Hypogonadotropism with elevated serum testosterone: reversible causes of secondary infertility.

BACKGROUND

A 33-year-old man presented with secondary infertility, increased libido, and extreme oligospermia. Testicular volumes were reduced, but no gynecomastia was apparent and androgen abuse was denied.

INVESTIGATIONS: Physical examination, semen-volume and sperm-density assessment, laboratory tests for serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone sulfate, karyotyping, testicular ultrasound, pelvic and abdominal CT, assessment for serum testicular tumor markers (alpha-fetoprotein and human chorionic gonadotropin), and histologic examination of testicular tissue.

DIAGNOSIS: Benign Leydig-cell adenoma.

MANAGEMENT: Left orchidectomy.