Low Testosterone Levels – What Is the Difference Between Hypogonadism and Tertiary Hypogonadism?

A low testosterone level is referred to as hypogonadism in medical terms. Depending on where the deficiency in testosterone production occurs, it can be further categorized as primary, secondary or tertiary hypogonadism. Primary hyponadism is diagnosed when the problem occurs in the organs that manufacture testosterone, the testicles. When it is damage to the hypothalamus that causes the deficiency in testosterone, the condition is referred to as tertiary hypogonadism.

Regardless of where the problem originates, low levels of testosterone can have a profound impact on the way a man’s body works, and you will be likely to experience the effects in a number of different areas. The classification of primary, secondary or tertiary hypogonadism is important because it will influence the course of treatment your doctor prescribes.

What Is Primary Hypogonadism?

Primary hypogonadism will be diagnosed when there is a problem with the Leydig’s cells in the testes that manufacture testosterone. This is a primary failure at organ level, meaning that biologically not enough testosterone can be manufactured by the body. There are a number of factors that can effect damage to the testicles.

Some of the factors that can cause primary hypogonadism include:

Undescended testes

If the testicles do not descend during fetal development or within the first year or two of life, permanent damage can occur. This could affect the testicles’ ability to produce enough testosterone to keep the body healthy.

Scrotal injuries

Physical damage and injuries to the scrotum can affect testosterone production. Often though, if there is just damage to one testicle, the other can produce enough to compensate, as part of the body’s commitment to homeostasis. Most often the problem comes up when both testicles are damaged.

Cancer treatment

Treatments for cancer such as radiation therapy or chemotherapy can damage the cells that produce testosterone.


Once you reach your middle years in life, your testosterone production declines naturally. This part is part of the normal life cycles and processes that slow down once you start to get older. Testosterone production lowers by 1-2% every year once you pass the age of 30.


Mumps can cause swelling and inflammation of the testicles, affecting their sex hormone production.

Genetic abnormalities

Klinefelter’s syndrome is an example of a genetic abnormality that can affect the levels of testosterone produced by the body. With this syndrome, an extra x chromosome finds its way into the genetic composition and the body cannot manufacture sufficient testosterone.

Tertiary Hypogonadism

Secondary and tertiary hypogonadism results when the glands that produce the hormones that manufacture testosterone do not work at their best or are damaged. This could include damage to the pituitary gland or hypothalamus, or other glands that produce hormones like LH, TSH and GRH.

Some of the problems that can cause tertiary hypogonadism can include:

  • Tumors in the pituitary glands or side effects from brain tumors can affect testosterone production.
  • Malformation of the hypothalamus, which usually occurs during fetal development, can cause low testosterone.
  • Bad circulation or insufficient blood flow to the pituitary gland and hypothalamus can result in them not manufacturing sufficient hormone levels.
  • Sarcoidosis or tuberculosis can both cause inflammation of the pituitary gland, affecting its functionality.
  • Steroid use or abuse can also affect the way the hypothalamus functions.

Obesity is another factor that can affect a man’s ability to produce enough testosterone to keep the body healthy. If a man is overweight or obese, the excess fat cells in the body convert testosterone into estrogen, significantly lowering the amount of testosterone that circulates in the body. This is a cyclical problem where both obesity and low testosterone levels require treatment in order to rectify it.