Beyond Traditional Hypogonadism: Distinctive Mechanisms and Clinical Implications in Subclinical Functional Hypogonadism (SFH) with Integrative Strategies for Hormonal Homeostasis
Abstract
Claudio Lombardo
Subclinical Functional Hypogonadism (SFH) represents a novel and multifactorial condition that transcends traditional definitions of hypogonadism, characterized by normal or slightly altered testosterone levels but impaired hormonal activity at the tissue level. The physiological response to stress, essential for human survival, has evolved from acute and episodic mechanisms in the past to a chronic and prolonged nature typical of modern society. Studies on Peruvian mummies (Journal of Archaeological Science) show the presence of cortisol, suggesting that stress also existed in primitive humans (Mayer & Rosen, 1975). However, the stress experienced by modern humans is significantly different, arising from factors such as technological overload, work pressures, and disrupted circadian rhythms, further exacerbated by metabolic imbalances and environmental pollutants. These contemporary triggers lead to persistent activation of the HPA axis, resulting in elevated cortisol levels and altered SHBG dynamics, which suppress testosterone bioavailability and disrupt hormonal homeostasis.
Unlike classic hypogonadism, SFH often presents sub clinically, with mild or nonspecific symptoms such as reduced libido, fatigue, and increased body fat, alongside systemic impacts on metabolism, mood, and cognitive function. The article distinguishes SFH from stress-related hypogonadism and age-related hormonal decline (Late-Onset Hypogonadism - LOH), emphasizing its unique physiological mechanisms and clinical implications. It also explores integrative strategies, including hormonal therapies, bio- neurofeedback, and interventions targeting circadian rhythms, tailored to gender differences, to restore endocrine balance and mitigate the systemic consequences of SFH. This framework highlights the importance of early recognition, precise diagnostic criteria, and personalized approaches to improve hormonal health and overall psycho-physical well-being.