Low Testosterone Production

If a man loses his ability to maintain adequate testosterone production, blood testosterone levels will decline and he will suffer a diminution in sex drive and become impotent.

Conditions responsible for low testosterone output are designated as primary hypogonadism and secondary hypogonadism. When the testicle itself does not function properly, the diagnosis is primary hypogonadism. In contrast, secondary hypogonadism occurs when normal testicles cannot manufacture testosterone because the stimulating hormones of the pituitary or hypothalamus are missing or inadequate.

Primary Hypogonadism

Primary hypogonadism may be congenital (present at birth), like Klinefelter’s syndrome, acquired as the result of a virus that lodges in the testicles, or caused by external assaults such as testicular injury, radiation treatment, and chemotherapy.

Occasionally, failure of the gonads is ordained at conception. Instead of the normal complement of forty-six chromosomes — 46 XY — some men are born with one extra X chromosome. This results in an unusual chromosomal pattern 47 XXY. The condition is called Klinefelter’s syndrome, after the physician who first recognized and described the characteristic physical features of this disorder.

As children, boys with the 47 XXY group of chromosomes are indistinguishable from other boys. The first signs of Klinefelter’s syndrome surface during adolescence. Although the pulsating rhythms of the hypothalamus and pituitary start on schedule, the testicles of the boy afflicted with this syndrome are unable to respond.

Some youngsters with Klinefelter’s syndrome produce no testosterone at all. They retain a youthful appearance, but without testosterone to signal an end to their adolescent growth spurt, they continue to grow and often become very tall. Under the continuous influence of growth hormone, boys grow taller, tower over their classmates, and often bring a twinkle to the eye of the high-school basketball coach. Despite their height, young boys with Klinefelter’s syndrome do not make good basketball players because without adequate testosterone, their muscles remain unstimulated and undeveloped. This is yet another legacy of their testosterone deficiency.

Not all young men with Klinefelter’s have such severe defects. Some boys make some testosterone early in their adolescence, do not grow to unusual heights, and become virilized. Their testicles produce testosterone briefly, then sputter, and thereafter fail. Men with the milder form of Klinefelter’s syndrome have low sexual desire but may enjoy brief intervals of potency. They eventually suffer the same fate as their more severely affected counterparts. As their testicles fail, testosterone and sperm production cannot proceed and they are left impotent and infertile.

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