Azoospermia is the complete absence of spermatozoa in the ejaculate in two or more semen analyses after centrifugation. Nonobstructive azoospermia (NOA) represents the most severe form of male factor infertility accounting for 10%-15% of cases and stems from an impairment to spermatogenesis. Understanding of the hypothalamic-pituitary-testicular axis has allowed NOA to be subcategorized by anatomic and/or pathophysiologic level. The etiologies of NOA, and therefore, the differential diagnoses when considering NOA as a cause of male factor infertility, can be subcategorized and condensed into several distinct classifications. Etiologies of NOA include primary hypogonadism, secondary hypogonadism, defects in androgen synthesis and/or response, defective spermatogenesis and sperm maturation, or a mixed picture thereof. This review includes up-to-date clinical, diagnostic, cellular, and histologic features pertaining to the multitude of NOA etiologies. This in turn will provide a framework by which physicians practicing infertility can augment their clinical decision-making, patient counseling, thereby improving upon the management of men with NOA.
Humans ; Azoospermia/diagnosis* ; Male ; Spermatogenesis/physiology* ; Hypogonadism/complications* ; Infertility, Male/etiology* ; Testis/pathology*

Non-obstructive azoospermia is a common condition associated with significant health risks, including increased mortality, cancer, and chronic diseases such as metabolic and cardiovascular disorders. This review aims to highlight the potential health challenges faced by men with this condition compared to fertile counterparts. Through a comprehensive bibliographic search on PubMed, using the following algorithm: ("infertility, male" [MeSH Terms] OR "azoospermia" [MeSH Terms]) AND ("mortality" [MeSH Terms] OR "neoplasms" [MeSH Terms] OR "chronic disease" [MeSH Terms] OR "diabetes mellitus" [MeSH Terms] OR "heart diseases" [MeSH Terms]), we analyzed existing literature to explore the associations between infertility, specifically azoospermia, and adverse health outcomes. Findings indicate that infertile men are at a higher risk of death, various cancers (particularly testicular cancer), metabolic syndrome, diabetes, hypogonadism, and cardiovascular disease. Although research specifically addressing azoospermia is limited, available studies support the notion that men with this condition may experience heightened health vulnerabilities. Given these risks, it is imperative for healthcare professionals, especially urologists, to conduct thorough health assessments for men diagnosed with azoospermia. Informing patients of these potential health issues and integrating comprehensive evaluations into their care can facilitate early detection and intervention for life-threatening conditions. Ultimately, men with azoospermia should receive ongoing monitoring to address their specific health concerns, thus improving their long-term health outcomes.
Humans ; Male ; Azoospermia/epidemiology* ; Cardiovascular Diseases/etiology* ; Metabolic Syndrome/epidemiology* ; Infertility, Male/complications* ; Testicular Neoplasms/epidemiology* ; Hypogonadism/epidemiology* ; Diabetes Mellitus/epidemiology* ; Risk Factors ; Neoplasms/epidemiology*

OBJECTIVE: To evaluate the clinical efficacy of "Shibao Decoction" in the management of late-onset hypogonadism (LOH) caused by deficiency of kidney essence. METHODS: Sixty male patients with late-onset hypogonadism of kidney essence deficiency type were randomly assigned to the treatment group and the control group, each with 30 cases. The patients in treatment group were treated with oral Shibao Decoction, while the control group was treated with oral Testosterone Undecanoate Capsules. The patients in both groups were treated for 12 weeks. The PADAM symptom score, TCM syndrome score, serum total testosterone (TT), serum free testosterone (FT), sex hormone binding globulin (SHBG), body mass index (BMI), total skeletal muscle mass index (SMI), appendicular skeletal muscle mass index (ASMI), FBG, FINS, and insulin resistance index (HOMA-IR) levels were compared between the two groups. RESULTS: After treatment, PADAM scores for each item and TCM symptoms score decreased, TT and FT increased in both groups, all with statistically significant differences from those of pre-treatment (P<0.05). The level of SHBG in the control group decreased (P<0.05), which had not changed significantly in the treatment group (P>0.05). After treatment, SMI and ASMI increased in both groups significantly (P<0.05). BMI decreased in the control group (P<0.05), which had not changed significantly in the treatment group (P>0.05). The level of FINS decreased in the control group (P<0.05), which had not changed significantly in the treatment group (P>0.05). FPG had not changed significantly in both groups (P>0.05), and the insulin resistance index (HOMA-IR) had significantly improved in both groups, all with statistically significant differences from those of pre-treatment (P<0.05). After treatment, the total effective rates of PADAM score and TCM syndrome score in the treatment group were 73.3% and 86.6% respectively, and the total effective rates in the control group were 66.7% and 76.6% respectively. The total effective rates of the two scores in the treatment group were slightly higher than those in the control group (P>0.05). There was no significant difference in the indicators between the two groups after treatment, and the treatment group is generally comparable with the control group in the therapeutic effects (P>0.05). And no adverse reactions occurred during treatment in both groups. CONCLUSION The "Shibao Decoction" has a remarkable therapeutic effect on late-onset hypogonadism caused by deficiency of kidney essence and has good safety. It can be used as an alternative to testosterone undecanoate and is worthy of clinical promotion and application.
Humans ; Hypogonadism/etiology* ; Drugs, Chinese Herbal/therapeutic use* ; Male ; Testosterone/therapeutic use* ; Treatment Outcome ; Sex Hormone-Binding Globulin ; Medicine, Chinese Traditional ; Middle Aged ; Adult ; Kidney

As more and more studies suggest that type 2 diabetes mellitus (T2DM) is closely related to male hypogonadism, people begin to pay more attention to the role of testosterone in the development of T2DM and the effect and safety of testosterone supplementary therapy. There is some controversy in randomized controlled studies and meta-analyses about the effects of testosterone supplementation on the blood glucose level, androgen deficiency symptoms, and cardiovascular diseases. This review focuses on the diagnosis of hypogonadism in T2DM males, differences in the therapeutic effects and safety of testosterone replacement among different studies, and rational use of testosterone supplementation for T2DM patients.
Androgens ; deficiency ; Blood Glucose ; Cardiovascular Diseases ; etiology ; Diabetes Mellitus, Type 2 ; etiology ; Hormone Replacement Therapy ; Humans ; Hypogonadism ; complications ; diagnosis ; drug therapy ; Male ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic ; Testosterone ; physiology ; therapeutic use

Adult ; Diabetes Mellitus ; etiology ; Fractures, Spontaneous ; etiology ; Humans ; Hypogonadism ; etiology ; Hypoparathyroidism ; etiology ; Hypothyroidism ; etiology ; Iron Overload ; etiology ; Male ; Osteoporosis ; etiology ; Osteoporotic Fractures ; etiology ; Recurrence ; Transfusion Reaction ; beta-Thalassemia ; therapy

ObjectiveTo analyze the clinical characteristics of secondary male hypogonadism induced by sellar space-occupying lesion, explore its pathogenesis, and improve its diagnosis and treatment.

METHODSWe retrospectively analyzed the clinical data about 22 cases of secondary male hypogonadism induced by sellar space-occupying lesion, reviewed related literature, and investigated the clinical manifestation, etiological factors, and treatment methods of the disease. Hypogonadism developed in 10 of the patients before surgery and radiotherapy (group A) and in the other 12 after it (group B). The patients received endocrine therapy with Andriol (n=7) or hCG (n=15).

RESULTSThe average diameter of the sellar space-occupying lesions was significantly longer in group A than in B (［2.35±0.71］ vs ［1.83±0.36］ cm, P<0.05) and the incidence rate of prolactinomas was markedly higher in the former than in the latter group (60% vs 0, P<0.01). The levels of lutein hormone (LH), follicle stimulating hormone (FSH) and testosterone (T) were remarkably decreased in group B after surgery and radiotherapy (P<0.01). Compared with the parameters obtained before endocrine therapy, all the patients showed significant increases after intervention with Andriol or hCG in the T level (［0.78±0.40］ vs ［2.71±0.70］ ng/ml with Andriol; ［0.93±0.44］ vs ［3.07±0.67］ ng/ml with hCG) and IIEF-5 score (5.00±2.61 vs 14.50±3.62 with Andriol; 5.36±1.82 vs 15.07±3.27 with hCG) (all P<0.01). The testis volume increased and pubic hair began to grow in those with hypoevolutism. The patients treated with hCG showed a significantly increased testis volume (P<0.01) and sperm was detected in 7 of them, whose baseline testis volume was markedly larger than those that failed to produce sperm (［11.5±2.3］ vs ［7.5±2.3］ ml, P<0.01). Those treated with Andriol exhibited no significant difference in the testis volume before and after intervention and produced no sperm, either.

CONCLUSIONSHypothyroidism might be attributed to surgery- or radiotherapy-induced damage to the pituitary tissue, space-occupying effect of sellar lesion, and hyperprolactinemia. Both Andriol and hCG can improve the T level and erectile function, but the former does not help spermatogenesis.

Adult ; Chorionic Gonadotropin ; therapeutic use ; Follicle Stimulating Hormone ; blood ; Humans ; Hypogonadism ; diagnosis ; etiology ; therapy ; Luteinizing Hormone ; blood ; Male ; Pituitary Neoplasms ; blood ; complications ; pathology ; therapy ; Prolactinoma ; blood ; complications ; pathology ; therapy ; Retrospective Studies ; Sella Turcica ; Spermatogenesis ; Spermatozoa ; Testis ; anatomy & histology ; drug effects ; Testosterone ; analogs & derivatives ; blood ; therapeutic use ; Tumor Burden

OBJECTIVETo observe the clinical effect of tadalafil combined with testosterone undecanoate on late-onset hypogonadism (LOH) in old and middle-aged males.

METHODSA total of 125 old and middle-aged (40 to 60 years) males with LOH were randomly assigned to a treatment group (n = 65) and a control group (n = 60) to be treated with tadalafil + testosterone undecanoate and testosterone undecanoate alone, respectively. We compared the levels of total testosterone (T), IIEF scores and the patients' sexual encounter profile (SEP) diaries before and 4 weeks after medication.

RESULTSThe T level, IIEF score and SEP score were significantly improved in both groups after medication as compared with the baseline (P < 0.05), and even more so in the treatment than in the control group (P < 0.05).

CONCLUSIONTadalafil combined with testosterone undecanoate, superior to testosterone undecanoate alone, can improve the T level, IIEF score and SEP score in old and middle-aged males with LOH and increase their sexual satisfaction and self-confidence.

Carbolines ; therapeutic use ; Erectile Dysfunction ; etiology ; Humans ; Hypogonadism ; drug therapy ; physiopathology ; psychology ; Male ; Middle Aged ; Sexual Behavior ; Tadalafil ; Testosterone ; analogs & derivatives ; analysis ; therapeutic use ; Treatment Outcome

We report a case of a 16 years old girl who presented sequentially with primary amenorrhoea, hypertension and hypokalaemia. Eight years later, she was finally diagnosed with 17alpha-hydroxylase deficiency congenital adrenal hyperplasia. Previous antihypertensive medications were stopped. Hydrocortisone alone successfully maintained normotension and normokalaemia.
Adrenal Hyperplasia, Congenital/*diagnosis ; Adrenal Hyperplasia, Congenital/*etiology ; Diagnosis, Differential ; Hypertension/etiology ; Hypogonadism/etiology ; Hypokalemia/etiology ; Steroid Hydroxylases/*deficiency

In humans androgen decline is presented as a clinical picture which includes decreased sexual interest, diminished erectile capacity, delayed or absent orgasms and reduced sexual pleasure. Additionally, changes in mood, diminished well being, fatigue, depression and irritability are also associated with androgen insufficiency. The critical role of androgens on the development, growth, and maintenance of the penis has been widely accepted. Although, the exact effect of androgens on erectile physiology still remains undetermined, recent experimental studies have broaden our understanding about the relationship between androgens and erectile function. Preclinical studies showed that androgen deprivation leads to penile tissue atrophy and alterations in the nerve structures of the penis. Furthermore, androgen deprivation caused to accumulation of fat containing cells and decreased protein expression of endothelial and neuronal nitric oxide synthases (eNOS and nNOS), and phosphodiesterase type-5 (PDE-5), which play crucial role in normal erectile physiology. On the light of the recent literature, we aimed to present the direct effect of androgens on the structures, development and maintenance of penile tissue and erectile physiology as well. Furthermore, according to the clinical studies we conclude the aetiology, pathophysiology, prevalence, diagnosis and treatment options of hypogonadism in aging men.
Aging ; Androgens ; physiology ; Erectile Dysfunction ; Humans ; Hypogonadism ; diagnosis ; etiology ; therapy ; Male ; Testosterone ; therapeutic use

Klinefelter's syndrome is one of the most common forms of primary hypogonadism and infertility in males. It is characterized by small and firm testes, gynecomastia, azoospermia, and an elevated gonadotropin level. The frequencies of diabetes mellitus, breast cancer, and germ cell neoplasia increases in Klinefelter's syndrome. We report upon a 35 year-old male patient with Graves' disease in association with Klinefelter's syndrome; as confirmed by chromosome analysis. The patient is being treated with antithyroid medication for Graves' disease and by testosterone replacement for Klinefelter's syndrome.
Adult ; Graves' Disease/*etiology/radionuclide imaging ; Human ; Hypogonadism/*etiology/genetics/pathology ; Klinefelter Syndrome/*complications/genetics/pathology ; Male