Differences in testosterone levels in perianal diseases: A comparative study of abscesses and fistulas

Anorectal abscess and cryptoglandular anal fistula are common conditions with high recurrence rates, reflecting an incomplete understanding of their pathophysiology. A classic, yet unproven hypothesis proposes that high androgen levels increase infection risk by stimulating anal gland secretion, potentially explaining the male predominance. However, direct evidence regarding sex hormone levels in patients remains scarce. We hypothesized that active perianal infection is associated with significantly altered testosterone (T) levels.

To investigate the association between perianal diseases and sex hormone levels and to identify factors associated with T levels.

This cross-sectional study included 249 men: 64 with hemorrhoids, 64 with anorectal abscess, and 121 with anal fistula. Preoperative serum sex hormone levels were measured. Multivariate linear regression identified factors associated with T levels.

There were no significant differences in age among the three groups at baseline. T levels differed significantly among the groups (P < 0.001). Multivariate regression analysis revealed that in the overall study population, anorectal abscess (B = -2.999, P < 0.001) and body mass index (BMI; B = -0.368, P < 0.001) negatively correlated with T levels. In the abscess group, white blood cell count (B = -0.565, P < 0.001) and BMI (B = -0.298, P = 0.011) negatively correlated with T levels. In the fistula group, BMI (B = -3.866 P < 0.001) and internal opening above the dentate line (B = -4.479, P = 0.048) were associated with lower T levels.

Patients with active perianal infections exhibited a significantly lower T level compared to those with hemorrhoids or fistulas, which is independently associated with systemic inflammation severity and obesity.