Andrology: Puberty-Fertility-Andropause

From boyhood to old age, males undergo changes in their levels of androgens, with resulting changes in stature, appearance, reproductive capacity, and physiologic function. During puberty, a dramatic surge in sex hormones initiates several significant events: the development of pubic hair and genital growth, the maturation of gametes, and the growth spurt. Extremely early or late onset of puberty may require evaluation by an endocrine specialist due to concern for an underlying pathology. Men become fertile following puberty, although 15 % of couples experience trouble conceiving, with half of cases involving a male factor. A careful medical evaluation, with semen, hormone, and occasionally genetic testing, may help diagnose a pre-testicular, testicular, or post-testicular etiology. A specialist may offer medical or surgical treatment directed at the underlying condition. Furthermore, assisted reproductive techniques may improve pregnancy outcomes. After the third decade, testosterone levels decline at a slow but steady rate. Andropause refers to a total testosterone level below 300 ng/dL with impaired libido and sexual function and/or nonspecific symptoms such as fatigue, irritability, decreased strength, and diminished neurologic function. After reversible causes are ruled out, testosterone supplementation therapy (TST) may be offered. Despite recent debate regarding the impact of TST on cardiovascular health and prostate cancer, most experts feel the benefits of TST outweigh the risks in the correctly selected patient.