Clinical Reviews in Andrologic Endocrinology III. Treatment of Seminal Failure

Abstract

In a preceding communication (1) the diagnosis and therapy of combined androgenic deficiency and seminal inadequacy were considered. However, deficiencies in seminal function are observed commonly in males who present no evidences of androgenic failure or other sexual incompetency as evaluated by present diagnostic criteria. Moreover it is unlikely that pronounced grades of hypogonadotropic failure exist in these patients for, if that were true, androgenic deficiency states would likewise be noted. The consideration of seminal inadequacy alone, therefore, assumes definite clinical importance. Impairment of seminal function of the male, unaccompanied by androgenic failure, may be due to several factors: a) intrinsic testicular failure due to maldescent; b) extra-endocrine factors; c) altered metabolism due to thyroid disease; d) altered metabolism due to adrenal disease; e) inadequate gonadotropic activation of the germinal epithelium due to low-grade pituitary deficiency; and f) intrinsic germinal failure of the testes. Identification and evaluation of these various factors defines the therapeutic approach and, to a limited degree, determines the prognosis.