Andrology is the medical science of men’s health and includes physiology, anatomy and pathology of male reproduction. Andrology also deals with endocrinological and sex therapy aspects and the problems of the aging male.
What is andrology?
Andrology is the medical science of male medicine and includes physiology, anatomy and pathology of male reproduction. As the study of the male reproductive organs, andrology also deals with their pathology and disorders at all stages of life and at all ages. Various focal points in research and teaching are at the forefront of andrology as a branch of medicine. Andrologists are mostly specialists in urology who have specialized in male medicine. In andrology consultations, the main focus is on disorders of male fertility, infertility. In addition, disorders of testicular function, for example hypogonadism, the so-called erectile dysfunction, questions about male contraception and aspects of sexuality in old age play a role. In the care of childless couples, findings from andrology play just as important a role as those from gynecology. In reproductive medicine practices, gynecologists and andrologists therefore always work together, because an unfulfilled desire to have children is often due to the inability of men to procreate, although this can have very different causes. Andrology is always open to cooperation and collaboration with other medical disciplines. This is because without this overall medical view, adequate treatment of not only fertility disorders is often not possible.
Treatments and therapies
The range of treatments offered by the medical specialty of andrology is designed entirely to meet the needs of men and their reproductive organs. In particular, hormonal and psychosocial aspects also play an important role in diagnosis and therapy. This is because by no means all disorders of male reproduction are actually of organic origin. This is most obvious in the case of erectile dysfunction, which affects up to one in three men over the age of 50 in Western industrialized nations. With increasing age, the production of the male sex hormone testosterone in the testicles decreases. Even with the appropriate sexual stimulus, an erection often fails to occur. In younger patients with erectile dysfunction, however, there are usually psychological causes. At the same time, the experience of orgasm or the process of ejaculation itself may also be disturbed. The treatment of erectile dysfunction often takes a long time and often includes several years of psychotherapy, which can also involve the partner. The andrologist is also the first point of contact for men when it comes to male contraception issues. The procedure of choice is the severing of the vas deferens, known as a vasectomy. This is usually a reversible procedure, so the ability to conceive can be regained at a later date by reassignment. A widespread andrological disorder is hypogonadism. Malformation of the testis results in impaired testosterone production, which can have far-reaching effects on mood, libido, cognitive function, and bone metabolism. Male newborns with undescended testes, i.e., abdominal or inguinal testes, are at particularly high risk for hypogonadism and associated infertility. Today, a testosterone deficiency can be largely remedied with substitution therapy using tablets or gel. However, testosterone replacement therapy is no longer the first choice for testosterone deficiency because of the significantly increased risk of carcinoma. Malignant neoplasms of the urinary and genital organs are also diagnosed and treated by andrologists. In older men, the focus is no longer on male fertility issues, but on diseases of the prostate gland. Prostate cancer detected too late can lead to death by metastasis if left untreated, andrology therefore also plays an important role in screening and prevention.
Diagnosis and examination methods
Doctors of men’s medicine, andrologists, like any other medical specialty, have the entire diagnostic outpatient and inpatient spectrum at their disposal.However, some specialized diagnostics are used within the scope of urological andrology and reproductive medicine. The most important andrological diagnostic and examination procedures include imaging procedures and hormone tests of the blood. During the first contact between the patient and the andrologist, an ultrasound examination of the testicles and epididymis is typically performed after taking a medical history. Using a special ultrasound probe, tissue structure and tissue changes in the testicles can be quickly identified and, if necessary, advanced diagnostics can be performed. In parallel, a blood test can be performed to determine testosterone levels and other important hormones such as DHEA. A urine status is also part of the standard examination in the andrology consultation. This is the best way for the andrologist to diagnose inflammatory changes in the urinary tract. In order to better isolate a fertility disorder, andrology often uses the so-called spermiogram as an in vivo diagnostic tool. The number and motility of the sperm present in the male ejaculate are examined under a light microscope. In addition, the ejaculate can also be examined for its chemical-biological composition. In reproductive medicine, it is also possible to deep-freeze the collected sperm in liquid nitrogen at -196 degrees Celsius in a sperm bank for later artificial insemination. If testosterone replacement therapy is carried out due to hypogonadism, the early recognition of contraindications is also one of the andrologist’s tasks. In the case of special andrological questions, human genetic examination methods are also used. This is because many so-called chromosomal aberrations can lead not only to limited fertility but also to underdevelopment of the primary and secondary male sexual characteristics.
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