Symptoms and signs of hypogonadism depend
primarily on the age of onset. Before puberty patient
may present with small testis, small phallus, scant pubic
and axillary hairs, disproportionately long arms and legs
and gynaecomastia. After puberty, signs and symptoms
may include decrease in muscle mass, loss of libido,
impotence, oligospermia or azoospermia,
hypercholesterolemia and increase in visceral fat mass.
Hypogonadism is often unrecognised before puberty
unless it is associated with growth retardation or other
anatomic or endocrine abnormalities. In most cases the
first sign is delayed puberty, defined as ‘absence of
secondary sexual characteristics at an age more than
2SD above the population mean for the onset of
puberty’