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The identification of potential environmental hazards may be clinically relevant in the diagnosis of male infertility. Knowledge about these factors will improve prevention of fertility disorders. Apart from drugs or factors related to lifestyle such as alcohol and tobacco smoke, various environmental and occupational agents, both chemical and physical, may impair male reproductive function. Reproductive toxicity may evolve at the hypothalamic-pituitary, testicular, or post-testicular level; endpoints comprise deterioration of spermatogenesis and sperm function as well as endocrine disorders and sexual dysfunction. With regard to the complex regulation of the male reproductive system, the available information concerning single exogenous factors and their mechanisms of action in humans is limited. This is also due to the fact that extrapolation of results obtained from experimental animal or in vitro studies remains difficult. Nevertheless, the assessment of relevant exposure to reproductive toxicants should be carefully evaluated during diagnostic procedures of andrological patients.

During complete inspection of skin a variety of penile skin alterations may be found. Not all dermatological findings have clinical relevance. Pearly papules and heterotopic sebaceous glands are physiological variations. Most penile melanotic macules, angiokeratoma, fibroma and angioma have not to be treated. However, other more severe diseases such as malignant skin lesions (erythroplasia of Queyrat), infectious disease (human papillomavirus-induced penile warts) or systemic skin diseases (psoriasis) may be detected. Since patients are alarmed by genital skin lesions and their sexuality may be affected, the initiation of adequate therapy is an important task for urologists and dermatologists.

A variety of dermatological diseases is associated with male or female sexual dysfunction. Some sexual disorders are caused organically; erectile dysfunction in men with systemic sclerosis may be due to penile vascular alterations and corporal fibrosis. Other dermatoses such as psoriasis are associated with risk factors (metabolic syndrome) for sexual disorders and may therefore indirectly induce erectile dysfunction. However, the majority of sexual dysfunctions in dermatological patients is caused by reduced self confidence and sexual self esteem leading to affected partnership and sexuality. Dermatologists should be trained in basic sexual medicine and ask their patients for sexual problems. They may not treat sexual disorders, but they should be identified as sympathetic physicians for these problems and should be able to refer the patient to specialists in sexual medicine.

Andrology deals with male infertility, erectile dysfunction, loss of libido, ejaculatory disorders, hypogonadism, delayed puberty, male contraception, gynecomastia and aspects of the aging male. New trends in reproductive medicine have influenced the evaluation of andrological patients in recent years. Even loss of ejaculated spermatozoa does not necessarily exclude paternity since testicular sperm extraction has been established in men with obstructive or non-obstructive azoospermia. The most important new aspect in andrology is the publication of the World Health Organization laboratory manual for semen analysis in 2010. Dramatic changes concerning sperm motility and morphology must now be considered for the interpretation of standard semen parameters.

Hypogonadism in men is defined as endocrine dysfunction of the testes, and due to reduced serum testosterone levels leads to symptoms of testosterone deficiency. Depending on the location of disruption in the endocrinological cycle, hypogonadism is classified as primary, secondary, or tertiary. In primary hypogonadism, the production of testosterone in the Leydig's cells of the testes does not function properly. Serum LH concentrations are elevated in the sense of counterregulation (hypergonadotropic hypogonadism). In secondary hypogonadism, LH secretion (and usually also FSH) from the hypophysis is impaired so that Leydig's cells are not stimulated, while in tertiary hypogonadism the hypothalamus is damaged. The clinical course in cases of reduced serum testosterone levels is determined essentially by the point in time when hypogonadism becomes manifest. Delayed puberty, eunuchoid stature, and underdeveloped secondary sex characteristics suggest prepubertal onset of hypogonadism.

A 62-year-old patient was referred with the suspected diagnosis of Peyronie disease. The patient showed the clinical picture of a beginning malignant priapism with hematogenous metastases from an recurrent prostatic carcinoma. The penile metastases were misdiagnosed as Peyronie disease. Although both clinical pictures show some superficial similarity, Peyronie disease usually fulfills classical criteria which help to clearly distinguish it from neoplastic diseases.

Since the skin and its appendages are androgen-dependent, male hypogonadism can be associated with dermatologically relevant lesions. The skin surface of hypogonadal patients is thin and shows increased wrinkles. In cases of prepubertal hypogonadism, severe acne does not occur. In contrast, patients may suffer from sebostasis due to missing stimulation of the sebaceous glands. The genital skin does not show pigmentation, which normally develops during puberty; the integument is pale. Hair growth on breast, pubia, axilla, face and integument is reduced; patients do not present with typical androgenetic alopecia. In addition to these features, dermatological diseases caused by treatment of the hypogonadism or drug-induced skin reactions have to be considered. While drug reactions to oral or intramuscular androgens or gonadotropins are rare, irritative or allergic skin lesions are observed frequently, especially in cases of non-scrotal transdermal therapeutic systems with testosterone. A variety of syndromes include dermatological symptoms associated with male hypogonadism; however, the prevalence of these syndromes is low.

The possibilities of treating male subfertility are still limited. Approaches at medical therapy include stimulation of spermatogenesis at the testicular level, improvement of epididymal function (sperm maturation), influence on sperm transport and activation of sperm metabolism with improvement of sperm motility. Causal therapy has been most successful in patients with hormonal insufficiency and male adnexitis, while microsurgical reconstructive measures have yielded best results in cases of occlusion within the efferent seminal ducts. New therapeutic approaches include the use of mast cell blockers and alpha blockers as well as vitamin C/E as an antioxidative treatment to reduce reactive oxygen species. If medical or surgical therapy has failed, methods for improvement of sperm quality in vitro must be considered (swim-up technique, glass wool filtration, migration/sedimentation technique, density gradient centrifugation). In cases of severe male sterility factor, intracytoplasmic sperm injection (ICSI) has been a breakthrough in the therapy of childlessness. A further progress is the collection of spermatozoa from the epididymis (MESA = microsurgical epididymal sperm aspiration) or testis (TESE = testicular sperm extraction). Finally, pressure in terms of time and organization can now be avoided by the use of cryopreserved spermatozoa from the ejaculate, epididymis or testicular tissue so that microinjection may be planned independently of the partner. In any case, a close cooperation between gynecologist and andrologist is of utmost importance.

Despite the availability of modern antimycotics, which produce high cure rates in early infections, the therapy of advanced chromoblastomycosis is still unsatisfactory. An initial chromoblastomycosis caused by a hitherto unidentified species of the genus Phialophora was diagnosed in a 46-year-old teacher. The organism was isolated twice at an interval of 6 weeks from a partly psoriasiform, partly verrucous lesion on the 4th toe. The infection was apparently acquired 4 years ago during a holiday at Cape Verde. Treatment with itraconazole (Sempera). 200 mg/day, and amphotericin B (Ampho-Moronal) cream for 6 weeks initially resulted in rapid regression. However, 4 weeks after cessation of therapy, the Phialophora species was cultured again from skin scrapings. Complete healing was achieved after re-treatment with itraconazole for 20 weeks at the same dosage in combination with topical amorolfine and local hyperthermia. Until now, no relapse has occurred. The present case demonstrates that this rare disease, which mainly occurs as a traumatic mycosis in the rural population of tropical regions, must be included in the differential diagnosis of psoriasiform or verrucous skin lesions and also included in the list of diseases which may be acquired while on vacation in exotic locations.

In view of demographic trends, andrology will increasingly be concerned with problems of the aging male. These will involve aspects of fertility and general quality of life rather than specific clinical pictures. While there is considerable interindividual variation, fertility in men usually persists well into old age. However, increased occurrence of spontaneous mutations means a higher genetic risk for children of older fathers. Diminished androgen levels in old age lead to diminished sexual activity and changes in muscles and bones, which raise the question of hormone substitution.

The storage of spermatozoa from tumour patients in sperm banks is an important medical task. As a result of improved treatment strategies the survival rate, particularly in patients with testicular tumours and Hodgkin's disease, is excellent if the diagnosis is made early. However, the necessary therapeutic measures often lead to the mutilation of reproductive function. At the Department of Dermatology at the University of Munich a sperm bank has been in existence since 1974; most of the patients who consult the sperm bank are men with testicular tumours. A synopsis of the last 12 years provides information about the patients, indications for storage, the method of preservation used and the fate of the cryopreserved samples used for insemination. To guarantee that optimal results are achieved, cryopreserved sperm samples should only be used by gynaecologists who are particularly experienced in the treatment of sterility.