Low Testosterone: Hypogonadism

Hypogonadism, otherwise known as Low T, has received a lot of press recently. Learn how hypogonadism is diagnosed, what causes it and treatment options available.

Hormone imbalances are a fairly common cause of fertility problems in men. Of hormone issues, Low testosterone (or hypogonadism) gets the most press. It is fairly common for testosterone levels to drop as men age and testosterone replacement therapy has gained popularity in helping men feel active and youthful. However, when you are trying to conceive, getting the right balance of hormones can be a little more involved.

Balancing hormones

The male endocrine system revolves around ensuring that there is enough, but not too much testosterone. As a quick refresher to high school sex ed, here is how hormones are produced. In the brain, the pituitary gland produces luteinizing hormone (LH) and follicle stimulating hormone (FSH). LH travels through the blood to the testicle where it stimulates production of Testosterone, which is a steroid, by leydig cells. Testosterone is soaked up by sertoli cells to feed baby sperm. Leftover testosterone goes into the blood stream, where it is put to use building muscles and growing your 5 o’clock shadow. (see our bio lesson on hormones for more details). When there is enough testosterone around, sertoli cells secrete inhibin, which in turn tells the brain to stop producing FSH.

If semen analysis comes back abnormal, most urologists will perform a physical exam and request a simple blood test to measure Testosterone and FSH (occasionally they will also measure LH as well, but usually it is unnecessary). It is best to take the test in the morning when blood testosterone levels are at their peak. See our article on hormone testing for more details.

What can go wrong?

There are a variety of ways that men’s hormones can get out of balance. These are the most common, although sometimes Testosterone and FSH can’t tell the whole story. There are certain conditions for which it is useful to gather information about additional hormones include thyroid stimulating hormone (TSH), luteinizing hormone (LH), and estrodiol (a form of estrogen).

Testosterone Level FSH Level
Primary Hypogonadism Low High
Androgen Use High Low
Secondary Hypogonadism Low Low
Aromatase Disorders Low or High Low or High

Primary Hypogonadism: Low T, High FSH

Primary hypogonadism, sometimes referred to as hypergonadotrophic hypogonadism, occurs when the brain is sending a signal to the testicle to produce testosterone, but for one reason or another, the testicle is unable to produce sufficient testosterone. Often this is due to some form of testicular failure which can come from injury, infection, toxins, genetic conditions, or congenital defects. If, indeed, the tissue of the testicle is damaged, there is little that medicine can do to repair or restore function.

Genetic Disorders Several genetic disorders can reduce testicular function and lower T levels. Some of the most common disorders include Klinefelter Syndrome,which happens when men receive an extra X chromosome and have XXY rather than just XY. Another common issue known as Y Chromosome Microdeletion (YCM) happens when key genes responsible for testosterone or sperm production are deleted from the Y Chromosome. See a full list of genetic disorders that can impact fertility.

Cryptorchidism: when balls go AWOL: Poor descent of the testicle is one of the most common birth defects in baby boys, affecting 3% of full-term babies and up to 30% of premies. Often the testicle will descend on its own during the first year of life (usually during the first 3 months), however sometimes surgery is required. When the testicles don’t descend, fertility is at risk. This is due to keeping the testicle in the body longer, which overheats the cells responsible for producing sperm and permanently cooks the ball.

Infection & Injury: “Protect the family jewels” has an element of truth to it. Injury to the testicle can destroy tissue needed for sperm production. A cheap shot below the belt isn’t likely to do it, but if you somehow injure yourself and the pain doesn’t subside, it is a good idea to go to the ER; Sometimes blood flow to the testicle can get cut off and cause irreversible damage. Infections such as mumps, gonorrhea, and syphilis, among others, can also cause severe damage. Often these can be treated with medication. Take home point: if it hurts or it’s weird and it doesn’t go away, it’s a good idea to see a doctor, even if its embarrassing. Your balls will thank you.

Testicular atrophy: Are my balls shrinking?

Testicular atrophy, or shrinking balls, are most commonly associated with steroid use, but there are a number of other reasons that a man’s testicles would begin to atrophy. The most common reason is age. Atrophy is a natural part of aging. As we get older blood doesn’t circulate quite as well and some of our less critical tissues (such as muscles) begin to shrink. Another common cause is leading a sedentary lifestyle. This lifestyle results in the body beginning to atrophy, and in extreme cases this can include testicular mass, creating a negative feedback loop: smaller testicles reduce testosterone production, which in turn increases fatigue, further reducing physical activity and increasing atrophy.

Steroids & Testosterone Replacement Therapy: High T, Low FSH

The most common way to boost testosterone is to use anabolic steroids or testosterone replacement therapy. These drugs are part of a family of drugs known as androgens. They all work on a similar principle: they are pumped into the bloodstream either inter-muscularly (via shot) or trans-dermal (with patch or gel), and bind to androgen receptors throughout the body, and enhance all the secondary sex characteristics (such as hair growth, muscle mass, etc). However, they do not pass into the testicle and therefore do nothing to help with sperm production. In fact, they have the opposite effect. When the brain senses that there are high levels of testosterone in the blood, it assumes the testosterone is coming from the testicle. The brain then shuts off production of FSH, which stimulates the production of testosterone in the testicle. So while the body enjoys the benefits of high serum testosterone, the testicles are stranded and begin to shrink.

If you have low T and have been on TRT but are now finding a drop in sperm count, pick your ego off the floor, there is a good chance that you can boost your sperm count. The first step is getting off the testosterone medication. Next, you need to figure out the causes of your low T. Lastly, there are a variety of medications that can help boost testosterone levels in sperm friendly ways. There are also a whole host of natural ways to boost testosterone.

Secondary Hypogonadism: Low T, Low FSH

Secondary hypogonadism occurs when there is a problem with the pituitary gland or the signaling pathway, that suppressed production of follicle stimulating hormone or luteinizing hormone, or both, which in turn suppresses testosterone production. The good news is that this form of hypogonadism is much easier to treat. Medications such as Gonal-f, Menopur or hCG which were originally developed to treat female infertility have proven to be very effective at resolving low T issues when there is a signalling problem. Many urologists have limited experience with endocrine issues. They may not be aware of medications to restore hormone levels and want to prescribe a testosterone, which will not be helpful for all the reasons mentioned above. Ask them to look into FSH or LH based medications.

Genetics: There are a number of known genetic conditions that can impair the production of key reproductive hormones. Most of these conditions are relatively rare (1 in 10,000), but are still worth knowing about. Kallman Syndrome is a condition that causes a late onset of puberty and is charactized by a complete lack or severely impaired ability to smell. It dramatically reduces the production of GnRH, the hormone responsible for stimulating the production of LH and FSH. Other genetic disorders that can lead to hormone imbalances include: Prader-Willi SyndromePasqualini Syndrome, Congenital adrenal hyperplasia

Got Prolactin?: The role of prolactin in men is not understood very well. Some scientific literature suggests that in small quantities prolactin helps the testicle produce testosterone. However, in large quantities it can inhibit production of GnRH and increase the production of stress hormones. Both of these things can suppress testosterone production. The most common cause of hyperprolactinemia, or elevated prolactin, are pituitary adenomas, which are small non-cancerous tumors that can sometimes grow on the pituitary gland. Pituitary adenomas can cause infertility, erectile and sexual dysfunction, and gynaemastia (man boobs). They are often not diagnosed until they have grown large enough to cause headaches or vision problems. If you are having trouble getting to the root of hormonal imbalances it may be a good idea to check prolactin levels to ensure that there aren’t problems with the pituitary gland. Read more…

Effects of Medications or Toxins

There is a lot of speculation and research going on to discover the effects of environmental toxins on male fertility. The studies are rather difficult to conduct and so much of the hard evidence remains inconclusive. However, there is quite a bit of anecdotal evidence that various medications and environmental toxins – certain forms of plastics, pesticides, building materials – can impact reproductive hormones.

Aromatase Disorders: Testosterone / Estrogen Imbalance

Aromatase is an enzyme responsible for converting testosterone into estrogen. Traditionally, aromatase disorders have been fairly rare and caused by genetic conditions that can lead to both deficiency or an excess of aromatase. However, more and more men are experiencing hormonal imbalances due to excessive aromatase. Here are a list of the most common reasons:

Obesity: Aromatase resides in fat cells, so the more fat a man has on his body, the more estrogen it produces (ain’t that just a kick in the balls)
Insulin: Eating sweets will spike your insulin and increase the activity of aromatase.
Alcohol: The more you drink, the more your body will convert testosterone into estrogen

If you suspect you may have issues with excessive aromatase activity, you may want to ask your doctor to check your testosterone to estrogen ratio. If estrogen excedes testosterone, you may benefit from using aromatase inhibitors.


Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.
Sara SDx

Author: Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.

46 thoughts on “Low Testosterone: Hypogonadism”

  1. Hypogonadism or also known as erectile dysfunction has also lots to talk about. However, on this site, it explains everything about hypogonadism. It explains how it could go wrong or even the effect of the medication on how to treat this one. This is a well-recommended site. It very helpful and lots of ideas to talk about.

  2. […] Low testosterone (or Low T) has gotten a lot of press lately. It’s fairly common for testosterone levels to drop as men age and testosterone replacement therapy has gained popularity in helping men feel active and youthful. However, when you are trying to conceive, getting the right balance of hormones can be a little more involved..fusion-button.button-21 .fusion-button-text,.fusion-button.button-21 i{color:#105378}.fusion-button.button-21{border-width:1px;border-color:#105378}.fusion-button.button-21 .fusion-button-icon-divider{border-color:#105378}.fusion-button.button-21:hover .fusion-button-text,.fusion-button.button-21:hover i,.fusion-button.button-21:focus .fusion-button-text,.fusion-button.button-21:focus i,.fusion-button.button-21:active .fusion-button-text,.fusion-button.button-21:active{color:#105378}.fusion-button.button-21:hover,.fusion-button.button-21:focus,.fusion-button.button-21:active{border-width:1px;border-color:#105378}.fusion-button.button-21:hover .fusion-button-icon-divider,.fusion-button.button-21:hover .fusion-button-icon-divider,.fusion-button.button-21:active .fusion-button-icon-divider{border-color:#105378}.fusion-button.button-21{width:auto}Learn More […]

  3. Hi Sara… Interesting blog, lots of useful information. I am interested in your feedback on my situation based on your experience.

    Had low T. FSH /LH/Estradiol levels were normal. SA showed extremely low count (200k/ml) with morphology and motility < 1%.

    Have just finished 4 months on Clomid. T levels now high normal. LH and FSH are normal. Estradiol is high – 1 or 2 points outside the normal reference range. SA now shows total count at 18 million per ml (great!), but my morphology was < 1% and motility was listed as 0% 🙁

    Genetic tests show no abnormalities (no XXY or Y microdeletions). My DNA fragmentation is within normal ranges, but on the "high" side of normal. Do not smoke or drink. Eat relatively healthy (wife is vegan). Was also using MotilityBoost while on Clomid therapy. Wear loose fitting boxers, do not use saunas/etc., and I try not to cook my balls.

    Any thoughts on how I might increase my motility and morphology, or are they a lost cause? And, what would your thoughts be on me continuing with Clomid, or should I just discontinue, since it looks like assisted reproduction will be our only option,
    and 18 million or 200K per ML is insignificant when they're doing ICSI. (Wife and I have started exploring ICSI, have an appt w/ her RE in another month.)

    Thanks very much!

  4. Hi Sara,

    I facing some hypogonadism issue. I have read so many articles about this illness, but i was unable to find the reason of my problem. Generally, I feel a bit depressed, without energy, and overweight (+15kg). To find the source of problem, I took a hormone tests two times during last month period, with following results (both are practically with the same values):

    Testosterone: 225
    LH: 5.7
    FSH: 4.8
    Prolactine 9.7
    Estradiol (E2) 15.0
    Cortisol 11.0
    TSH 2,071

    Years: 25 (not from blood tests :-))

    During last month i have changed lifestyle to more healthy: more excersises, diet and so on, but without visible effects in lab results.

    So according to my understanding, I dont have primary hypogonadism, couse normal LH+FSH levels. I would suspect owerveight and aromathase problems, but the E2 Levels are in lower part of range. My thyroid seems to be also ok. I´m going to visit andrologist next week, but maybe You can suggest something, some others hormones, parameters to check?

    Best Regards

    1. Sorry for the delay in getting back to you…I wanted to double check reference ranges for your blood results and it took a few days to get to…

      Have you visited the Andrologist yet?
      Was this blood test taken first thing in the morning or mid-day?

      As one who has struggled with weight myself, I personally feel like added weight messes with our hormones in ways that don’t fully show up on blood tests. Your testosterone is lower than it should be and that is likely contributing to what you are feeling. I don’t have suggestions for additional measurements. This is a pretty good set. An endocrinologist would have better recommendations and might be the type of doctor to help you figure out what’s going on

      A few questions about the onset of symptoms — was is gradual or sudden? There things in your life that you could pin point as a contributing factors (working too much, stressful event, etc). Our minds and our bodies are connected. Sometime mental or emotional stress can cause a physical issue. It is possible to reverse the issue by taking actions to improve physical health. Exercising, losing weight, change of diet, etc can both boost testosterone and improve emotional symptoms that you are experiencing. If I were you, I would start with an exploration of simple ways to boost natural testosterone production…

      > reduce sugar, carbs & alcohol in diet
      > improve sleep quality and duration
      > physical activity… particularly weight-lifting, jogging or team sports
      > lose a few pounds
      > engage with an activity that you love

      Let me know how your appointment goes. I’m happy to chat more…

  5. HI Sara,

    I did a sperm analysis on 3/4/2016 result came as 2 Progressive motile, 2 shaking , 2 non motile sperm observe over entire slide.
    Following which I did a sperm analysis again on 03/25/ 2016 and found zero seprm count (Azoospermia).
    Then I took blood work on the same date 03/25/2016 and the results where
    I had low testrostone 178. FSH 12.91, LH 5.73, Prolactin 9.36 and TSH 1.85.

    It was absorbed my testile was smaller than usually expected.

    I took sperm analysis many times after that but always came as zero.
    I have acute hypertension which i noticed on 03/2016 and took medication (hydrochlorotiazide) for few months and it came normal. few weeks back i again saw it shooting to 160 – 175 and now normalizing around 140.
    I’m not taking any medication now.

    Feb 2017 I took clomid for three months untiil end of april
    05/2017 I again took lab my Total testostrone improved to 394, but the sperm count was zero again.

    Can you please let me know your observation.
    Do you think i need to continue with clomid or any other hormone theraphy.
    Do you think sperm count can be for my case.

    Please help.

    1. interesting. This is kind of a tricky case. Are you working with a urologist or endocrinologist? Does anyone have any insight into the cause of the low T? FSH / LH numbers suggest that there are some issues with testicular tissue, but the clomid was effective at increasing T and you’ve had sperm so sperm production is possible. Have you done genetic tests (y chrom deletion, XXY, etc)? Do you have history of undescended testicle, injury or any kind of injury or trauma in the groin?

  6. I m 29 year old man. My testosterone is 513 range is 400 to 1080. Lh is 2.90 range is .57 to 12. Fsh is 2.64 range is .95 to 11.95. Please tell me all r normal or not. If not, by doing exercise can it be improoved.

    1. Looks normal to me. What is causing concern?

      If you want to boost testosterone, you can try to drink less alcohol, eat less sugar, get good sleep and do squats and deadlifts…

  7. Greetings,
    My testosterone is low. My levels of FSH, LH are normal, free testosterone is normal. Prolactin levels were extremely high last year but I am taking bromocriptine and the prolactin levels are now in normal range, putinary gland was checked and it is normal. I’m also taking clomid but we don’t think that is working. I really thought that when my prolactin levels would go back to normal, my testosterone would go up and therefore increasing my sperm count but this hasn’t happened.

    1. This is pretty interesting — they don’t have any idea what is causing the high prolactin? How low is the T? How low is sperm count? What are LH and FSH levels?

  8. I am 35years old and I have one child when I was in my country but have move to a cold country now and because of that I have been wearing heavy cloths to keep me warm, but about a year now l have notice a change in my sperms consistency and colour.It is now more lighter than before.Please what is wrong with me?

    1. It is pretty common for semen to change color and consistency with changes in environment, diet or other things. Typically it doesn’t impact fertility. Are you currently trying for another baby? Do you have other symptoms that concern you?

  9. Hi Sara.

    14 months ago I was fine one day, vigorous libido, strong and fit.
    The next day I felt absolutely exhausted, and had no libido whatsoever.
    After a couple,of days I checked my testicles, and noticed they were half normal volume.
    I went to emegency, they examined, said my testicles were “normal”, and not to worry. Since then I’ve seen 6-7 urologists, 3 endocrinoloigists, and half a dozen generalists. Most of them don’t believe that my testicles shrank, and don’t seem to want to find the cause or resolve it.
    My libido hasn’t returned. I lost my girlfriend. My arms and torso have become skinny. I have other symptoms too.
    It isn’t psychogenic, as nighttime/morning erections are nearly non existent. Once a month if that, and weak.
    I’m 35, don’t drink, smoke or take any drugs. Always been physically fit and eaten healthily.
    There was no pain or traumatic event. The cause remains unknown and I have received no treatment. It is ruining my life.

    I can post several sets of blood results. I had an ecography of scrotum, bladder and kidneys. Small varicocele was found and two spermatoceles on left testicle. Doctors claim varicocele is too small to be likely to cause problems. I however think it is a key.
    Bladder and kidney showed nothing (those were scanned following blood in the urine for 24 hours several months after the first incident).
    Also have had an MRI of pituitary. Showed no adenomas.

    Some general info, slightly raised prolactin consistently for a year.
    Most recent test, Februrary, showed raised TSH, endocrinologist suggested
    thyroid problem that does not currently require medication.
    Testosterone levels have all been within ranges. (540-780) but have
    fluctuated between that range which I consider abnormal.

    No doctor has been able to explain what has happened to me.


    1. Sorry it has been a while. I’ve been thinking about this… it looks like you’ve had a pretty comprehensive work up.

      What is the testicular volume? Have they measured it?
      FSH and LH normal?
      How high has prolactin been?
      How old are you?
      What other symptoms do you have?
      Have you been tested for any genetic conditions?

  10. Hi Sara,

    I’m 32, from the UK and currently I’m on 3-monthly injections of Nebido (been on it for 6 years) for secondary hypogonadism and was hoping you could clarify something for me:

    Can the effectiveness of my TRT be reduced or “blocked” by lifestyle factors?

    i.e. will excessive sugar or lack of exercise mean my body can’t utilise the testosterone as much as it can?

    Many thanks,


    1. It certainly can. Sugar and alcohol consumption are post-production. They encourage aromatase to convert testosterone – natural or TRT – to convert into estrogen and when on TRT if the levels are high, these things can cause an over abundance of estrogen which leads to gynecomastia and other symptoms. Testosterone is best utilized by a healthy body and a healthy lifestyle. 🙂

  11. Thanks a lot Sara. I exercise 2-3 times a week(Jogging,Resistance & Bodyweight exercises) & eat healthy diet too!!! I am into Intermittent fasting of late,Not into alcohol & do marijuana occasionally.That pretty much defines my lifestyle habits.I am doing all what I can,but feeble erection issues & common colds are creating a havoc in my life.I suppose I have a lot of body heat which I need to lose.I plan to stop taking more of heat generating foods like eggs,milk & switch to leafy vegetables & fruits.I am also going up my activity levels.

    These tests were done on my own,I will also go to an Endocrinologist as suggested.Please suggest if I need to change anything about my lifestyle.

  12. That’s very sweet of you,Sara.Thanks for the kind gesture.I will like to provide you with some additional test results for your reference.

    FSH – 1.92 mIU/ml
    Prolactin – 8.54 ng/ml
    SHBG – 22 nmol/l
    PSA -0.88 ng/ml
    DHEA – 508.71 ug/dl
    Free Testosterone – 140 pg/ml
    Estradiol – 47.8 pg/ml

    Yes I did the last two tests to be sure about the results,Free testosterone levels is shocking.It’s strange my body is producing lot of free testosterone.Could you please help me understand what is creating so much of free testosterone in my body when SHBG is in the normal range & DHEA-S is sufficiently high.How do I reduce my free testosterone & estradiol levels? Should I abstain from orgasms for while(tough one)?

    I don’t have any known medical conditions till date other than varicocele i had till last year. I usually get common cold a lot after orgasms,maybe because of hyperthermia just guessing.

    1. Orgasms shouldn’t alter anything. You are fine to have them.

      How much do you exercise and what type do you do?

      Doctors I reached out to mostly feel like these kind of problems can be solved with exercise and healthy diet. They did say that you could go to an endrocrinologist to get more tests done. It seems that you have had the appropriate follow up test, so I’m not sure what else to suggest.

      I will continue to research and get back to you.

    1. Sorry it took me a while to get back to you. I had to do a little bit of additional research.

      It looks like your body is doing a good job of producing hormones, but not such a good job of using them effectively. The Testosterone that your body makes is not being used by the body which is giving you some of the symptoms of low T even though your testosterone levels are normal. Since you have excess free testosterone, the body is converting some of it into estrogen. Luckily, it’s not causing too many of the effects of high estrogen.

      I’ve written a few doctor friends of mine to see what the best next steps are for you. I’ll get back to you when I get some better answers.

      From my research, typically low testosterone absorption is caused by a variety of other conditions and or medications.
      Do you have any other known medical conditions? Are you on any medications?

  13. Thanks Sara for your reply.You make me feel a lot better.I am able to have short span of erections but not strong enough to ejaculate with an erection.I can’t ejaculate through penetrative sex.I have orgasms,but I don’t feel relaxed or euphoric after the orgasm as I used to before like 5-7 years.I am not sure what is causing high estradiol,I usually have a low sugar diet,have alcohol rarely & have normal BMI. Do you think I should do additional tests & if yes,what tests would help for a diagnosis?

  14. Hi Sara,

    I’m 28 years old. I had a bilateral Grade 3 varicocele surgery almost a year back.I recently did couple of hormone tests.Below are the results:-

    Total Testosterone – 457 pg/ml
    Free Testosterone – 90.25 pg/ml
    Estradiol – 53 pg/ml
    LH – 3.7 miU/ML
    PROGESTERONE – 0.7 ng/ml

    No Hydrocele present,No gynaecomastia,semen analysis seems normal,lesser sex drive,unable to focus.Everything else seems normal,low risk of cardiovascular risk,diabetes,cholesterol issues.

    Request you to please give me an insight about my hormone profile and how can I get rid of these hormonal imbalances.How soon can get these Hormonal imbalances in check?

    1. From a quick review, your hormone profile doesn’t look terribly abnormal.
      Your testosterone and LH look great. This means that the testicles are working well and producing testosterone at a good level.
      Progesterone also looks to be in the normal range.

      The only one that looks slightly high is Estradiol. It is not out of the normal range but it is a little elevated. Do you have a diet that is high in sugar? Do you drink a lot of alcohol? Do you have higher body fat? These things can convert testosterone into Estrogen and cause some of the symptoms you are describing.

      Are you able to achieve erections? Enjoy orgasm? How is sex drive impacted? Has it always been reduced?

      Inability to focus can be caused by hormones. It can also be caused by stress, lack of sleep, low calories / sugar intake, and a host of other issues.

      What do you feel is the biggest problem?

  15. Hi, I am a 26 year old male from India. I am 178 cm in height and weigh 70 kgs. My blood pressure is usually either normal or a bit low. I am writing here because I think I have some serious problems with my Testicles. My free testosterone levels are similar to that of an 85-100 year old male. Below are the details.

    I had a normal puberty and my libido and orgasm was satisfactory 7 years back.However, I was very thin with very very low muscle mass(49kgs) and I used to stay indoors mostly. I joined a gym in 2008 (november) and there was a sudden increase in my appetite. I ate almost double of what I used to eat. I took body mass increasing supplement for a month and a half . By 2009 end I started developing gynaecomastia bilaterally (grade 1+). I went to a plastic surgeon in early 2011 and he asked me to get some tests done – LFT and Free testosterone. LFT results were in normal range but my Free testosterone level was 8.44 pg/ml where as the bio reference range was 8.9 – 42.5 pg/ml. However, the surgeon didn’t concern me about the low free TT lvl and suggested me to go for a liposuction which I didnt go for. I also noticed that the intensity and pleasure from my orgasms were lesser compared to before. I quit gym in late 2010 as I had to move to hostel.

    I started having spasm type pain in my testicles in 2012. I experienced those pains mostly during arousal/erection/sexual excitement and sometimes without those. The pain was gradual, intense and rarely sharp. Some times it would spread to entire perineum. It would also reside gradually. Even after the erections were gone (after or without masturbation), the pain would stay for hours. Once, it even lasted an entire night and it was still there in the morning. There used to be swelling in my epididymis whenever the pain occured and it resided when the pain was gone. The more pain, the bigger the swelling. The pain and swelling was mostly in my right testicle but sometimes I would experience them in my left testicle too. This continued till the fourth quarter of 2013 after which such incidents and their intensities became rare and low respectively untill end of september 2015 when I had a spasm in my buttocks while sitting on my motorcycle and the pain in
    my balls immediately started. Since then I have been experiencing such pain but its not as intense as it used to be. It is dull aching and more persistent than ever.Swelling is also present during the pain and mostly in the right testicle. 6 days ago i was diagnosed with filariasis and I have been taking meds since then.

    Since 2011, i have been experiencing a constant reduction in energy,motivation, concentration, memory, sex drive, erection, pleasure in orgasm and increase in body fat. I also feel depressed and irritated most of the times. I came across a condition known as ‘Hypogonadism’ whose symptoms are similar to mine. I have been having nightmares since then.

    I started working out again in may this year and have been taking whey protein suppliments. I got my free TT tested recently and this time it was 12.66pg/ml but its still very low for some one my age. Blood was collected before 9am for both the Free TT level tests.

    Can I please be advised whats wrong with my testicles? Whatever damage has been done,is it reversible or permanent? Can I live a healthy sexual life without any dependence on drugs?

    Test results –
    Eosinophil – 13% , count – 758/cmm.
    Basophil & premature cells – 0%

    LFT(reflectance photometry) 16/10.2015-
    AST-22 u/l
    ALT-25 u/l
    ALP-82 u/l
    Bilirubin total-0.83 mg/dl
    Bilirubin Direct- 0.16 mg/dl, bilirubin indirect-0.67 mg/dl
    Total protein- 6.44 g/dl
    Albumin- 3.82 g/dl
    A:G ratio- 1.46

    Prolactin Serum (Chemiluminescent Immunoassay) 16/10/2015- 8.92 ng/ml

    Free TT serum (RIA) 16/10/2015 – 12.66 pg/ml

    Thyroid Profile total serum (Chemiluminescent Immunoassay) 16/8/2015-

    T3 tot- 1.17 ng/ml
    T4 tot- 7.40 ug/dl
    TSH- 3.78 ulU/ml

    Awaiting reply eagerly.

    1. Sorry for the delay in responding. There was a lot of information in your post and I needed to do a little research to understand what’s going on. I don’t have any clear answers but I have some ideas:

      1. Filairasis can cause fluid to build up in the testicle, called a hydrocele. These hydroceles can cause testicular pain. It is probably also increasing your percentage of eosinophils. Taking the medicine that they gave you should treat the infection and help your ball feel better.

      2. I don’t see test results for other hormones related to testicular function and hormonal issues. I would recommend blood test for LH, FSH, and Estrodial. I would also recommend an estrodial / testosterone ratio.

      3. The gynaecomastia can often come from elevated estrogen levels. Do you still have it, or has it gone away?

      4. You may also want to get a semen analysis performed to see how well the testicles are producing sperm.

      5. What type of doctor are you visiting? A urologist, particularly one that specialized in male hormones may be helpful in figuring out why your testosterone levels are low. A physical exam may also be helpful in diagnosing what is going on

      6. Does working out help improve symptoms? Do you have a better sex drive? Better able to focus?

  16. Hi
    Is there any treatment for primary hypogonadism (undescended testes at birth later one descended surgically) other than testosterone replacement therapy??


    1. It really depends on the condition and development of each of the testes. Is one still somewhere in the body?

      Undescended testicles / late descended testicles often mature slightly abnormally and therefore can have trouble with both sperm and testosterone production. If some of the tissue is healthy, you may be able to stimulate testosterone production with medications like clomid or others that work upstream from the testicle. If you got a blood test done that measured LH and FSH and maybe a few others, you would find out if that is a viable strategy.

      The treatment will also depend on the goal. Treatment options will vary if the goal is producing sperm vs reducing symptoms of low T. There may be additional surgical options to retrieve sperm if you are looking to conceive. In this case, I would recommend talking to a urologist who specializes in male fertility. We have a good list on this site.

      If low T is the issue then general urologist should have a few tricks up their sleeves, just let them know that you would like to avoid TRT if possible.

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