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Causes include: -Genetic causes (eg, Klinefelter syndrome, XX males) -Developmental causes (eg, testicular maldescent) -Testicular trauma or ischemia (eg, testicular torsion, surgical mishap during hernia operations) -Infections (eg, mumps) -Autoimmune diseases (eg, autoimmune polyglandular endocrine failure) -Metabolic disorders (eg, hemochromatosis, liver failure) -Orchidectomy Secondary/tertiary hypogonadism, also known as hypogonadotrophic hypogonadism, shows low testosterone and low, or inappropriately "normal," LH/FSH levels; causes include: -Inherited or developmental disorders of hypothalamus and pituitary (eg, Kallmann syndrome, congenital hypopituitarism) -Pituitary or hypothalamic tumors -Hyperprolactinemia of any cause -Malnutrition or excessive exercise -Cranial irradiation -Head trauma -Medical or recreational drugs (eg, estrogens, GNRH analogs, cannabis) Increased testosterone levels: -In prepubertal boys, increased levels of testosterone are seen in precocious puberty.

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Testosterone production in testes and ovaries is regulated via pituitary-gonadal feedback involving luteinizing hormone (LH) and, to a lesser degree, inhibins and activins.

Measurement of total testosterone (TTST / Testosterone, Total, Serum) is often sufficient for diagnosis, particularly if it is combined with measurements of LH and follicle-stimulation hormone (FSH) (LH / Luteinizing Hormone [LH], Serum and FSH / Follicle-Stimulating Hormone [FSH], Serum).