[Endocrine diseases and male infertility]

Male infertility is secretory or excretory. The excretory form lies outside the endocrinologist's evaluation. As regards the secretory form, infertility practically identifies itself with hypogonadisms, both primitive, congenital or acquired, that spring from testicular alterations, and secondary to that result from gonadotropic deficiency however derived. The various diseases and the large number of events responsible for primitive or secondary male hypogonadism and so cause of infertility, are minutely examined. Peripheral hypogonadism forms are mentioned in brief too. During diagnostic evaluation, anamnesis and objective examination are the first step. Afterwards hormonal basal dosages supply useful information in case of severe oligospermia or azoospermia. Particularly FSH plasma dosage values the tubular function and this hormone is the most significant clinical and prognostic parameter. LH plasma dosage is less useful. FSH and LH levels allow us to distinguish hypergonadotropic hypogonadism from the hypogonadotropic type. Testosterone dosage is also important. Prolactin measurement is useful too and likewise, in particular cases, other hormone measures. Dynamic tests are also mentioned. As a therapeutic guideline, treatment with androgens is exclusively substitutive in primitive hypogonadism, however of no avail on spermatogenesis; in cases of secondary hypogonadism, gonadotropins give satisfactory results; pulsatile Gn-RH use is not easy anyway; clomifen and tamoxifen don't seem of particular advantage; in hyperprolactinemia, dopaminergic drugs improve seminal parameters.