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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (2): 294-298. doi: 10.19723/j.issn.1671-167X.2022.02.016

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Testosterone levels in patients with varicocele and azoospermia

PENG Jing,FANG Dong,ZHANG Zhi-chao(),GAO Bing,YUAN Yi-ming,TANG Yuan,SONG Wei-dong,CUI Wan-shou   

  1. Department of Urology, Andrology Center, Peking University First Hospital, Beijing 100034, China
  • Received:2020-04-19 Online:2022-04-18 Published:2022-04-13
  • Contact: Zhi-chao ZHANG E-mail:zhangzhichao@bjmu.edu.cn

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Abstract:

Objective: Androgen deficiency is common in aging males and may have unfavourable health consequences. Large-scale studies suggested low testosterone level might increse mortality and morbidity in ageing males. However, young men with low testosterone level might be neglected. Recent studies reported young men with infertility may have reduced testosterone level. To investigate the incidence of androgen deficiency in males with infertility and possible factors affecting the low testosterone level. Methods: Between January 2011 and December 2012, 407 men with infertility caused by varicocele (VC), obstructive azoospermia (OA) and nonobstructive azoospermia (NOA) in our center were included. The number of men in each group of OA, NOA and VC was 141, 97 and 169, respectively. All the eligible patients underwent a serum testosterone assessment by a single morning blood draw (between 8:00 to noon) to test for concentration of the total testosterone. All serum samples were determined by radioimmunoassay in our andrology laboratory. Androgen deficiency was defined as having a total testosterone level less than 300 ng/dL. Results: The mean age was (30.4±5.8) years. The mean testosterone level was (4.18±1.64) ng/dL (range 0.30 to 11.32 ng/dL). The overall incidence of androgen deficiency was 26.5% (108/407). The incidences of androgen deficiency in NOA, OA and VC groups were 40.2% (39/97), 19.1% (27/141) and 24.9% (42/169), respectively, which were significantly higher in the NOA than in the VC and OA groups (P<0.001). The incidences had no difference between the VC and OA groups (P=0.229). Univariate analysis revealed the cause of infertility, FSH and the mean testis volume as possible affecting factors for androgen deficiency. However, on multivariate analysis the only cause of infertility was an independent predictor. The incidence of androgen deficiency was the highest in the NOA group [OR 0.492 (95% confidence interval 0.288-0.840)]. Conclusion: NOA and varicocele might be risk factors of androgen deficiency. Young men with NOA may have a higher possibility of low testosterone level. Testosterone level should be followed up after NOA and varicocele treatment. Androgen deficiency should be assessed in males with infertility in clinical practice.

Key words: Androgen efficiency, Infertility, Varicocele, Azoospermia

CLC Number: 

  • R698

Table 1

Baseline characteristics of men with infertility ( x -±s)"

Variable Value
Age/years 30.4±5.8
FSH/(IU/mL) 8.16±6.9
LH/(IU/mL) 7.16±3.01
Testosterone level/(ng/dL) 4.18±1.64
Mean testis volume/mL 13.06±3.48

Table 2

Univariate analysis of factors affecting low testosterone level ( x -±s)"

Items <300 ng/dL ≥300 ng/dL P value
Age/years 30.88±6.23 30.27±5.61 0.352
FSH/(IU/mL) 9.87±8.32 7.54±6.22 0.009
LH/(IU/mL) 6.99±3.28 7.22±2.91 0.484
Mean testis volume 12.33±3.89 13.32±3.29 0.010
Infertility causes/% <0.001
VC 24.9 75.1
NOA 40.2 59.8
OA 19.1 80.9

Table 3

Univariate and multivariate analysis with Logistic regression of factors predicting low testosterone level"

Factors Univariate analysis
OR (95%CI)		 P value Multivariate analysis
OR (95%CI)		 P value
Age/years 0.982 (0.946-1.020) 0.351 - NS
FSH/(IU/mL) 0.957 (0.928-0.986) 0.004 - NS
LH/(IU/mL) 1.028 (0.952-1.109) 0.484 - NS
Mean testis volume 1.086 (1.019-1.158) 0.011 - NS
Infertility causes
OA 1 - 1 -
VC 1.396 (0.809-2.410) 0.230 1.396 (0.809-2.410) 0.230
NOA 0.492 (0.288-0.840) 0.009 0.492 (0.288-0.840) 0.009
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