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Symptoms of low testosterone. Because testosterone affects many tissues, lack of testosterone can cause many different symptoms. In adults, the symptoms are likely to be worse if the hypogonadism develops over the course of weeks or months than slowly over years. ●Adolescents and young adults who have not yet completed puberty appear younger than their chronologic age. They may also present with small genitalia, difficulty gaining muscle mass in spite of vigorous exercise, lack of a beard, and failure of the voice to deepen. ●In adult men, several common but nonspecific symptoms begin within a few weeks of the onset of testosterone deficiency: decreased vigor and libido and depressed mood. Decreased muscle mass and body hair are less common but do not occur for a year or many years. Hot flashes occur only when the degree of hypogonadism is severe and especially when the rate of fall is rapid. Gynecomastia, tender or not, is more likely to occur in primary than secondary hypogonadism, as is infertility. There are a number of signs on physical examination that provide strong evidence of hypogonadism. The physical examination should focus first on whether or not the patient is normally virilized and has normal genitalia. If either is abnormal, the exam should then be directed toward clues as to whether the hypogonadism is primary or secondary and if it began before or after puberty. ●Males who develop hypogonadism before the onset of puberty and are not treated do not develop body hair and a beard characteristic of other men in the family, temporal hair recession, full male musculature, or deep voice. Men who develop hypogonadism after puberty may lose these characteristics if the hypogonadism is severe enough and/or of sufficient duration, usually years. ●Males who develop hypogonadism before the onset of puberty have small testes and a small phallus . If hypogonadism develops after puberty, the testes usually decrease in size if the hypogonadism is primary, which preferentially damages the seminiferous tubules, but they usually do not decrease to a recognizable degree if it is secondary. The phallus does not decrease in size. ●Gynecomastia, the presence of glandular breast tissue in a male, is more likely to occur in primary than secondary hypogonadism. ●Finding eunuchoid proportions in an adult male at any age indicates that the hypogonadism developed prepubertally. Eunuchoid proportions include a lower body segment (floor to pubis) that is more than 2 cm longer than upper body segment (pubis to crown) and an arm span that is more than 5 cm longer than height. In comparison, a normal adult male has approximately equal upper and lower body segments as well as arm span and height. The absence of testosterone (and as a result, estradiol) during puberty causes a delay in epiphyseal closure so that the continued presence of growth hormone results in an increase in the length of the long bones. This relationship persists even after testosterone treatment. While the presence of physical findings provides evidence of hypogonadism, their absence in an adult is less helpful because regression of secondary sexual characteristics, such as body hair and muscle mass, may not occur for years after the onset of hypogonadism. Consequently, men with symptoms of hypogonadism should be evaluated by appropriate laboratory tests even in the absence of physical findings Text to speech AI used to generate the voice over.