Free Testosterone and Percentage Free Testosterone are Superior Marker than Total Testosterone in Evaluation of Male Infertility—A Case-control Study

Objectives To evaluate the hormonal profiles, specifically focusing on gonadotropins (FSH, LH) and testosterone levels (Total, free and Percentage free Testosterone), in infertile males (oligozoospermia and azoospermia) compared to fertile controls, and which of these hormones provide a better clinical relevance during evaluation of male reproductive health. Material and Methods Study design-A retrospective study in which a total of 250 infertile male patients were studied and categorized into: 172 patients with oligozoospermia (68.8%), 78 patients with azoospermia (31.2%) and 52 fertile males included as a control group (proven fertile males). Blood samples were collected from all participants to measure serum levels of Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Estradiol, Prolactin Total testosterone, Free testosterone and Percentage Free testosterone along with controls and a comparison of hormonal levels between infertile patients (both oligozoospermic and azoospermic) and the control group was performed using appropriate statistical methods to check significance. Results Significant differences were observed in the levels of FSH, LH, free testosterone, and percentage free testosterone between the oligozoospermic and azoospermic patients when compared to the control fertile group. However, no significant differences were found in estradiol, prolactin, and total testosterone levels between the oligozoospermic and azoospermic patients compared to the control fertile males. Conclusion The study highlights the critical role of hormones in male fertility. The significant alteration in FSH, LH, free testosterone levels and percentage free testosterone levels in infertile men suggests that hormonal evaluation is crucial for understanding and diagnosing male infertility. Anomalies in these hormones may contribute to the pathophysiology of spermatogenic dysfunctions, emphasizing the importance of endocrine function in male reproductive health.