Hypoandrogenism is common finding in infertile men

October 1, 2008

Hypoandrogenism is common among men with nonobstructive azoospermia, and even those with normospermia.

Orlando, FL-Hypoandrogenism is common among men with nonobstructive azoospermia, oligospermia, and even those with normospermia, according to researchers from the University of Illinois, Chicago.

At the 2008 AUA annual meeting, first author Beneranda S. Ford, MD, and colleagues presented the results of a chart review study of 104 men who presented to the university clinic with infertility of at least 1 year duration. The patients were categorized into subgroups of obstructive azoospermia, nonobstructive azoospermia, oligospermia (sperm density <20 million/mL), and normospermia (sperm density >20 million/mL). Then the proportion of men fulfilling the FDA criterion for hypoandrogenism (total testosterone <300 ng/dL) were analyzed for each subgroup.

Men with nonobstructive azoospermia had the highest incidence of hypoandrogenism at 45%. Hypoandrogenism was also present among 42.9% of men with oligospermia and 35.3% of men with a sperm density >20 million/mL.

"In the mid 1990s, Sigman and Jarow reported in a retrospective study of men presenting to an infertility clinic that the incidence of endocrinopathy was low among patients with a sperm density exceeding 10 million/mL," Dr. Ford said. "In contrast, we found hypoandrogenism was present in almost half of men with nonobstructive azoospermia, two of five men with oligospermia, and one in three infertile men with a sperm density above 20 million/mL.

"The widespread use of the FDA criteria for hypoandrogenism and an increasing number of men presenting with nonobstructive azoospermia for evaluation for ICSI may account for the higher incidence of hypoandrogenism in our more contemporary population. Based on our findings, we believe that all men presenting with infertility should receive a hormonal workup to identify hypoandrogenism if it exists so that it can be treated."

A subset analysis was performed based on calculation of bioavailable testosterone using the free testosterone index with total testosterone, albumin, and sex hormone binding globulin. Data were available for 16 men with nonobstructive azoospermia that showed 83.3% had bioavailable testosterone <200 ng/dL.

"Consistent with the finding of our primary analysis based on measurement of total testosterone, this result confirms there is a high incidence of hypoandrogenism in men with nonobstructive azoospermia," Dr. Ford said.

Dr. Ford noted the groups were relatively well matched with respect to age. The obstructive azoospermia group included approximately equal numbers of men with a congenital etiology and vasectomy reversal patients.