Testicular endocrine function recovers following Fournier's gangrene

Between 5.6-21% of Fournier's Gangrene (FG) patients undergo orchiectomy, despite testicular viability. Arguments for this practice center around the presumed lack of functional recovery following critical illness as well as improved ease of wound closure. We aimed to study the effects of FG on the hypothalamic-pituitary-gonadal (HPG) axis and characterize hormonal recovery patterns.

We retrospectively studied male FG patients at a quaternary center from July 2023-September 2024. Total testosterone (TT), free testosterone (FT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG), and estradiol (E2) at admission, discharge, and follow-up (1-9 months) were examined. Two-sided Wilcoxon signed-rank tests were used to compare paired hormone levels across time points. A validation analysis using two-sided Mann-Whitney U tests was performed to compare hormone distributions between patients with complete vs. incomplete data at all three time points.

Of 31 FG patients, 20 had hormone measurements at multiple time points; 12 had complete data at all time points. All patients presented with castrate to near-castrate levels of TT. TT and FT increased significantly throughout recovery (both P ≤ 0.011). E2 decreased significantly from admission to discharge and from admission to follow-up (P = 0.014 and P = 0.008, respectively). All reconstruction types showed similar recovery patterns.

FG transiently suppresses testicular hormone production to castrate levels via the HPG axis. However, the HPG axis has the capacity to recover to physiologic ranges, with testicular steroidogenesis following suit. Without clear evidence of testicular necrosis, efforts should prioritize testicular preservation during debridement and reconstruction.