What is andrology?
As an interdisciplinary field, andrology focuses on men’s health as it relates to sexuality, fertility, and reproductive capacity. It is closely linked to urology/gynecology, endocrinology, diabetology, dermatology, and internal medicine.
In Germany, andrology is an additional specialty training program and certification for urologists; the field is supported by the German Society for Andrology, among others. Urologists with a focus on andrology are often simply referred to as andrologists and offer andrology consultations.
However, due to its complexity, it is fundamentally an interdisciplinary field. Depending on the specific issue, various specialists may be involved, such as
.
Erectile dysfunction or premature ejaculation can be very frustrating for men © VadimGuzhva | AdobeStock
Andrologists treat
in men.
A hormonal imbalance can affect men of any age. Hormonal disorders can
and trigger diseases. In adolescents, a delayed onset of puberty often indicates a hormonal disorder. In aging men, andropause (male menopause) can be responsible for hormonal imbalances.
The most common form of male hormonal disorder is low testosterone. This hormone influences sexual function but is also essential for
- muscles and bones,
- metabolism, and
- the cardiovascular system
.
The natural decline in testosterone levels in men begins around age 35. Combined with risk factors such as
- excess weight,
- an unhealthy lifestyle,
- lack of exercise,
- overwork, or
- stress
can cause testosterone levels to drop so significantly that symptoms develop.
Sexual problems such as erectile dysfunction, ejaculation disorders, and low libido, or difficulties in daily life such as reduced performance, eventually lead men to see a doctor. A blood test reveals the testosterone deficiency.
The doctor then prescribes medication to regulate hormone levels.
Another area of andrology is erectile dysfunction (ED). Studies show that about 30 percent of all men experience difficulties with erectile function at some point in their lives.
If symptoms persist, it is advisable to seek a diagnosis from an andrologist or urologist; in addition to a clinical examination, vascular, hormonal, and neurological factors are assessed.
The condition affects all age groups, but symptoms become more common with increasing age. ED can have many causes:
To treat erectile dysfunction, the underlying cause must be identified and addressed. This process is not always straightforward. In the meantime, devices such as a vacuum pump or intracavernosal autoinjection therapy can provide relief.
With a vacuum pump, penile rigidity is achieved mechanically. With autoinjection therapy, a medication that induces an erection is used. The medication is injected into the erectile tissue of the penis immediately before sexual intercourse.
Ejaculatio praecox is one of the most common male sexual dysfunction disorders and affects men of all ages.
Premature ejaculation is classified as an ejaculatory disorder; treatment is often a combination of approaches (sex therapy plus medication, if necessary).
Doctors refer to premature ejaculation when ejaculation occurs before or within the first minute after penetration begins. The resulting frustration for both the man and his partner usually exacerbates the disorder.
An andrologist can provide support in this difficult situation. He can diagnose or rule out organic causes and suggest treatment options.
Sexologists advocate for a combined therapy approach. With the help of sex therapy, psychological counseling, and medication, the problem can usually be effectively managed.
The inability to conceive can place a heavy strain on a relationship. While the woman contacts her trusted gynecologist, the man’s path leads to an andrologist.
Often, the initial examination alone provides insight into the causes of possible infertility.
can be just as much to blame as congenital causes.
A semen analysis provides certainty. In this procedure, a semen sample (ideally collected after a few days of sexual abstinence) is examined under a microscope and analyzed. Important parameters include
- the volume of the ejaculate,
- the shape and
- motility of the sperm, as well as
- the percentage of sperm cells.
If the results do indeed indicate male infertility, it is treated under the supervision of an andrologist. The following
- surgical procedures,
- hormone therapy, and
- psychotherapeutic support.
If these measures are unsuccessful, artificial insemination at the clinic may still lead to the couple having the child they desire.
Diagnosis & Treatment for Infertility
In cases of fertility disorders or infertility (often involving couples who are unintentionally childless), andrology investigates causes such as inflammation of the testicles or epididymis, genetic factors (e.g., Klinefelter syndrome), or ejaculatory or transport disorders of the ejaculate. Depending on the findings, surgical and medical procedures may be considered—such as microsurgical testicular sperm extraction (TESE), MESA (sperm retrieval from the epididymis), or sperm cryopreservation. These measures improve the chances of artificial insemination and thus fertility/reproductive capacity, and help couples fulfill their desire to have children.
Andrology also addresses issues related to male contraception. A commonly chosen option is vasectomy (male sterilization): In this procedure, the vas deferens are surgically severed or blocked—erections, ejaculation, and sexual sensation remain intact, but no sperm are present in the ejaculate. In some cases, reversal is possible, but the chances of success are limited; therefore, cryopreservation of sperm is often recommended beforehand. Assessment and counseling ideally take place during an andrology consultation with an andrologist or urologist.
In addition to congenital penile malformations, trauma can also lead to malformations of the male genitalia. Treatment in such cases may require complex reconstruction of the male genitalia.
A distinction is made between congenital (present at birth) and acquired forms; acquired induratio penis plastica (penile deviation) is significantly more common. If there is significant curvature, surgical correction (using microsurgical techniques) is often the most reliable option.
One of the most common penile abnormalities is penile curvature. Depending on the severity of the curvature, it can lead not only to functional problems during attempted penetration but also to psychosexual issues.
Penile curvatures are classified as either acquired (induratio penis plastica) or congenital. Induratio penis plastica is more common and, according to estimates, affects approximately 10 percent of all men. Congenital penile curvature is far less common and affects approximately 0.4–2 percent of all men.
In many cases where there is a medical indication for treatment, surgical penile straightening is the only valid treatment option.
