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Hypogonadotropism with elevated serum testosterone: reversible causes of secondary infertility
Robert I McLachlan1, David M de Kretser
1Prince Henry's Institute, Melbourne, Australia. rob.mclachlan@princehenrys.org
Background:
A 33-year-old man presented with secondary infertility, increased libido, and extreme oligospermia. Testicular volumes were reduced, but no gynecomastia was apparent and androgen abuse was denied.
Investigations:
Physical examination, semen-volume and sperm-density assessment, laboratory tests for serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone sulfate, karyotyping, testicular ultrasound, pelvic and abdominal CT, assessment for serum testicular tumor markers (alpha-fetoprotein and human chorionic gonadotropin), and histologic examination of testicular tissue.
Diagnosis:
Benign Leydig-cell adenoma.
Management:
Left orchidectomy.
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