Low Testosterone & Hypogonadism | Naas Clinic
Male Hormonal Health · Naas, Co. Kildare

Male Hypogonadism & Testosterone Deficiency

Specialist endocrine evaluation of testosterone deficiency syndrome. Assessment of symptoms, investigation, and personalised management including testosterone replacement therapy where clinically indicated.

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Understanding the Condition

What is Male Hypogonadism?

Male hypogonadism is a clinical syndrome resulting from failure of the testes to produce adequate levels of testosterone, sperm, or both. It is classified by the level at which the failure occurs:

Primary hypogonadism (hypergonadotrophic) results from testicular failure — the testes do not respond normally to hormonal stimulation from the pituitary. Causes include Klinefelter syndrome, previous chemotherapy or radiotherapy, mumps orchitis, or cryptorchidism.

Secondary (hypogonadotrophic) hypogonadism results from insufficient pituitary or hypothalamic stimulation of the testes. Causes include pituitary tumours, haemochromatosis, obesity, opioid use, and idiopathic hypogonadotrophic hypogonadism.

Distinguishing between these types requires specialist assessment and directs appropriate treatment.

This page is for educational purposes only. It does not constitute medical advice. Always consult a qualified healthcare professional for assessment and management of suspected testosterone deficiency.
Symptoms

Signs of Testosterone Deficiency

  • Persistent fatigue
  • Reduced libido
  • Erectile dysfunction
  • Low mood or depression
  • Reduced muscle mass and strength
  • Increased body fat
  • Reduced motivation
  • Poor concentration
  • Hot flushes
  • Reduced body or facial hair
  • Osteopenia or osteoporosis
  • Reduced testicular volume

Symptoms are non-specific and overlap with many other conditions. Biochemical confirmation of low testosterone is essential before any treatment is considered.

Specialist Services

Our Assessment Approach

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Hormonal Investigation

Early morning testosterone measurement (two samples required for diagnosis), LH, FSH, SHBG, prolactin, and comprehensive metabolic assessment to establish the cause and type of hypogonadism.

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Clinical Assessment

Detailed history including symptom onset, medications (particularly opioids, steroids, and anabolic agents), general health, and physical examination including testicular assessment.

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Testosterone Replacement Therapy

Where clinically indicated, discussion and initiation of testosterone replacement therapy (TRT), with selection of the most appropriate preparation (gel, injection, or other formulation) based on individual circumstances and preference.

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Monitoring & Safety

Structured follow-up including haematocrit, PSA, lipids, and ongoing symptom monitoring. Safe prescribing with awareness of contraindications including active prostate pathology and desire for fertility.

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Fertility Considerations

Assessment of the impact of hypogonadism on fertility. Where testicular sperm production and fertility are priorities, alternatives to testosterone therapy are considered and appropriate reproductive specialist liaison arranged.

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Metabolic Health

Assessment of the significant cardiometabolic associations of hypogonadism including obesity, Type 2 diabetes, and metabolic syndrome, with integrated management of these risk factors.

Diagnosis

Diagnosing Testosterone Deficiency

Diagnosis of hypogonadism requires both symptoms consistent with testosterone deficiency and confirmed low testosterone levels on at least two early morning blood samples. Testosterone levels fluctuate throughout the day and are highest in the morning. A single borderline result in isolation does not establish the diagnosis.

It is equally important to establish the cause — distinguishing primary from secondary hypogonadism determines management. Secondary hypogonadism in particular requires pituitary assessment, including measurement of LH, FSH, and prolactin, and may require MRI imaging of the pituitary gland.

All hypogonadism consultations are led by Dr Syed Kashif Hussain Kazmi, Consultant Endocrinologist (IMC: 213626), who provides a thorough, evidence-based, and confidential assessment.

Patient Questions

Frequently Asked Questions

Hypogonadism is the failure of the gonads (testes in males) to produce adequate levels of sex hormones (primarily testosterone) and/or reproductive cells (sperm). It is classified as primary when the failure originates in the testes, and secondary (or hypogonadotrophic) when the failure is at the level of the pituitary or hypothalamus — the brain regions that stimulate testicular function. Both types result in low testosterone but require different investigation and management approaches. Accurate classification is important before treatment is commenced.
Low testosterone can cause a wide range of symptoms that significantly affect quality of life. These include persistent fatigue and low energy, reduced libido (sex drive), erectile dysfunction, low mood or depression, poor concentration and memory, reduced muscle mass and strength, increased body fat particularly around the abdomen, reduced body or facial hair, hot flushes or sweating, and decreased bone density. Symptoms are non-specific and can be attributed to other conditions, which is why biochemical confirmation is essential. Many men live with significant testosterone deficiency for years without it being recognised or investigated.
Diagnosis requires a combination of symptoms consistent with testosterone deficiency and confirmed low total testosterone levels on at least two early morning blood samples (before 10am, ideally before 9am). SHBG (sex hormone-binding globulin) levels are also measured to calculate free testosterone, which may be more informative — particularly in men with obesity, where SHBG tends to be lower and total testosterone may underestimate the degree of deficiency. LH and FSH levels help distinguish primary from secondary hypogonadism. A specialist endocrinologist will interpret these results in the context of symptoms, clinical examination, and overall health.
Testosterone replacement therapy (TRT) is the medical treatment of confirmed testosterone deficiency using exogenous testosterone. It is available in several formulations including daily topical gels, short-acting intramuscular injections, and long-acting injections. The choice of preparation depends on patient preference, lifestyle factors, monitoring requirements, and clinical considerations. TRT can improve energy, mood, libido, muscle mass, and bone density in men with genuine hypogonadism. It requires careful monitoring including haematocrit (red blood cell levels), PSA, and lipids. TRT is generally contraindicated in men who wish to maintain or restore fertility, as exogenous testosterone suppresses natural sperm production.
Testosterone levels do decline gradually with age — approximately 1–2% per year after the age of 30–40. This age-related decline is sometimes called the "andropause" or "late-onset hypogonadism." However, not all low testosterone is simply ageing — many cases have treatable underlying causes, and symptoms attributable to genuinely low testosterone are not an inevitable or untreatable aspect of getting older. It is important to distinguish age-related decline from true pathological hypogonadism, which requires proper investigation. A specialist consultation can determine whether testosterone levels are outside the expected range for age, whether symptoms are attributable to low testosterone, and whether treatment would be appropriate and beneficial.

Expert Assessment of Testosterone Deficiency

Book a confidential consultation with Dr Kazmi, Consultant Endocrinologist, at our Naas clinic. Thorough, evidence-based assessment.

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