What Is an Andrologist and What Do They Do?

An andrologist is a medical specialist who focuses on male reproductive and sexual health. Think of andrology as the male counterpart to gynecology: while gynecologists address reproductive medicine in women, andrologists handle the full range of conditions affecting male fertility, sexual function, and hormonal balance. In practice, the field is multidisciplinary, with urologists, endocrinologists, and reproductive medicine specialists all contributing. A global survey found that urologists made up about 31% and clinical andrologists about 25% of practitioners in the field, with areas of practice spanning male infertility, sexual dysfunction, and sexually transmitted infections.¹

How Andrologists Differ From Urologists

Urology covers the entire urinary tract in both sexes plus the male reproductive system. An andrologist narrows that focus to male reproductive and sexual health specifically. In many countries, andrologists train first as urologists or endocrinologists and then pursue additional fellowship or certification in andrology. That said, formal board-certified training in andrology is available in fewer than half of all countries, and many practitioners identify as andrologists based on clinical experience rather than a specific credential.¹ The result is that the boundary between “urologist” and “andrologist” can be blurry. If you are dealing with a kidney stone or bladder infection, a general urologist is your doctor. If you are struggling with fertility, erection problems, hormonal imbalance, or conditions like Peyronie’s disease, an andrologist or a urologist with andrology subspecialty training is the better fit.

Evaluating Male Infertility

Male infertility evaluation is the single most common reason people see an andrologist. The workup typically starts with a semen analysis, which measures a handful of key parameters. World Health Organization reference values set the lower limits for a normal result: a volume above 1.5 mL, a sperm concentration above 15 million per mL, total sperm count above 39 million, motility above 40%, and normal morphology above 4%.² Falling below any of those thresholds does not automatically mean you cannot conceive, but it does signal that something deserves a closer look.

Beyond the basic semen analysis, andrologists can order more specialized tests. Sperm DNA fragmentation testing, for example, measures how much damage exists in the genetic material inside sperm cells. High fragmentation has been linked to recurrent pregnancy loss and lower success rates with assisted reproduction, and the test can help identify men who would benefit from varicocele repair or a switch in reproductive strategy.³ Hormonal bloodwork, genetic screening, and imaging studies round out the diagnostic toolkit, depending on the individual case. Updated WHO guidelines emphasize a structured approach that includes lifestyle risk assessment, screening for infections, and standardized diagnostic algorithms.⁴

Surgical Procedures for Fertility

When no sperm appear in the ejaculate at all, a condition called azoospermia, the andrologist’s job is to figure out why and whether sperm can be retrieved directly from the testicle. The most well-known procedure for this is micro-TESE (microsurgical testicular sperm extraction), in which a surgeon uses an operating microscope to identify and extract tiny pockets of sperm-producing tissue. In men with the most severe form of the condition, sperm sufficient for use in IVF with intracytoplasmic sperm injection (ICSI) have been found in roughly half to two-thirds of cases, depending on the technique and the study.⁵⁶ When sperm are found and ICSI is performed, roughly three-quarters of cycles result in at least one good-quality embryo, and about a third of first-cycle transfers lead to an ongoing pregnancy.⁵

Varicocele repair is another bread-and-butter surgery. A varicocele is an enlargement of veins inside the scrotum, and it is one of the most treatable causes of male infertility. Microsurgical varicocelectomy has been shown to improve semen parameters significantly, with pregnancy rates in the range of 30–42% during follow-up, regardless of whether the man has primary or secondary infertility.⁷

Vasectomy Reversal and Reconstructive Microsurgery

Men who had a vasectomy and later want to father children can turn to an andrologist for reversal surgery. The procedure is technically demanding but effective: it restores the flow of sperm in roughly 80–99% of cases and leads to unassisted pregnancy in about 40–80% of couples.⁸ A large single-surgeon series reported an overall patency rate near 87%, with about half of couples achieving pregnancy at a median of 16 months after surgery.⁹

Sometimes the blockage is not from a vasectomy but from infection, injury, or a congenital issue in the epididymis, the coiled tube where sperm mature. In those cases, an andrologist may perform a vasoepididymostomy, connecting the vas deferens directly to the epididymis. A meta-analysis of over 1,500 patients found an overall patency rate of about 68% and a natural pregnancy rate of roughly 38%.¹⁰ These are painstaking operations performed under a microscope, stitching together structures that are only fractions of a millimeter wide.

Fertility Preservation Before Cancer Treatment

One area where andrology intersects with oncology is sperm banking before chemotherapy or radiation. Many cancer treatments are toxic to sperm production, and the damage can be permanent. Current ASCO guidelines recommend that sperm cryopreservation be offered to males before cancer-directed treatment, with testicular sperm extraction available for those unable to provide a semen sample.¹¹ The standard approach centers on freezing sperm before treatment begins, since unlike eggs in women, there is no equivalent post-treatment gamete retrieval option that works reliably for men.¹²

An andrologist’s role here includes counseling on the urgency of banking, performing the actual collection and coordination with a cryobank, and later assisting with sperm retrieval if the standard route is not possible. For adolescent boys or prepubertal patients, the situation is more complex because they may not yet produce mature sperm, and experimental techniques like testicular tissue cryopreservation are still under investigation.

Erectile Dysfunction and Sexual Health

Andrologists treat erectile dysfunction (ED) across the full spectrum, from initial medication management to surgical implants. First-line treatment is usually an oral medication like sildenafil or tadalafil, but these drugs do not work for everyone. Roughly 30% of men with ED continue to need more invasive options after oral medications fail.¹³ For those men, the options include injectable medications, vacuum devices, and ultimately penile prosthesis surgery. An inflatable penile prosthesis is indicated when other treatments have failed, are contraindicated, or are simply unacceptable to the patient, and satisfaction rates among men who choose the implant tend to be higher than with other ED therapies.¹⁴¹⁵

An important part of the andrologist’s assessment is recognizing ED as a potential early warning sign of cardiovascular disease. The arteries in the penis are narrower than those supplying the heart, so they tend to clog first. Research has shown a close association between ED and vascular disease driven by the same underlying process, and ED can precede heart symptoms by several years. Men presenting with erection problems, especially younger men without obvious risk factors, may benefit from a cardiovascular workup.¹⁶

Peyronie’s Disease

Peyronie’s disease involves the formation of scar tissue (plaque) inside the penis, causing curvature, pain, and sometimes difficulty with intercourse. Andrologists manage this condition with both nonsurgical and surgical approaches. The most widely studied nonsurgical treatment is injection of collagenase clostridium histolyticum (CCH) directly into the plaque. Clinical trials involving more than 1,500 patients have shown that CCH significantly decreases penile curvature and plaque consistency while improving quality of life.¹⁷ In a large series, men who completed treatment or reported satisfaction had a median curvature improvement of about 27 degrees.¹⁸

The degree of improvement depends on several factors. Men with more severe baseline curvature, hourglass deformities, and strong nocturnal erections tend to see greater gains. Pure lateral curvatures and decreased motivation to comply with the treatment protocol are associated with worse outcomes.¹⁹ When injections and other conservative measures are not enough, surgical correction or penile prosthesis implantation are options the andrologist can discuss.

Hormonal Management and Testosterone Therapy

Diagnosing and treating low testosterone (hypogonadism) is another core andrological function. The process starts with recognizing symptoms like persistent fatigue, low libido, depressed mood, and reduced muscle mass, then confirming the diagnosis with repeat morning blood tests measuring total and free testosterone. Transient dips from acute illness or stress can mimic hypogonadism, so guidelines stress that hormone levels need to be checked more than once.²⁰ Once confirmed, testosterone replacement therapy (TRT) comes in several forms: injections, gels, patches, and newer oral or nasal formulations. Monitoring involves tracking not only testosterone levels but also red blood cell counts, liver function, and prostate health.²¹

Here is where andrological expertise really matters: testosterone therapy suppresses sperm production. Exogenous testosterone shuts down the brain signals that drive the testicles to make sperm, which means it functions as a male contraceptive.²² Men who still want children should not be started on standard TRT without a conversation about this risk. Alternative approaches, such as clomiphene citrate or human chorionic gonadotropin (hCG), can raise testosterone levels while preserving or restoring sperm production.²³ For men who have already been on TRT and want to recover fertility, the process can take months. Increasing age and longer duration of testosterone use both reduce the likelihood and speed of sperm recovery.²⁴ This is one of the more common cautionary tales in andrology clinics: a man put on testosterone for low energy by a primary care doctor or a men’s health clinic, who only later discovers it has made him temporarily (and sometimes permanently) infertile.

Ejaculatory Disorders

Andrologists also manage conditions where ejaculation does not work the way it should. Premature ejaculation is the most common sexual complaint in men and involves both behavioral strategies and medication. Retrograde ejaculation, where semen travels backward into the bladder instead of forward, is less common but can be a significant obstacle to conception. It often develops after prostate surgery or as a complication of diabetes. Diagnosis involves analyzing a post-ejaculatory urine sample for sperm, and management ranges from medication to assisted reproduction.²⁵

Pharmacological treatment for retrograde ejaculation can be surprisingly effective. In one study, men treated with pseudoephedrine saw some improvement in about 70% of cases, with a meaningful number recovering enough sperm in the antegrade ejaculate to attempt natural conception or intrauterine insemination.²⁶ When medication does not work, sperm can be harvested from the urine sample after ejaculation, processed, and used for assisted reproduction.

Emergency and Trauma Andrology

Andrological emergencies are less common but high-stakes. Testicular torsion, which cuts off blood supply to the testicle, requires surgery within hours to save the organ. Testicular trauma from sports injuries, accidents, or, in rarer cases, penetrating injuries demands urgent surgical exploration. The principle in these situations is to save as much functional tissue as possible. Even in cases of severe bilateral testicular injury, meticulous reconstruction and preservation of even a single viable testis can be enough to preserve both hormone production and fertility.²⁷ When substantial tissue loss is anticipated, andrologists should discuss fertility preservation options early.²⁸ Outcomes vary, however, and severe injuries sometimes result in impaired sperm production even after successful reconstruction.²⁹

Paternal Age and Its Effects on Fertility

A growing area of andrological counseling involves paternal age. While there is widespread awareness that female fertility declines with age, the parallel decline on the male side gets far less attention. Research consistently shows that advancing paternal age is associated with decreased sperm quality, reduced testicular function, and higher rates of DNA mutations and chromosomal abnormalities in sperm.³⁰ The effects extend beyond fertility itself: older paternal age has been linked to increased rates of conditions like autism spectrum disorder, schizophrenia, and childhood leukemia in offspring.³¹ IVF and ICSI success rates also tend to decline when the male partner is older. An andrologist can assess sperm quality, discuss these risks candidly, and offer options like sperm banking at a younger age for men who plan to delay fatherhood.

The Psychological Side of Male Reproductive Health

An often-overlooked part of andrology is the emotional toll these conditions take. Male infertility, in particular, is consistently associated with depression, anxiety, lower self-esteem, and disruptions to masculine identity. Many men report emotional suppression, isolation, and reluctance to seek support.³² Compared to fertile controls, men diagnosed with male factor infertility show more symptoms of psychological distress and worse quality of life on several measures.³³

The fertility world has historically centered its psychological support around women, with men treated as supporting partners rather than patients with their own needs. Good andrological care increasingly integrates psychosexual counseling into the treatment plan, recognizing that sexual dysfunction, relationship strain, and the emotional weight of a diagnosis deserve direct attention. If your andrologist does not raise the topic, it is worth asking about referral to a mental health professional experienced in reproductive issues. The science makes it clear these concerns are not peripheral to male reproductive health; they are part of it.