Last reviewed:December 2019
Last updated:February  2018

Summary

Definition

History and exam

Key diagnostic factors

  • inability of a couple to conceive
  • vasectomy
  • palpable and dilated testicular veins
  • erectile dysfunction and decreased libido
  • testis atrophy (testis smaller than 20 cm^3)
  • body habitus, abnormal hair distribution, and gynecomastia
  • absent vasa or epididymis

Other diagnostic factors

  • headaches, galactorrhea, and visual disturbance
  • anosmia
  • frequent respiratory infections
  • pain, blood, or pus with ejaculation

Risk factors

  • varicocele
  • cryptorchidism
  • prior chemotherapy or radiation therapy
  • current medications
  • cystic fibrosis and congenital bilateral absence of vas deferens (CBAVD)
  • Y chromosome abnormalities
  • Klinefelter syndrome (47,XXY)
  • endocrinopathy
  • genital tract infection
  • erectile dysfunction
  • previous infertility
  • retrograde ejaculation
  • obesity
  • testicular torsion or trauma
  • lifestyle including smoking and alcohol consumption
  • exposure to androgen
  • age >55 years
  • environmental toxin exposure
  • hx of CAD or diabetes
  • hx of STD
  • hot tub use

Diagnostic investigations

Treatment algorithm

Contributors

Director of Male Reproductive Medicine and Sexual Medicine

Henry Ford Health System

K9 Urology Clinic

Detroit

MI

Disclosures

AAD declares that he has no competing interests.

Medical Director

IVF Michigan Fertility Center

Bloomfield Hills

MI

Disclosures

AOH declares that he has no competing interests.

Dr Ali A. Dabaja and Dr Ahmad O. Hammoud would like to gratefully acknowledge Dr Benjamin Emery, the previous contributor to this monograph. BE declares that he has no competing interests.

Peer reviewersVIEW ALL

Associate Professor

Division of Urology

University of Alabama at Birmingham

Birmingham

AL

Disclosures

PNK declares that he has no competing interests.

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