Andrologist: men's health

An andrologist is a physician specializing in the diagnosis, treatment, and prevention of diseases of the male reproductive and genital systems. In clinical practice, an andrologist addresses issues related to male infertility, hormonal imbalances, erectile dysfunction, ejaculation disorders, urogenital tract infections, and the consequences of trauma. [1]

In various medical systems, andrologists may be urologists, endocrinologists, or reproductive specialists with additional training in andrology. The primary value of this specialization is the integration of reproductive system examinations, hormonal status, and a man's overall health to select a personalized treatment plan. [2]

Consulting an andrologist is recommended for problems with conception, decreased libido, erectile dysfunction, suspected testosterone deficiency, recurring urogenital infections, and after scrotal or penile injuries. Early consultation increases the likelihood of preserving fertility and preventing chronic complications. [3]

The key principle of an andrologist's work is comprehensiveness. A simultaneous assessment of sperm, hormones, local organ status, and associated systemic factors, including metabolism, cardiovascular system, and psychosocial factors, is conducted. Only such a systematic assessment allows for the selection of safe and effective therapy. [4]

Main clinical syndromes in the practice of an andrologist

The leading topic is male infertility. This includes absolute azoospermia, oligospermia, and impaired sperm motility and morphology. Diagnosis and treatment rely on standardized semen analysis according to WHO recommendations and the identification of reversible causes. [5]

Erectile dysfunction remains a common problem in men of all ages. Its causes include vascular, neurological, endocrine, psychosocial, or mixed factors. Current EAU guidelines emphasize the need for a comprehensive examination before initiating therapy. [6]

Hypogonadism and testosterone status disorders include primary and secondary forms. Diagnostic criteria combine characteristic symptoms with laboratory confirmation of low testosterone levels, according to international recommendations of professional societies. Decisions regarding replacement therapy are made after assessing the patient's risks and goals. [7]

Urogenital infections, inflammatory processes of the appendage, and chronic prostatitis often impair fertility and quality of life. Their diagnosis requires a combination of clinical presentation, microbiological studies, and, if necessary, instrumental methods. Correct identification of the pathogen and adequate therapy reduce the risk of complications. [8]

Table 1. Main conditions in the practice of an andrologist and typical complaints

State	Typical complaints	Comment
Male infertility	Inability to conceive despite regular attempts	Requires couple evaluation and standardized semen analysis.[9]
Erectile dysfunction	Inability to maintain an erection	Multifactorial etiology requires a systematic examination. [10]
Hypogonadism	Decreased libido, fatigue, decreased muscle mass	Laboratory confirmation is necessary before therapy.[11]
Chronic prostatitis and epididymitis	Pain, discomfort, decreased fertility	Requires microbiological and instrumental examination. [12]
Ejaculation dysfunctions	Premature ejaculation, retrograde ejaculation	Have organic and functional causes. [13]

Diagnostic Algorithm: What Does an Andrologist's Assessment Include?

The initial examination begins with a detailed medical history: duration of the problem, family history, past infections, injuries, and medications. A history of sexual behavior and associated risk factors help plan the examination. [14]

A physical examination includes an assessment of secondary sexual characteristics, the condition of the scrotum, and the prostate gland, if necessary. If varicocele or azoospermia is suspected, palpation and ultrasound examination of the scrotum and vas deferens are mandatory. [15]

The key laboratory block is a standard semen analysis performed according to the WHO methodology and an assessment of the hormonal profile: total testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and thyroid hormones, if indicated. The semen analysis must meet quality requirements and be repeated if there are any deviations. [16]

Instrumental methods include scrotal sonography, Doppler studies, urethroscopy when indicated, magnetic resonance imaging in complex cases, and, if necessary, genetic testing for azoospermia or severe spermatogenesis disorders. The sequence of examinations is determined by the initial results and the clinical picture. [17]

Table 2. Standard set of examinations by an andrologist

Study	Indication	What does it give?
Sperm analysis according to WHO	In case of infertility	Concentration, mobility, morphology. [18]
Blood hormones	Suspected hypogonadism or azoospermia	Evaluation of the hypothalamic-pituitary-testicular axis. [19]
Ultrasound of the scrotum	Pain, suspected varicocele, abnormalities	Testicular morphology, varicocele, cysts. [20]
Doppler ultrasound of the penile vessels	In case of vascular etiology of erectile dysfunction	Evaluation of penile blood supply. [21]
Genetics and microbiology	Severe sperm disorders, azoospermia, infections	Chromosomal and infectious factors. [22]

Seed analysis: standards and interpretation

Semen analysis is a basic and often decisive test for male infertility. The methodology and reference values are standardized by the WHO in the latest edition of the laboratory manual. Adherence to the rules for sample collection, storage, and processing is critical to the reliability of the results. [23]

The WHO identifies key parameters: ejaculate volume, sperm concentration, total motility, proportion of progressively motile sperm, and morphology. Interpretation is based on population thresholds, but the final conclusion is made taking into account the clinical context and repeated studies. [24]

Analysis errors may occur due to improper preparation of the abstinence period, fever in the preceding weeks, the use of certain medications, and technical errors in the laboratory. If deviations are observed, a repeat analysis and extensive testing are recommended. [25]

New guidelines emphasize the importance of accredited centers with quality assurance programs for performing semen analysis. This is particularly important when making decisions about costly reproductive medicine interventions. [26]

Table 3. Approximate thresholds for individual sperm parameters according to WHO recommendations

Indicator	Threshold value (lower limit)	Comment
Ejaculate volume	1.4 ml	Depends on the abstinence interval. [27]
Sperm concentration	16 million in 1 ml	Less significant without clinical context.[28]
General mobility	42%	Includes progressive mobility. [29]
Progressive mobility	30%	Critical for fertility. [30]
Morphology of normal forms	4%	Depends on the methodology and criteria of calculation. [31]

Erectile dysfunction

Erectile dysfunction is a symptom reflecting a wide range of diseases. The primary goal of an andrologist is to distinguish systemic from local causes and assess the risk of cardiovascular disease, as vascular dysfunction often accompanies erectile dysfunction. [32]

Diagnosis includes a detailed sexual history, functional assessment scales, and, if necessary, vascular tests and laboratory hormone testing. Only after contraindications have been ruled out can therapy be planned. [33]

First-line therapy typically includes oral phosphodiesterase type 5 inhibitors, management of comorbid conditions, and lifestyle education. If these are ineffective, alternative and invasive treatments are indicated, including intracavernous injections, vacuum erection devices, and, as a last resort, penile prosthesis implantation. [34]

Current EAU guidelines also consider psychosexual therapy an integral part of treatment in the presence of psychogenic components. The approach is personalized and should be consistent with the expectations of the patient and their partner. [35]

Table 4. Main treatment options for erectile dysfunction and indications

Option	Indications	Advantages and limitations
Oral PDE5 preparations	First line in the absence of contraindications	Effective in most patients; contraindicated with nitrate therapy. [36]
Intracavernous injections	Refractory to oral therapy	Highly effective; injection skills required. [37]
Vacuum pumps	An alternative for patients without surgery	Non-pharmacological method, convenient to use. [38]
Penile prosthesis	Resistant cases	An operational solution with high satisfaction rates. [39]

Hypogonadism

The diagnosis of hypogonadism requires a combination of characteristic symptoms and laboratory confirmation of a decrease in total testosterone in morning blood, usually in two repeated measurements. International societies provide recommendations on thresholds and indications for therapy. [40]

The decision to initiate testosterone replacement therapy is made on an individual basis. Preliminary screening for prostate cancer and cardiovascular risk assessment are necessary. When prescribing therapy, monitoring of hormone levels, hematocrit, lipid profile, and symptom dynamics is required. [41]

Replacement therapy options include transdermal preparations, long-acting injections, and gels. The choice depends on patient preference, cost, fertility goals, and side effects. Replacement therapy suppresses spermatogenesis and is therefore contraindicated for men planning immediate fatherhood without sperm preservation measures. [42]

Alternatives to replacement therapy for fertility preservation include clomiphene, gonadotropins, and other hormonal strategies. These approaches require coordination with a reproductive specialist and endocrinologist. [43]

Urogenital tract infections and their role in fertility

Epididymal and prostate infections can reduce sperm quality, cause pain, and contribute to the development of chronic conditions. Identifying the pathogen followed by targeted antibiotic therapy is a key step in treatment. [44]

Chronic inflammatory processes often require a comprehensive approach: antibacterial therapy, anti-inflammatory measures, physical therapy, and risk factor correction. In some cases, testing for chlamydia, mycoplasma, and other latent infections is indicated. [45]

The impact of infections on fertility is twofold: direct damage to spermatogenesis and changes in sperm parameters, as well as immunological mechanisms with the formation of antisperm antibodies. Evaluation and treatment should take both approaches into account. [46]

Prevention includes safe sex practices, prompt treatment of acute infections, and monitoring of concomitant conditions. In cases of couple infertility, both partners are recommended to undergo examination and, if necessary, receive simultaneous therapy. [47]

Reproductive technologies and surgical options

In cases of severe spermatogenesis disorders or obstructive azoospermia, an andrologist coordinates discussions of assisted reproductive technologies. Possible options include intracytoplasmic sperm injection, testicular sperm extraction, and microsurgical interventions. The decision is made in consultation with a fertility specialist. [48]

Surgical corrections include varicocelectomy for varicoceles, restorative microvascular surgery for obstructive azoospermia, and reconstructive surgeries for structural anomalies. The effect on improving sperm parameters and fertility depends on the initial condition and surgical technique. [49]

Before any surgical intervention, alternatives, expected effectiveness, and risks are discussed. In some cases, it is preferable to proceed directly to assisted reproductive technologies, especially if the partner is of an age-related nature. [50]

Treatment planning requires documenting the couple's goals: immediate conception, preservation of reproductive potential, symptomatic relief, or a combination of goals. This determines the sequence of investigations and the choice of interventions. [51]

Table 5. Surgical and assisted options for male infertility

Option	Indication	Effect
Varicocelectomy	Clinical varicocele with sperm dysfunction	Possible improvement in sperm parameters in some men. [52]
Microsurgical reconstructive surgery	Obstructive azoospermia	Restoring the patency of the vas deferens. [53]
Testicular sperm extraction	Ineffectiveness of spermatogenesis in the ejaculate	Obtaining sperm for ICSI. [54]
ICSI	Severe sperm disorders	Allows fertilization with low sperm quality. [55]

Red flags and indications for urgent consultation

Urgent medical attention is necessary if you experience acute scrotal pain, a sudden increase in scrotal size, symptoms of acute infection with fever, severe bleeding, or suspected spermatic cord torsion. These conditions require urgent diagnosis and often surgical intervention. [56]

Other warning signs include a sudden deterioration in sexual function, rapidly increasing penile swelling, symptoms of systemic infection, and an acute deterioration in general condition in the presence of chronic prostatitis. In such cases, delay worsens the prognosis for fertility and function. [57]

If signs of hematuria, severe dyspepsia after therapy, a sudden decrease in hemoglobin levels, or a suspected complication of therapy occur, an examination should be performed immediately. Any intervention requires informed consent and risk assessment. [58]

Regular checkups with an andrologist are recommended for men with chronic illnesses, those planning to become fathers, and those receiving hormone therapy. This allows for the early detection of complications. [59]

Preventive recommendations and lifestyle

Controlling risk factors significantly improves reproductive health. Recommendations include stopping smoking, drinking alcohol in moderation, maintaining a healthy weight, engaging in regular physical activity, and managing chronic diseases. These measures improve vascular function and sperm parameters. [60]

It is recommended to avoid overheating the scrotum, frequent sedentary work without breaks, wearing tight underwear, and exposure to toxins. When planning a pregnancy, it is helpful to reduce exposure to harmful factors three months before conception, as this is the period of spermatogenesis. [61]

Maintaining sexual activity and promptly treating urogenital infections reduce the risk of chronic complications. When taking medications with reproductive risks, alternatives and possible sperm preservation measures should be discussed. [62]

Couples experiencing difficulty conceiving after more than six months of regular sexual intercourse should consult a specialist for evaluation of both partners. Early involvement of a fertility specialist increases the chances of a successful outcome. [63]

Conclusion

An andrologist is a specialist whose job it is to combine clinical assessment, modern laboratory diagnostics, and individualized treatment strategies to address male reproductive and sexual health issues. WHO standards and professional society recommendations provide the basis for modern examination and treatment protocols. [64]

Any complex or long-term problems with fertility or sexual function require a systematic approach and coordination with reproductive specialists, endocrinologists, and cardiologists. Early and accurate diagnosis significantly increases the likelihood of successful treatment. [65]