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Low Testosterone (Low-T) (cont.)

What are the causes of low testosterone?

The causes of low-T are many and can be separated into three categories: primary, secondary, and tertiary.

Primary types of low-T or primary hypogonadism refer to the injury or failure of organs that are the main producers of testosterone, the testes atnd ovaries. Causes of primary low-T include scrotal or testicle injuries, undescended testicles, mumps, orchitis, chemotherapy or radiation therapy, chromosomal abnormalities, ovarian failure or surgical removal, and aging.

Causes of secondary low-T or secondary hypogonadism are related to the pituitary gland regulation of testosterone, while tertiary low-T or tertiary hypogonadism is related to the hypothalamus (a gland within the brain that regulates the pituitary and other glands) regulation of testosterone. Most causes of secondary and tertiary low-T are the same for the pituitary and hypothalamus; in addition, the causes may affect both at the same time. Causes of secondary and tertiary low-T include:

  • Tumors associated with the pituitary or hypothalamus
  • Chemotherapy of nearby tumors
  • Gland malformations
  • Decreased blood flow to glands for any reason
  • Gland inflammation due to disease (HIV, tuberculosis, sarcoidosis)
  • Taking anabolic steroids to enhance performance or muscle mass (athletes, body builders)

There are other causes that reduce testosterone that do not fit well into the above categories. Most notable is obesity, in which fat cells enhance conversion of testosterone to estrogen. Diseases such as diabetes, renal disease, COPD, high blood pressure, and lifestyles that include smoking and drug abuse also contribute to low-T.

Other less frequent causes are modified cell receptors for testosterone and unusual cell mechanisms that are rarely identified.

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