Subclinical Hypogonadism: Diagnosis and Management in Aging Men

May 21, 2024

Subclinical hypogonadism is a condition characterized by mildly low testosterone levels with few or no overt symptoms, often detected incidentally during routine medical evaluations. It can affect younger individuals with a history of testicular damage or older men experiencing age-related testosterone decline. Diagnosis involves blood tests and monitoring, with treatment primarily focusing on lifestyle changes, while hormone replacement therapy is considered only for cases with significant symptomatic impact.

Subclinical hypogonadism is a term that refers to a condition where an individual has borderline or mildly low levels of testosterone, with few or no overt symptoms typically associated with classic hypogonadism. It is often detected incidentally during routine blood tests or evaluations for other medical conditions and is a similar condition to that known as subclinical hypogonadism. Since most primary care physicians rarely check testosterone levels, many men go undiagnosed, despite having low T.

Two main clinical forms of secondary hypogonadism can be identified. The first form affects young patients with a history of testicular damage before puberty. The second form results from an age-related decline in testosterone. While the first form can be due to various congenital or acquired conditions, including primary hypogonadism, the significance of age-related secondary hypogonadism remains debated.

Evidence shows that age-related secondary hypogonadism is common, affecting 9.4% of older men in the general population. Studies have linked it to poor health and an increased risk of cardiovascular mortality and morbidity. While evidence suggests that secondary hypogonadism in aging populations is associated with higher cardiovascular risk, it is unclear if testosterone treatment can improve outcomes. In studies published by the national library of medicine, researchers have found that for patients with cardiac arrhythmia, stroke and cardiac failure, testosterone replacement therapy demonstrated beneficial effects among the test subjects with morbidities, like testosterone deficiency, diabetes mellitus, and hypertension.  Further interventional studies are needed to better understand secondary hypogonadism and the potential benefits of early testosterone replacement therapy (TRT).

What is Subclinical Hypogonadism?

Testosterone Levels for the Aging Male.

In subclinical hypogonadism, testosterone levels are lower than what is traditionally considered normal but not significantly enough to cause clear clinical symptoms. These levels might be just below the lower limit of the normal ranges or fluctuate around it. Typical ranges of testosterone levels in men are often between 250-1000ng/dl, however this reference range can vary, and actual levels will differ among aging populations.

The average testosterone level for an 18-year-old male will traditionally be much higher than that of a 70-year-old patient however most doctors use the same scale to measure, diagnose and treat both patients based on the same reference range despite there being a dramatic difference between what their bodies should naturally be producing in terms of T levels.

As far as how men make testosterone, the hormone is produced in the testes in males and is a part of a larger system known as the hypothalamic-pituitary-thyroid (HPT) axis. It is a sophisticated neuroendocrine system that controls metabolism, growth, and reproduction in the body. It operates through a pathway that starts in the hypothalamus, moves to the pituitary gland, and then reaches peripheral target organs, which in this case are cells in the testes that produce testosterone. These are called Leydig cells which are located in the interstitial tissue between the seminiferous tubules.

Symptoms of subclinical hypogonadism.

Unlike overt hypogonadism, where the more well-known symptoms such as fatigue, decreased libido (sex drive), erectile dysfunction, and loss of strength and lean muscle mass are both evident and pronounced, subclinical hypogonadism may present with subtle or nonspecific symptoms. Patients may have become accustomed to the way their body now feels and not even think that there could be an underlying medical cause. Some individuals might experience mild symptoms such as:

·  Slight reductions in energy levels and fatigue

·  Mild mood disturbances or irritability

·  Subtle changes in muscle mass or strength

·  Mild decrease in sexual function, performance and libido

However, many individuals may remain asymptomatic or have symptoms so mild that they don’t realize that they may have the beginning stages of Low T or subclinical hypogonadism.

Diagnosing subclinical hypogonadism.

Diagnosing subclinical hypogonadism can be tricky for even an experienced physician, however as it becomes more well known among the medical community, it may become more commonly diagnosed and eventually treated when appropriate. Diagnosing Subclinical Hypogonadism can involve the following:

·  Measuring serum testosterone levels via a blood test, typically in the morning when levels are highest. Blood tests needed to start TRT can vary from one physician to the next.

·  Conducting repeat tests to confirm low testosterone levels, as levels can fluctuate from one day to the next.

·   Assessing levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to distinguish between primary (testicular) and secondary (pituitary or hypothalamic) hypogonadism. Even measuring sex hormone binding globulin (SHBG) can be important to see how much testosterone in being bound to these proteins and potentially causing the signs and symptoms associated with sub optimal testosterone levels.

·   Evaluating overall health and ruling out other potential causes of low testosterone, such as obesity, chronic illnesses, or medications.

Potential Causes of subclinical hypogonadism.

Factors that might contribute to subclinical hypogonadism include aren’t fully understood and more research is needed, however we do know that several factors can contribute to a decline in T levels. Some of these factors include:

·  Excessive body fat/Obesity

·  Chronic diseases such as type 2 diabetes, metabolic syndrome)

·  Certain medications (e.g., opioids, glucocorticoids)

·  Stress and poor lifestyle habits

·  Smoking, drinking alcohol and using drugs

·  Lack of physical activity and exercise

·  Poor sleep quality

·  Aging (age-related testosterone decline)

Management and Treatment of Subclinical Hypogonadism

The approach to managing subclinical hypogonadism can vary based on the severity of symptoms, lab results from blood tests, physician preference and experience as well as desired patient outcomes and goals. Different physicians may also treat the condition differently as there is little in terms of a standardized approach to this field of medicine for healthcare providers.

Lifestyle Modifications: Improving diet, increasing physical activity, losing weight, reducing stress, and ensuring adequate sleep will all help potentially increase testosterone levels naturally.

Monitoring: Regular monitoring of testosterone levels and symptoms to detect any progression to overt hypogonadism. It’s a good idea to get a baseline hormone reading and monitor it regularly to see what is actually happening in your body as you age. Unfortunately, this is something that’s rarely done in medicine despite the tremendous impact that our hormones play in our overall health.

Testosterone Replacement Therapy (TRT): Not always recommended for subclinical hypogonadism unless symptoms are present and impact quality of life. The decision to start TRT should be made cautiously, considering potential benefits and risks but there is significant evidence that shows the positive benefits to optimized hormone levels and the potential medical complications that come from having Low T. The benefits of TRT must be weighed against the potential risks, particularly in cases of subclinical hypogonadism for each patient on a case-by-case basis.

Subclinical hypogonadism is characterized by mildly low testosterone levels with few or no significant symptoms. It requires careful diagnosis and monitoring, with management primarily focused on lifestyle changes and addressing underlying health conditions.

Hormone replacement therapy is generally reserved for cases with clear symptomatic impact and is approached with caution. To learn more, visit NovaGenix  and call/text us at (561) 277-8260 with any questions regarding hormone health and testosterone treatments.


Contact Us

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Blood Work Request Form

This subsequent lab panel is necessary for males undergoing Testosterone Replacement Therapy (TRT) through NovaGenix Health and Wellness. It allows physicians to assess the patient's response to prescribed medications, covering sex hormone levels, thyroid function, adrenal health, hematocrit, and liver and kidney function. The panel includes tests such as:

  • Complete Blood Count
  • Comprehensive Metabolic Panel
  • Testosterone (Free and Total)
  • Estradiol Sensitive
  • Thyroid Stimulating Hormone
  • Prostate Specific Antigen

Each test serves a specific purpose in monitoring overall health and treatment effectiveness. When required, Dr Mackey may require LH and FSH (Luteinizing hormone, follicle stimulating hormone) SHBG (Sex hormone binding globulin) or any other tests which may be important for your health and optimizing your hormones.

The Comprehensive Hormone and Wellness Panel for Women offers a foundational assessment of sex hormones, thyroid function, adrenal health, metabolic activity, and overall well-being. This panel serves as a diagnostic tool for identifying testosterone and estrogen deficiencies, assessing health risks, and detecting potential thyroid issues before considering hormone replacement therapy. Additionally, it includes insights into hematocrit (red blood cell volume), as well as liver and kidney function. The panel encompasses various tests such as:

  • Complete Blood Count (CBC)
  • Complete Metabolic Panel
  • Testosterone (free and total)
  • Estradiol
  • Thyroid Stimulating Hormone (TSH)
  • Progesterone

When indicated, Dr. Mackey may require additional tests such as Follicle Stimulating Hormone (FSH), and IGF-1 and Cortisol.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

609 N Hepburn avenue suite 106. Jupiter, Florida 33458

Schedule a Consultation

Learn what you want to know about hormone therapy by scheduling a free consultation.

Contact Us Today

609 N Hepburn avenue suite 106. Jupiter, Florida 33458