{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T09:40:35Z","timestamp":1777887635807,"version":"3.51.4"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Current guidelines recommend endocrine evaluation for infertile men; however, those with normal sperm concentration (\u226515 million\/mL) may be under-referred for comprehensive assessment. This study aimed to investigate the prevalence of low testosterone in infertile men with normal sperm concentration and to determine the proportion who remain endocrinologically unevaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted on infertile men with initial sperm concentration \u226515 million\/mL evaluated at a single tertiary center from January 2013 to December 2020. Low testosterone was defined as serum total testosterone below 300 ng\/dL. Multivariate logistic regression identified independent predictors of low testosterone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3,147 men meeting inclusion criteria, 77.2% (n=2,429) did not undergo hormonal evaluation. Endocrine assessment rates varied significantly by specialty: 100% for male infertility fellowship-trained urologists, 23.2% for general urologists, and 1.2% for gynecologists. Among 718 men who underwent hormonal testing, 24.1% had low testosterone. Multivariate logistic regression identified higher BMI (OR 1.083, 95% CI 1.031\u20131.136, p=0.001) and lower estradiol (OR 0.956, 95% CI 0.937\u20130.976, p&amp;lt;0.001) as independent predictors. Obese men had significantly higher odds of low testosterone compared with normal-weight men (OR 1.725, 95% CI 1.010\u20132.943, p=0.046). Of 66 treated men, significant testosterone increases were observed at all follow-up time points (all p \u2264 0.001), and six achieved natural pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over three-quarters of normozoospermic infertile men did not receive hormonal evaluation. Among those evaluated, nearly one-quarter had low testosterone, with obesity identified as an independent risk factor. These findings highlight a critical screening gap and support routine endocrine screening regardless of sperm concentration, particularly in men with metabolic risk factors such as obesity, as low testosterone represents a treatable condition that may improve fertility outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1797678","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:19:34Z","timestamp":1777609174000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and risk factors of low testosterone in infertile men with normal sperm concentration"],"prefix":"10.3389","volume":"17","author":[{"given":"Chyau-Wen","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Urology, Taipei City Hospital","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric Yi-Hsiu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Urology, Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Urology, National Yang Ming Chiao Tung University School of Medicine","place":["Taipei, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Urology, Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Urology, National Yang Ming Chiao Tung University School of Medicine","place":["Taipei, Taiwan"]},{"name":"Department of Urology, National Yang Ming Chiao Tung University Hospital","place":["Yilan, Taiwan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I-Shen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Urology, Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"Department of Urology, National 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