Age, testosterone levels, and hypogonadism-related symptoms among men with azoospermia

Abstract

ABSTRACT Introduction Considering that most men who complain of infertility are of an age traditionally defined by social and physical activity, disability in performing these activities may worsen their quality of life. Among those who complain of infertility, it is suspected that some of them have hypogonadism or symptoms intrinsic to aging; however, these associations have not been completely elucidated in current literature. Objective This study aimed to assess the prevalence of aging- or hypogonadism-related symptoms among men with azoospermia. We also assessed relationships between serum testosterone levels and severity of symptoms under the domains of the Aging Males' Symptoms (AMS) -scoring system. Methods Clinical records of 494 patients with azoospermia (106 from obstructive and 388 from nonobstructive etiologies) who underwent surgical sperm extraction at Nagoya City University were retrospectively reviewed. Correlations between age and serum total testosterone (TT) and AMS scores (total and by each of three domains) were evaluated using the Spearman's rank correlation coefficient. Results Moderate or severe (total AMS score of≥ 37) symptoms were present in 9.5% and 12.7% of patients with obstructive and nonobstructive azoospermia, respectively. Symptoms were present regardless of etiology of azoospermia. Among our study population, no significant correlation between age and TT was observed (R=-0.057, p=0.21). However, there was positive correlation between age and total (R=0.090, p<0.05) or sexual (R=0.218, p<0.01) scores among the AMS scale's domains. Moreover, there were negative correlations between serum TT level and total (R=-0.177, p<0.01), psychological (R=-0.149, p<0.01), somatic (R=-0.183, p<0.01), and sexual (R=-0.097, p<0.05) domain scores. Multiple comparisons using Bonferroni-Holm's correction showed statistically significant correlations between aging and sexual symptoms and between hypogonadism (decreased serum TT) and psychological or somatic domains in the AMS-scoring scale. Conclusions This study revealed that men with azoospermia have not only underlying deterioration in sexual symptoms with aging, but that psychological and somatic symptoms also deteriorate as a function of hypogonadism. Our results indicate that assessment, treatment, and supportive management of underlying hypogonadism-related symptoms should be considered for patients with azoospermia who are currently undergoing infertility treatment. Disclosure Work supported by industry: no.