In der Weiterbildungsordnung zum Arzt für Dermatologie und Venerologie werden „Kenntnisse,
Erfahrungen und Fertigkeiten in der Erkennung andrologischer Störungen und Indikationsstellung
zur weiterführenden Behandlung“ gefordert. Damit wird eine „Überweisungskompetenz“
verlangt. Dieser Beitrag soll die dazu erforderlichen Grundkenntnisse vermitteln.
Andrological Aspects in Dermatological Practice
In the dermatology practice patients attend with andrological aspects even though
the treating physicians might not consider them at first sight. This concerns hypogonadism
which may occur primarily in the context of genetic disorders (Klinefelter’s syndrome,
rare genodermatoses) or later in life as a consequence of ageing or diseases (like
infections, autoimmune disorders or chronic inflammatory diseases like psoriasis).
The history should ask for sexual symptoms (lack of nocturnal erections, decrease
of libido, erectile dysfunction). The physical examination could also reveal symptoms
of hypogonadism. The investigation of testosterone and SHBG confirms the suspicion
of hypogonadism. Erectile dysfunction due to skin diseases is uncommon (scleroderma,
psoriasis). It is mostly caused by circulatory disorders, or of psychogenic origin
or drug induced (such as finasteride). Treatment is primarily with phosphodiesterase
type 5 inhibitors. Dermatological therapies can impair testicular function. Therefore
patients should be asked whether they have a wish for a child. If a wish for a child
is present, drug therapy has to take this into account. If immunomodulatory drugs
are to be described cryopreservation of sperm should be offered. For the infertility
workup a sperm analysis fulfilling certain quality criteria is mandatory but not sufficient.
The counselling has to take into account aspects of history (e. g., age of the partner)
and clinical aspects (e. g., varicocele). The decision for reproductive measures has
to be made together with the treating gynecologist.
Schlüsselwörter Hypogonadismus - Testosteronmangel - männliche Infertilität - erektile Dysfunktion
Keywords hypogonadism - testosterone deficiency - male infertility - erectile dysfunction
