Purpose The short- and long-term andrological effects of coronavirus disease 2019 (COVID-19) have not been clarified. Our aim is to evaluate the available evidence regarding possible andrological consequences of COVID-19 either on seminal or hormonal parameters. The safety of the COVID-19 vaccines in terms of sperm quality was also investigated. Methods All prospective and retrospective observational studies reporting information on severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) mRNA semen and male genitalia tract detection (n = 19), as well as those reporting data on semen analysis (n = 5) and hormonal parameters (n = 11) in infected/recovered patients without any arbitrary restriction were included. Results Out of 204 retrieved articles, 35 were considered, including 2092 patients and 1138 controls with a mean age of 44.1 ± 12.6 years, and mean follow-up 24.3 ± 18.9 days. SARS-CoV-2 mRNA can be localized in male genitalia tracts during the acute phase of the disease. COVID-19 can result in short-term impaired sperm and T production. Available data cannot clarify long-term andrological effects. Low T observed in the acute phase of the disease is associated with an increased risk of being admitted to the Intensive Care Unit or death. The two available studies showed that the use of mRNA COVID-19 vaccines does not affect sperm quality. Conclusions The results of our analysis clearly suggest that each patient recovering from COVID-19 should be monitored to rule out sperm and T abnormalities. The specific contribution of reduced T levels during the acute phase of the infection needs to be better clarified.

Male hypogonadism (MH) is a common endocrine disorder. However, uncertainties and variations in its diagnosis and management exist. There are several current guidelines on testosterone replacement therapy that have been driven predominantly by single disciplines. The Society for Endocrinology commissioned this new guideline to provide all care providers with a multidisciplinary approach to treating patients with MH. This guideline has been compiled using expertise from endocrine (medical and nursing), primary care, clinical biochemistry, urology and reproductive medicine practices. These guidelines also provide a patient perspective to help clinicians best manage MH.

BackgroundThere are no current pharmacological therapies to improve sperm quality in men with sub‐fertility. Reducing the exposure to lifestyle risk factor (LSF) is currently the only intervention for improving sperm quality in men with sub‐fertility. No previous study has investigated what proportion of men with sub‐fertility are exposed to adverse lifestyle factors. Furthermore, it is not known to what extent men with sub‐fertility are aware of lifestyle factors potentially adversely impacting their fertility.MethodsA cross‐sectional anonymous questionnaire‐based study on self‐reported exposure and awareness of LSF was conducted in 1149 male partners of couples investigated for sub‐fertility in a tertiary andrology centre in London, UK.ResultsSeventy per cent of men investigated for sub‐fertility had ≥1 LSF, and twenty‐nine per cent had ≥2 LSF. Excessive alcohol consumption was the most common LSF (40% respondents). Seventeen per cent of respondents used recreational drugs (RD) regularly, but only 32% of RD users believed RD impair male fertility. Twenty‐five per cent of respondents were smokers, which is higher than the UK average (20%). Twenty‐seven per cent of respondents had a waist circumference (WC) >36 inches (91 cm), and 4% had WC >40 inches (102 cm). Seventy‐nine per cent of respondents wanted further lifestyle education to improve their fertility.ConclusionsOur data suggest that men with sub‐fertility are as follows: (a) exposed to one or more LSF; (b) have incomplete education about how LSF may cause male sub‐fertility; (c) want more education about reducing LSF. Further studies are needed to investigate the potential of enhanced education of men about LSF to treat couples with sub‐fertility.

A 35-year-old woman presented as an emergency complaining of right-sided abdominal pain, vomiting and abdominal distension. She also had a cough, increased difficulty in breathing and was febrile. Three years previously she had been diagnosed with tuberous sclerosis, bilateral renal angiomyolipomas (AMLs) and pulmonary lymphangio-leiomyomatosis (LAM). On admission her plasma creatinine level was 156 mmol/L and her haemoglobin level was 73 g/L. Initial management required intravenous resuscitation, broad-spectrum antibiotics and blood transfusion. At 72 h her respiratory and renal function deteriorated significantly and she was transferred to the intensive care unit for respiratory support and haemofiltration. Her respiratory function deteriorated further and the abdominal distension increased, requiring regular blood replacement and ultimately becoming transfusion dependent (although she was not haemodynamically compromised). CT of the abdomen revealed bleeding into the left kidney and retroperitoneal haemorrhage on the right side (Fig. 1). CT of the chest showed the abnormal features seen in LAM (Fig. 2). Renal angiography detected massively dilated renal arteries with the AMLs acting as arteriovenous shunts, but failed to identify active bleeding (Fig. 3); in view of her deteriorating clinical condition she underwent bilateral nephrectomy. At surgery two enormous kidneys were removed through a transverse anterior incision. The right kidney was 30 ¥ 21 ¥ 13 cm and weighed 3.828 kg, with the left kidney being even heavier (4.015 kg) and 30 ¥ 18 ¥ 1 cm. The patient made an impressive recovery, with normal respiratory function. Haemodialysis was commenced and the patient is currently awaiting a renal transplant.