain sends to tell your testes to make testosterone in the first place. Either way, the result is the same: your testosterone levels drop lower than they should.
Primary hypogonadism is when the problem is in the testes themselves. They're not able to produce enough testosterone, even though your brain is sending the right signals.
Secondary hypogonadism is when the testes are working fine, but the pituitary gland or hypothalamus (the parts of your brain that control hormone signals) aren't sending the right instructions. Without that signal, your testes don't get the message to produce testosterone.
Hypogonadism symptoms can be easy to miss. That's mostly because they overlap with everyday tiredness, stress, or just getting older. Common signs include a lower sex drive and persistent fatigue. Loss of muscle mass and low mood or irritability are also common. Because these symptoms show up in so many other conditions, it's not something you can diagnose yourself. A GP visit and a blood test are the only reliable way to know what's going on.
A few subtler signs are worth paying attention to, especially if they've crept up gradually rather than appeared overnight:
Low energy that doesn't improve with rest
Difficulty concentrating or a foggy head
Low mood or a general lack of motivation
Testosterone plays a direct role in sperm production, so when levels drop, sperm production can drop too. This is one of the reasons hypogonadism sometimes only comes to light when a couple starts investigating why they're having trouble conceiving. If you're trying for a baby and things are taking longer than expected, it's worth mentioning any of the symptoms above to your GP alongside your fertility concerns.
There isn't one single cause of hypogonadism. It can be present from birth, or it can develop later in life. Common causes include:
Ageing – testosterone naturally declines by around 1% a year from around age 30 to 40, though this gradual dip rarely causes hypogonadism on its own.¹
Testicular injury or infection – damage to the testes can affect how much testosterone they produce.
Genetic conditions – Klinefelter syndrome, where a man is born with an extra X chromosome, is one of the more common genetic causes and often affects testosterone production and fertility.³
Pituitary or hypothalamus disorders – problems with the brain signals that control your testes, sometimes caused by a tumour.²
Obesity and type 2 diabetes – both are linked to a form called late-onset hypogonadism.¹
Certain medications and illegal drug use – some medicines and recreational drugs, including anabolic steroids, can interfere with testosterone production.²
If you recognise any of these symptoms, the first step is a conversation with your GP. They'll usually ask about your general health and lifestyle before arranging a blood test to measure your testosterone levels. If your results suggest a deficiency, you may be referred to an endocrinologist, a specialist in hormone conditions who can arrange further tests.
The main treatment for hypogonadism is testosterone replacement therapy (TRT), usually given as a gel or an injection. Where hypogonadism is linked to an underlying cause, such as obesity, addressing that cause can also help.
Lifestyle changes can support treatment too. A balanced diet, regular exercise, and cutting back on alcohol and smoking are all worth focusing on alongside any medical treatment your doctor recommends.
Getting a hypogonadism diagnosis while you're trying to conceive can feel like a lot to take in at once. The good news is that a diagnosis gives you and your partner a clear next step, and there's support available for the parts of the process that feel harder to manage.
twoplus's male fertility supplements are designed to sit alongside whatever your doctor recommends for your hypogonadism treatment, giving you one less thing to think about while you focus on your diagnosis. And for couples who want a more comfortable, private way to try each month, the twoplus Applicator Extra deposits sperm close to the cervix, working with your body rather than adding extra pressure to the process. It's not a replacement for medical treatment or advice from your doctor, but it can be a supportive part of your routine while you work through diagnosis and treatment together.
Whatever stage you're at with a hypogonadism diagnosis, you don't have to navigate the fertility side of things alone. twoplus was built for couples trying to conceive at home, and our products are designed to fit into your life without adding extra stress to a journey that can already feel like a lot.
Can hypogonadism be cured? It depends on the cause. Some causes, like a hormone imbalance from obesity, can improve with lifestyle changes. Others, like genetic conditions, aren't curable but can be managed effectively with testosterone replacement therapy under a doctor's care.³
Does low testosterone always mean infertility? Not always. Low testosterone can affect sperm production, but it doesn't automatically mean you can't conceive. A GP or fertility specialist can assess your specific situation with the right tests.²
What are the first signs of hypogonadism in men? Early signs often include low energy, reduced sex drive, difficulty concentrating, and a general lack of motivation. These are easy to put down to stress or tiredness, which is why a blood test is the only way to confirm what's really going on.¹
Can hypogonadism be treated naturally? Lifestyle changes like losing weight, cutting back on alcohol, and regular exercise can support healthy testosterone levels, particularly where obesity is a factor. But these steps work alongside medical treatment, not as a replacement for it. Speak to your GP before making changes based on a suspected diagnosis.¹
NHS – The 'male menopause': https://www.nhs.uk/conditions/male-menopause/
NHS – Causes of infertility: https://www.nhs.uk/conditions/infertility/causes/
NHS – Klinefelter syndrome: https://www.nhs.uk/conditions/klinefelters-syndrome/
