Andrology: Diseases, Diagnosis, Treatment Methods, and Examination

Andrology is the medical field concerned with the diagnosis, treatment, and monitoring of diseases affecting the male reproductive system and sexual health. Its main areas of focus include evaluating male reproductive function, examining sperm production and quality, investigating hormonal disorders, and treating sexual dysfunction. Male reproductive health is not limited to the ability to have children. Sexual function, hormonal balance, and the proper functioning of the reproductive organs are also evaluated within this field.

Andrology is closely related to urology. The evaluation and treatment of andrological conditions are generally carried out by urologists experienced in this field. The main conditions addressed by andrology services include male infertility, erectile dysfunction, premature ejaculation, testosterone deficiency, and varicocele.

The male reproductive system consists of various anatomical structures, including the testes, epididymis, sperm ducts, prostate, seminal vesicles, and penis. Developmental, structural, or functional problems affecting any of these structures may compromise reproductive and sexual health. In addition, diabetes, obesity, cardiovascular diseases, hormonal disorders, and certain chronic conditions may affect male sexual and reproductive function.

During an andrological assessment, the focus is not limited to the patient's current symptoms. Age, general health, medications, previous surgeries, lifestyle habits, and reproductive plans are also taken into consideration. When necessary, a multidisciplinary approach may be adopted in collaboration with endocrinology, obstetrics and gynecology, psychiatry, and other relevant specialties.

Men experiencing difficulty conceiving, changes in sexual function, testicular pain or swelling, symptoms suggestive of hormonal problems, or structural changes in the genital area should undergo an andrological evaluation. Early assessment can help identify underlying causes and determine appropriate treatment options.

Which Diseases Does Andrology Treat?

Andrology deals with the diagnosis and treatment of numerous conditions affecting the male reproductive organs, sperm production, hormonal balance, and sexual function. While some andrological disorders cause noticeable symptoms, others may only be detected during investigations performed when a couple is trying to conceive.

The main diseases and health conditions evaluated by andrology services are described below.

Male Infertility

Male infertility refers to conditions affecting male reproductive function that make achieving pregnancy more difficult. In general, failure to achieve pregnancy after 12 months of regular, unprotected sexual intercourse warrants an infertility evaluation. Assessment may begin earlier if the female partner is aged 35 or older or if a known reproductive health problem is present.

Male infertility may result from various causes, including a low sperm count, reduced sperm motility, abnormalities in sperm morphology, hormonal disorders, blockages in the sperm ducts, or impaired testicular function. In some individuals, no clear cause can be identified despite investigations.

Diagnostic procedures may include semen analysis, hormonal tests, physical examination, and genetic testing when indicated. Treatment is planned according to the underlying cause of infertility.

Varicocele

A varicocele is a condition caused by the enlargement of veins surrounding the testicles. It usually occurs on the left side but may develop on both sides. Some individuals have no symptoms, while others may experience testicular pain, a feeling of heaviness, or impaired reproductive function.

A varicocele may adversely affect temperature regulation around the testicles and sperm production. However, not every man with a varicocele develops infertility.

Physical examination is fundamental to diagnosis. Scrotal Doppler ultrasonography may be performed when considered necessary. Treatment decisions are based on the patient's symptoms, semen analysis results, testicular findings, and reproductive plans.

Erectile Dysfunction

Erectile dysfunction is the inability to achieve or maintain sufficient penile rigidity for sexual intercourse. Occasional difficulties with erections do not necessarily indicate a medical condition. However, recurring or persistent problems may require medical evaluation.

Erectile dysfunction may be associated with diabetes, high blood pressure, vascular diseases, hormonal disorders, neurological conditions, certain medications, and psychological factors. Smoking, physical inactivity, and obesity may also negatively affect erectile function.

During an andrological assessment, the duration and progression of the problem, associated medical conditions, and sexual health history are examined. Treatment may include lifestyle modifications, medications, interventional procedures for suitable patients, and psychosexual support.

Premature Ejaculation

Premature ejaculation is a sexual dysfunction characterized by insufficient control over the timing of ejaculation, resulting in significant distress for the individual or their partner.

Premature ejaculation may occur from the first sexual experiences or develop later in individuals who previously had normal ejaculatory control. Psychological factors, relationship dynamics, and certain urological or hormonal problems may contribute to the condition.

Treatment options may include behavioral approaches, sexual counseling, topical medications, and oral medications deemed appropriate by a physician. The treatment plan is tailored to the characteristics of the problem and the individual's needs.

Testosterone Deficiency (Male Hypogonadism)

Testosterone is a hormone involved in many physiological processes in men, including sexual development, sperm production, the maintenance of muscle and bone structure, and the regulation of sexual desire.

Testosterone deficiency may cause symptoms such as reduced sexual desire, fewer morning erections, low energy levels, decreased muscle mass, reduced bone density, and infertility. However, these symptoms are not specific to testosterone deficiency and may have other causes.

Diagnosis requires the assessment of appropriate clinical symptoms and confirmation of low testosterone levels through blood tests, generally performed in the morning on separate days. Treatment depends on the cause of the deficiency and the patient's plans to have children. It is particularly important to consider that externally administered testosterone can suppress sperm production.

Peyronie's Disease (Penile Curvature)

Peyronie's disease is a condition in which fibrous plaques develop in the penile tissue, potentially causing penile curvature, changes in shape, pain, or erectile difficulties.

In some individuals, the curvature may become severe enough to make sexual intercourse difficult. Symptoms may include areas of firmness in the penile tissue, pain during erections, or changes in penile length.

Treatment is selected according to whether the disease is in its active or stable phase, the degree of curvature, and the extent to which sexual function is affected. Monitoring, interventional treatments in suitable patients, or surgical procedures may be considered.

Ejaculatory Disorders

In addition to premature ejaculation, andrology addresses disorders such as delayed ejaculation, anejaculation, retrograde ejaculation, and the absence of semen emission.

These conditions may be associated with diabetes, nervous system disorders, certain medications, previous surgical procedures, or psychological factors. In retrograde ejaculation, semen travels into the bladder rather than being expelled through the urethra.

Evaluation includes a detailed medical history, a review of medications, assessment of neurological status, and laboratory investigations when necessary. Treatment is directed at the underlying cause.

Sperm Production Disorders and Azoospermia

Azoospermia is the absence of detectable sperm cells in a semen sample. It may result from impaired sperm production or obstruction of the ducts that transport sperm.

Reduced or completely absent sperm production may be associated with hormonal, genetic, anatomical, or acquired medical conditions. Confirmation of the diagnosis may require repeat semen analysis under appropriate conditions and a detailed evaluation.

Patients diagnosed with azoospermia may undergo hormonal investigations, genetic testing, and, when appropriate, surgical sperm retrieval procedures.

Testicular Diseases and Structural Problems of the Reproductive Organs

Developmental abnormalities of the testes, a history of undescended testicles, reduced testicular volume, and certain reproductive organ abnormalities may be evaluated as part of andrological care.

These conditions may affect sperm production, hormonal function, or sexual health. Urological assessment and follow-up are planned according to the patient's age, current findings, and reproductive plans.

A newly detected testicular mass, significant swelling, or sudden and severe pain requires prompt medical evaluation. Sudden, severe testicular pain may indicate testicular torsion, a condition requiring emergency intervention.

Diagnostic Methods in Andrology

The diagnosis of andrological conditions involves evaluating the patient's symptoms, medical history, physical examination findings, and, when necessary, laboratory tests and imaging studies. Since male reproductive and sexual health problems can arise from different causes, not every patient requires the same tests. Investigations are selected according to the symptoms and clinical findings.

The main diagnostic methods used in andrology are described below.

Semen Analysis (Spermiogram)

Semen analysis is one of the fundamental laboratory tests used to assess male reproductive function. The examination evaluates characteristics such as semen volume, sperm concentration, total sperm count, sperm motility, and sperm morphology.

Sexual abstinence for approximately 2–7 days is generally recommended before the test. The semen sample is collected under the conditions specified by the laboratory and analyzed within the appropriate timeframe.

Results outside the normal reference ranges do not, on their own, establish a definitive diagnosis of infertility. Since sperm parameters may change over time, repeat testing may be requested when necessary. Results are interpreted alongside the patient's other clinical findings.

Hormonal Tests

Hormones such as testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin play important roles in regulating sperm production and sexual function in men. Blood tests may be used to measure relevant hormone levels when a hormonal disorder is suspected.

Testosterone measurement is particularly important in individuals experiencing reduced sexual desire, erectile difficulties, or symptoms suggestive of hypogonadism. FSH and LH levels can help evaluate testicular function and disorders of sperm production.

Thyroid function tests and other hormonal investigations may also be performed when indicated. Test results are interpreted in conjunction with the patient's age, symptoms, and existing medical conditions.

Scrotal Ultrasonography and Doppler Ultrasonography

Scrotal ultrasonography is an imaging method used to examine the testes and surrounding structures. It can help assess testicular volume, structural changes, cysts, and certain other anatomical findings.

Doppler ultrasonography helps evaluate blood flow. It may be preferred when a varicocele is suspected or when physical examination findings require further assessment.

Ultrasonography is not routinely required for every andrology patient. The physician determines whether imaging is necessary based on the examination and other test results.

Genetic Testing

Genetic factors may underlie sperm production disorders in some cases of male infertility. Genetic investigations may be necessary, particularly in cases of severely reduced sperm counts or azoospermia.

These investigations may include chromosome analysis (karyotyping), Y-chromosome microdeletion testing, and other genetic tests when appropriate. Testing for specific genes may also be considered in certain congenital abnormalities of the sperm ducts.

Genetic evaluation is important not only for investigating the cause of infertility but also for planning assisted reproductive techniques and providing counseling about hereditary risks.

Penile Doppler Ultrasonography

Penile Doppler ultrasonography is an imaging method that may be used in selected cases of erectile dysfunction to evaluate blood flow in the penile blood vessels.

When necessary, medication may be administered into the penis during the examination to assess the vascular response responsible for producing an erection. This allows the physician to investigate findings associated with arterial blood flow and possible venous leakage.

This test is not necessary for every patient with erectile dysfunction. It is generally used when a vascular problem is suspected following the initial assessment or when specific treatment decisions need to be made.

Urinalysis and Other Laboratory Tests

Some andrological symptoms may be associated with infections, metabolic diseases, or other systemic conditions. Therefore, tests such as urinalysis, urine culture, blood glucose, HbA1c, and blood lipid measurements may be performed when necessary.

Post-ejaculatory urine testing may be carried out in selected patients during the evaluation of ejaculatory disorders. Appropriate microbiological tests may also be requested when a sexually transmitted infection is suspected.

Sexual Health Assessment Questionnaires

Standardized questionnaires may be used to assess the frequency of symptoms and their impact on quality of life in individuals with erectile dysfunction or ejaculatory problems.

For example, the International Index of Erectile Function (IIEF) may be used to evaluate erectile function. These assessments support the diagnostic process but are not sufficient to establish a definitive diagnosis on their own.

What Treatment Methods Are Used in Andrology?

Treatment for andrological conditions is planned according to the underlying problem, its severity, and the patient's general health. Medication and lifestyle modifications may be sufficient for some conditions, while others may require surgical procedures or assisted reproductive techniques.

The primary goals of andrological treatment are to identify the cause of the health problem, evaluate its effects on sexual or reproductive function, and develop a treatment approach suited to the patient's needs.

Medical Treatment

Medications used in andrology vary according to the diagnosis and treatment objectives. Treatment may include medications that improve blood flow to penile tissue in erectile dysfunction, medications that affect ejaculatory control in premature ejaculation, and therapies aimed at regulating hormone levels in certain hormonal disorders.

Some medications used to treat erectile dysfunction can cause a severe drop in blood pressure when taken with nitrate-containing cardiac medications. Therefore, the patient's current medications and cardiovascular health should be evaluated before treatment begins.

Medication selection, dosage, and duration of use must be determined by a physician. Unsupervised use of medications or supplements intended to enhance sexual performance can pose serious health risks.

Hormonal Treatments

Treatments targeting hormone deficiencies or imbalances may be used for certain andrological conditions caused by hormonal disorders.

Testosterone replacement therapy may be considered for selected patients with confirmed testosterone deficiency and appropriate clinical symptoms. However, administering external testosterone may not be suitable for men planning to have children in the near future because it can suppress sperm production.

Hormonal treatments intended to preserve or support reproductive function vary according to the underlying cause of the disorder. For this reason, hormonal therapy must always be planned following a detailed medical evaluation.

Varicocele Surgery (Varicocelectomy)

Surgical treatment may be preferred for selected patients with varicocele. Surgery may be considered in suitable cases of infertility when a clinically detectable varicocele affects sperm parameters.

Microsurgical varicocelectomy is a procedure in which enlarged veins are ligated using an operating microscope. Care is taken during the procedure to preserve the testicular arteries, lymphatic vessels, and other important anatomical structures.

Not every patient with a varicocele requires surgery. The decision is based on the patient's symptoms, examination findings, semen analysis results, and reproductive plans. Although sperm parameters may improve following surgery, this does not mean that pregnancy will be achieved in every case.

Surgical Sperm Retrieval Techniques

In some men whose semen samples contain no sperm, surgical procedures may be performed to retrieve sperm from testicular or epididymal tissue.

These procedures include testicular sperm extraction (TESE), microsurgical testicular sperm extraction (Micro-TESE), and percutaneous epididymal sperm aspiration (PESA).

Micro-TESE may be performed in suitable patients with azoospermia caused by impaired sperm production. An operating microscope is used to search for sperm within the testicular tissue.

Retrieved sperm may be used in assisted reproductive techniques such as intracytoplasmic sperm injection (ICSI), under appropriate conditions. However, successful sperm retrieval cannot be guaranteed in every patient. The likelihood of success depends on the underlying cause of infertility and testicular function.

Interventional Treatments for Erectile Dysfunction

Alternative treatment options may be considered when oral medications are ineffective or cannot be used to treat erectile dysfunction.

Vacuum erection devices and certain medications injected into the penis are among the treatment options available for suitable patients. Penile implant surgery may also be considered for patients who have not benefited from other treatments and meet the necessary criteria.

Penile prostheses are surgically implanted devices designed to mechanically support erectile function. The choice of prosthesis depends on the patient's anatomical characteristics, expectations, and general health.

Treatment Methods for Peyronie's Disease

Treatment for Peyronie's disease takes into account the degree of penile curvature, the presence of pain, disease progression, and the extent to which sexual intercourse is affected.

Regular monitoring may be preferred in mild cases that do not significantly affect sexual function. Penile traction devices or certain interventional treatment options may be considered for suitable patients.

Surgical procedures may be performed during the stable phase of the disease when curvature is significant and affects sexual function. The surgical technique is selected according to the characteristics of the curvature and the patient's erectile function.

Counseling and Supportive Treatments for Sexual Dysfunction

Male sexual health is influenced by more than anatomical and hormonal factors. Anxiety, stress, depression, relationship problems, and performance anxiety may also affect sexual function.

For this reason, some patients may benefit from supportive approaches alongside medication, including psychosexual counseling, cognitive behavioral approaches, or couples therapy.

These approaches may form part of the treatment plan, particularly for premature ejaculation and erectile difficulties accompanied by psychological factors.

Lifestyle Modifications

Smoking, excessive alcohol consumption, obesity, physical inactivity, and sleep disorders may negatively affect male reproductive and sexual health.

As part of andrological treatment, lifestyle modifications may be recommended, including regular physical activity, a balanced diet, maintaining a healthy body weight, smoking cessation, and adequate sleep.

Appropriate management of diabetes, high blood pressure, and other chronic conditions is also important for preserving sexual function. However, lifestyle changes do not replace necessary medical treatment; they should be considered supportive measures within the overall treatment process.

Are Andrology and Urology the Same?

Although andrology and urology are closely related, they do not have exactly the same scope. Urology is a surgical medical specialty concerned with diagnosing and treating diseases of the urinary tract in women and men, as well as diseases of the male reproductive system. Andrology focuses particularly on male reproductive health, male infertility, and sexual dysfunction.

Urology departments evaluate diseases of the kidneys, bladder, ureters, and urethra, as well as conditions affecting the prostate, penis, and testes. Kidney stones, urinary tract obstructions, prostate enlargement, urinary incontinence, and urological cancers fall within this specialty.

Andrology can be considered a more specialized area within urology that focuses on male reproductive and sexual health. Its main areas of interest include sperm production disorders, male infertility, hormonal problems, erectile dysfunction, premature ejaculation, and other male sexual health conditions.

The main differences between urology and andrology can be summarized as follows:

Andrological conditions are generally diagnosed and treated by urologists with experience in this field. Therefore, individuals experiencing male infertility or sexual dysfunction may consult a urologist specializing in andrology.

In some cases, diagnosis and treatment require collaboration between multiple specialties. For example, endocrinology may be involved in evaluating hormonal problems, while obstetrics and gynecology and reproductive medicine may contribute to the process of achieving pregnancy. Relevant mental health professionals may also be involved when psychological factors contribute to sexual dysfunction.

How Is an Andrology Examination Performed?

An andrology examination is a comprehensive medical assessment performed to evaluate concerns related to male reproductive and sexual health. The examination varies according to the reason for the patient's visit. The assessment of a patient presenting with infertility may differ from that of a patient presenting with erectile dysfunction or testicular pain.

The first stage of an andrology examination generally involves taking a detailed medical history. The physician assesses when the current symptoms began, how frequently they occur, and how they affect daily life.

For patients seeking evaluation for male infertility, the physician may ask how long they have been trying to conceive, whether there have been previous pregnancies, and whether the patient has a history of infections, surgeries, testicular diseases, or medication use. In cases of sexual dysfunction, information is collected about the onset of symptoms, sexual desire, erectile characteristics, and ejaculatory function.

The main stages that may be included in the examination are outlined below.

Taking the Patient's Medical and Sexual Health History

A detailed medical history is an important part of the andrological assessment. Conditions such as diabetes, hypertension, thyroid diseases, previous infections, and surgical procedures may affect male reproductive and sexual health.

The physician may also ask about smoking and alcohol consumption, physical activity levels, sleep habits, medications, and hormone-containing products. The use of anabolic steroids is particularly important because these substances can suppress the body's natural testosterone and sperm production.

Answering questions about sexual health helps the physician reach an accurate diagnosis. The consultation is conducted in accordance with patient privacy and medical confidentiality principles.

Physical Examination

Depending on the reason for the visit, the physical examination may include an assessment of general physical characteristics and the male genital organs.

When necessary, the physician examines anatomical structures such as the penis, testes, epididymis, and sperm ducts. Testicular size, consistency, position, and possible structural changes are assessed. If a varicocele is suspected, the veins surrounding the testes may be examined while the patient is standing and using appropriate examination maneuvers.

In patients with suspected hormonal disorders, physical characteristics such as body hair distribution, muscle structure, and breast tissue may also be evaluated.

Genital examinations are performed after the patient has been informed and has provided consent. Not every examination requires all of these procedures.

Planning Laboratory Tests

Following the physical examination and medical history, the necessary tests are determined. Semen analysis is frequently one of the initial investigations for patients experiencing difficulty conceiving.

If a hormonal problem is suspected, testosterone, FSH, LH, and other relevant hormone levels may be measured. In patients with erectile dysfunction, metabolic parameters such as blood glucose and blood lipids may also be evaluated.

Laboratory results are interpreted alongside the patient's symptoms and examination findings rather than in isolation.

Performing Imaging Studies When Necessary

Ultrasonography is not necessary for every patient undergoing an andrology examination. However, scrotal ultrasonography may be requested when a structural problem affecting the testes is suspected or when findings related to a varicocele need to be assessed.

In certain cases of erectile dysfunction, Doppler ultrasonography may be used to evaluate the blood vessels of the penis.

Imaging methods are selected by the physician based on the physical examination and laboratory results.

Developing a Treatment Plan After Diagnosis

Once the examination and necessary investigations have been completed, the findings are evaluated together. Appropriate treatment options are determined according to the cause and severity of the condition and the patient's general health.

Medication or lifestyle modifications may be recommended for some patients, while procedures may be planned when surgical intervention is necessary. Patients with male infertility may also be assessed for assisted reproductive techniques when appropriate.

The patient's expectations and plans to have children in the future are important considerations throughout treatment. Patients are therefore informed about the potential benefits, risks, and alternatives associated with the proposed treatment methods.

An andrology examination is not limited to treating existing symptoms. It is also important for identifying diseases that may affect male reproductive and sexual health, assessing potential risk factors, and planning long-term follow-up when necessary. Men experiencing persistent sexual dysfunction, difficulty conceiving, or noticeable changes in the testes are advised to seek evaluation by a urology or andrology specialist.