How to diagnose the causes of low estradiol and testosterone
Aug 20, 2025
Source: Cainiu Health
Dr. Zhang Lu
Introduction
Hormone level testing directly measures the specific values of estradiol and testosterone through blood tests, while also assessing related hormone levels such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH). If estradiol and testosterone levels are decreased while gonadotropins are elevated, it may indicate dysfunction of the gonads themselves; if gonadotropins are also decreased, it may be related to hypothalamic or pituitary dysfunction.
The causes of low estradiol and testosterone can generally be diagnosed through hormone level testing, hypothalamic-pituitary function assessment, gonadal ultrasound, chromosomal karyotype analysis, and autoantibody testing. Detailed explanations are as follows:
1. Hormone level testing: Blood tests directly measure the specific values of estradiol and testosterone, while also assessing related hormones such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH). If estradiol and testosterone levels are low while gonadotropins are elevated, it may indicate intrinsic gonadal dysfunction. If gonadotropins are also low, it may suggest hypothalamic or pituitary dysfunction.
2. Hypothalamic-pituitary function assessment: Includes cranial magnetic resonance imaging (MRI) to evaluate the morphology and structure of the hypothalamus and pituitary gland, checking for lesions such as tumors, inflammation, or developmental abnormalities. Lesions in these areas can affect the release of gonadotropin-releasing hormone, subsequently leading to reduced estradiol and testosterone synthesis.
3. Gonadal ultrasound: Ultrasound examination of the testes or ovaries to assess their size, shape, and internal structure. Conditions such as testicular hypoplasia or premature ovarian failure can be identified through ultrasound, indicating that intrinsic gonadal pathology may be responsible for the decreased hormone levels.
4. Chromosomal karyotype analysis: Examination of chromosomes to determine whether chromosome number and structure are normal. Certain chromosomal abnormalities can impair gonadal development and function, leading to hormone synthesis disorders and subsequently reduced estradiol and testosterone levels.
5. Autoantibody testing: Detection of autoantibodies targeting gonadal tissues or hormone receptors. Autoimmune diseases may attack gonadal cells, impairing their normal function and reducing hormone secretion. This testing helps determine whether autoimmune factors are involved in the disease process.
If abnormally low estradiol and testosterone levels are detected, prompt medical evaluation at a reputable hospital is recommended to conduct comprehensive examinations and determine the underlying cause by integrating clinical symptoms and test results.
