| Endocrine and systemic disorders (hypogonadotropic hypogonadism) |
| Congenital disorders |
- Congenital GnRH deficiency (Kallmann syndrome)
- Iron overload syndromes
- Multiorgan genetic disorders (Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, familial cerebellar ataxia)
|
| Acquired disorders |
- Pituitary and hypothalamic tumors (pituitary macroadenoma, craniopharyngioma)
- Pituitary and hypothalamic infiltrative disorders (sarcoidosis, histiocytosis, tuberculosis, fungal infections)
- Pituitary and hypothalamic lymphocytic infundibulitis or hypophysitis
- Head trauma, intracranial radiation, or surgery
- Vascular (pituitary infarction, aneurysm)
- Hormonal (hyperprolactinemia, androgen excess, estrogen excess, cortisol excess)
- Drugs (exogenous androgens, opioids and psychotropic drugs, GnRH agonists or antagonists)
|
| Systemic disorders |
- Severe systemic illness
- Nutritional deficiencies
- Morbid obesity
|
| Primary testicular defects in spermatogenesis |
| Congenital disorders |
- Klinefelter syndrome (XXY) and its variants (XXY/XY, XXXY)
- Cryptorchidism
- Myotonic dystrophy
- Functional prepubertal castrate syndrome (congenital anorchia)
- Androgen insensitivity syndromes
- 5-alpha-reductase deficiency
- Estrogen receptor or synthesis disorders
|
| Acquired disorders |
- Varicocele (large, palpable without Valsalva maneuver)
- Infections – Viral orchitis (mumps, echovirus, arbovirus), granulomatous orchitis (leprosy, tuberculosis), epididymo-orchitis (gonorrhea, chlamydia)
- Drugs – Alkylating agents, alcohol, marijuana, antiandrogens, ketoconazole, spironolactone, histamine-2 receptor antagonists, ionizing radiation
- Environmental toxins – Dibromochloropropane, carbon disulfide, cadmium, lead, mercury, environmental estrogens, and phytoestrogens; smoking; hyperthermia
- Immunologic disorders, including polyglandular autoimmune disease and antisperm antibodies
- Trauma
- Testicular torsion
|
| Systemic illness |
- Idiopathic dysspermatogenesis
- Renal failure, hepatic cirrhosis, cancer, sickle cell disease, amyloidosis, vasculitis, celiac disease
|
| Genetic causes of dysspermatogenesis |
- Y-chromosome microdeletions and related disorders
- Autosomal and X-chromosome defects
- Mutations causing severe defects in sperm morphology
|
| Sperm transport disorders |
- Epididymal dysfunction (drugs, infection)
- Abnormalities of the vas deferens (congenital absence, Young syndrome, infection, vasectomy)
- Seminal vesicles and prostate
- Ejaculatory ducts disorders
|
| Sexual dysfunction |
- Infrequent vaginal intercourse, erectile dysfunction, and premature ejaculation
|
| Idiopathic male infertility |
