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Causes are generally categorized as pre\u2010testicular, testicular, or post\u2010testicular, based on the level of dysfunction within the hypothalamic\u2013pituitary\u2013gonadal axis. Primary testicular failure is caused by intrinsic testicular dysfunction, while secondary testicular failure originates from a dysfunction in the hypothalamus or the pituitary gland. Post\u2010testicular causes are attributed to obstructive, ejaculatory, or erectile dysfunction. Evaluation should thus entail a full history followed by a detailed physical exam and stepwise investigation. Semen analysis is recommended as the initial test, followed by hormonal tests, imaging, biopsies, and karyotyping as needed. Treatment is tailored based on the specific cause identified.<\/jats:p>","DOI":"10.1002\/ijgo.16196","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T08:00:55Z","timestamp":1739260855000},"page":"913-920","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Approach to evaluation and management of male infertility in Sub\u2010Saharan Africa"],"prefix":"10.1002","volume":"169","author":[{"given":"Charles","family":"Muteshi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Aga Khan University Hospital Nairobi  Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Chesire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Aga Khan University Hospital Nairobi  Nairobi 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