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Hypogonadotropism with elevated serum testosterone: reversible causes of secondary infertility

Nature Clinical Practice Urology volume 3, pages 560–565 (2006)Cite this article

Abstract

Background A 33-year-old man presented with secondary infertility, increased libido, and extreme oligospermia. Testicular volumes were reduced, but no gynecomastia was apparent and androgen abuse was denied.

Investigations Physical examination, semen-volume and sperm-density assessment, laboratory tests for serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone sulfate, karyotyping, testicular ultrasound, pelvic and abdominal CT, assessment for serum testicular tumor markers (α-fetoprotein and human chorionic gonadotropin), and histologic examination of testicular tissue.

Diagnosis Benign Leydig-cell adenoma.

Management Left orchidectomy.

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Figure 1: The Leydig-cell tumor is characterized by typical Leydig cells, which show no unusual mitotic activity.
Figure 2: An algorithm for the investigation and management of the infertile male presenting with oligoazoospermia, suppressed serum gonadotropin levels, and no evidence of testicular tumor on clinical exmaination.

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Acknowledgements

RI McLachlan is supported by an Australian National Health and Medical Research Council Fellowship #169020 and Program Grant #241000, DM de Kretser is supported by National Health and Medical Research Program Grant # 334011.

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Authors and Affiliations

  1. Prince Henry's Institute,

    Robert I McLachlan & David M de Kretser

  2. Department of Obstetrics & Gynaecology, Monash University,

    Robert I McLachlan & David M de Kretser

  3. Monash Institute of Medical Research, Monash University, Melbourne, Australia

    Robert I McLachlan & David M de Kretser

Authors
  1. Robert I McLachlan
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  2. David M de Kretser
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Correspondence to Robert I McLachlan.

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The authors declare no competing financial interests.

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McLachlan, R., de Kretser, D. Hypogonadotropism with elevated serum testosterone: reversible causes of secondary infertility. Nat Rev Urol 3, 560–565 (2006). https://doi.org/10.1038/ncpuro0585

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  • DOI: https://doi.org/10.1038/ncpuro0585

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