ConditionHormones & metabolism
Hormone Deficiency
A hormone deficiency occurs when an endocrine gland makes too little of a hormone the body needs. Common examples are an underactive thyroid (hypothyroidism), adrenal insufficiency (Addison's disease), low testosterone, menopause-related estrogen loss, growth hormone deficiency, and insulin deficiency in type 1 diabetes. Symptoms depend on the hormone but often include tiredness, weight changes, low mood, sexual problems and feeling cold or weak. Most deficiencies are diagnosed with blood tests and treated with hormone replacement.
Also called: Endocrine deficiency, low hormone levels, hormone insufficiency, hypofunction of a gland
At a glance
- What it is
- Too little of one or more hormones because a gland is underactive or damaged.
- Common types
- Hypothyroidism, adrenal insufficiency, low testosterone, estrogen loss at menopause, growth hormone and pituitary deficiencies.
- Typical symptoms
- Fatigue, weight change, low mood, low libido, cold intolerance, weakness, menstrual changes.
- Causes
- Autoimmune disease, surgery or radiation, pituitary tumors, genetics, aging and some medicines.
- Diagnosis
- Blood tests of the hormone and the pituitary signal that controls it, sometimes stimulation tests.
- Treatment
- Replacing the missing hormone, usually for life.
When to get help
Call 911 or go to the ER
- Severe weakness, vomiting, abdominal pain, low blood pressure or confusion in someone with known or suspected adrenal insufficiency (possible adrenal crisis). Give an emergency hydrocortisone injection if you have one and call 911
- Extreme drowsiness, very low body temperature and confusion in someone with severe untreated hypothyroidism (possible myxedema coma)
- Sudden severe headache, vision loss and collapse in someone with a pituitary tumor (possible pituitary apoplexy)
See a doctor within a day or two
- Excessive thirst and passing large volumes of dilute urine, day and night
- Muscle cramps, tingling around the mouth or spasms (possible low calcium)
- Darkening skin with weight loss, salt craving and dizziness on standing
Book a routine appointment
- Persistent tiredness, weight gain, feeling cold and constipation
- Low sex drive, erectile dysfunction, loss of body hair or breast enlargement in men
- Periods stopping before age 40, or hot flashes and night sweats affecting daily life
- A child growing much more slowly than peers
How hormones work
Hormones are chemical messengers made by endocrine glands and carried in the blood. Many are controlled by the pituitary gland at the base of the brain, which releases "stimulating" hormones that tell other glands what to do. A deficiency can therefore be:
- Primary: the gland itself fails (for example, the thyroid in Hashimoto's thyroiditis). Pituitary signals rise as it tries to compensate.
- Secondary: the pituitary or hypothalamus fails to send the signal. Both the pituitary signal and the gland hormone are low. See hypopituitarism.
Common hormone deficiencies
| Deficiency | Gland | Key symptoms | Treatment |
|---|---|---|---|
| Hypothyroidism | Thyroid | Fatigue, weight gain, cold intolerance, dry skin, constipation, low mood | Levothyroxine |
| Adrenal insufficiency | Adrenal | Fatigue, weight loss, dizziness, salt craving, darkened skin (primary) | Hydrocortisone, sometimes fludrocortisone |
| Low testosterone | Testes or pituitary | Low libido, erectile dysfunction, fatigue, reduced muscle, low mood | Testosterone replacement |
| Estrogen deficiency (menopause, early ovarian insufficiency) | Ovaries | Hot flashes, night sweats, vaginal dryness, irregular or absent periods, bone loss | Hormone therapy |
| Growth hormone deficiency | Pituitary | Children: slow growth. Adults: fatigue, increased fat, reduced muscle | Growth hormone injections |
| Diabetes insipidus (vasopressin deficiency) | Pituitary or hypothalamus | Extreme thirst, large volumes of dilute urine | Desmopressin |
| Hypoparathyroidism | Parathyroid | Tingling, muscle cramps, low calcium | Calcium and active vitamin D |
| Insulin deficiency (type 1 diabetes) | Pancreas | Thirst, frequent urination, weight loss | Insulin |
| Vitamin D deficiency (a hormone precursor) | Skin, liver, kidney | Bone pain, weakness | Vitamin D supplements |
Causes
- Autoimmune disease: the immune system attacks the gland, as in Hashimoto's thyroiditis, Addison's disease and type 1 diabetes. Autoimmune deficiencies often cluster together
- Surgery or radiation to the gland, neck or brain
- Pituitary tumors and other brain lesions
- Head injury, stroke or bleeding into the pituitary
- Genetic conditions, such as Turner syndrome or Klinefelter syndrome
- Infections such as tuberculosis
- Medicines: long-term steroids (suppressing the adrenal glands), opioids (lowering testosterone), some cancer treatments and immunotherapy
- Aging: natural decline in estrogen at menopause and a gradual fall in testosterone
- Severe illness, extreme weight loss and over-exercise, which can suppress reproductive hormones
Symptoms
Many symptoms are vague and develop slowly, so they are easily blamed on stress or aging:
- tiredness and low energy
- weight gain or weight loss
- low mood, anxiety or poor concentration
- reduced sex drive, erectile dysfunction, menstrual changes or infertility
- feeling cold or hot
- hair thinning, dry skin
- muscle weakness and aches
- dizziness on standing
- excessive thirst and urination
Diagnosis
- Blood tests of the hormone and its controlling pituitary hormone, such as TSH and free T4 for the thyroid, morning cortisol and ACTH for the adrenals, or testosterone with LH and FSH.
- Timed tests: some hormones vary through the day; testosterone and cortisol are best measured in the morning.
- Stimulation tests: for example, an ACTH (Synacthen) test for adrenal insufficiency or growth hormone stimulation tests.
- Antibody tests for autoimmune causes.
- Imaging: MRI of the pituitary if a secondary cause is suspected.
Treatment
Most deficiencies are treated with hormone replacement, aiming to restore normal levels:
- Daily tablets (thyroid hormone, hydrocortisone)
- Gels, patches or injections (testosterone, estrogen)
- Injections (growth hormone, insulin)
- Nasal spray or tablets (desmopressin)
Doses are adjusted using blood tests and symptoms. Replacement is often lifelong. People taking steroid replacement for adrenal insufficiency need "sick day rules" (increasing the dose during illness), an emergency injection kit and a medical alert.
Treating the underlying cause, such as removing a pituitary tumor or stopping an offending medicine, may restore function in some cases.
Frequently asked questions
What are the symptoms of hormone deficiency?
Symptoms depend on the hormone but commonly include tiredness, weight changes, low mood, poor concentration, reduced sex drive, menstrual changes, feeling cold, hair and skin changes, muscle weakness and dizziness. Many develop slowly and are easily overlooked.
What is the most common hormone deficiency?
Hypothyroidism, an underactive thyroid, is one of the most common, especially in women and older adults. Estrogen decline at menopause affects all women but is a natural life stage rather than a disease. Low testosterone is common in older men.
How is hormone deficiency tested?
It is tested with blood tests measuring the hormone and the pituitary hormone that controls it, sometimes at specific times of day. Stimulation tests, antibody tests and pituitary MRI scans help confirm the diagnosis and find the cause.
Can hormone deficiency be cured?
Some can be reversed if the cause is treated, such as stopping a medicine or removing a tumor. Most, including autoimmune hypothyroidism and Addison's disease, need lifelong hormone replacement, which usually controls symptoms well.
Is hormone replacement therapy safe?
When prescribed for a confirmed deficiency and monitored by a doctor, replacement is generally safe and often essential. Menopausal hormone therapy has benefits and risks that depend on age, timing and health history, so decisions are individualized.
Sources
This guide was written from current patient and clinical guidance, including:
- Endocrine Society: Hormones and endocrine function patient resources; Clinical practice guidelines (hypothyroidism, adrenal insufficiency, testosterone therapy, hypopituitarism)
- American Thyroid Association: Hypothyroidism
- NIDDK: Adrenal Insufficiency and Addison's Disease
- The Menopause Society: Hormone therapy position statement
- MedlinePlus: Hormones