TESTOSTERONE AND ANDROPAUSE IN MALES WITH INFLAMMATORY ARTHRITIDES

Abstract

Infertility is emerging as one of the leading global health concerns. The spectrum of global diseases has shifted from communicable to non-communicable, with autoimmune diseases being at the crux of it. Infertility among females with autoimmune diseases has been explored. Many inflammatory arthritides affect men in their peak reproductive and functional age. However, data on male infertility in persons having these diseases is scarce. This topical review explores the multifactorial causation of male infertility in inflammatory arthritis. These individuals tend to have gonadal dysfunction, Sertoli cell dysfunction and hypotestosteronaemia. Individuals with rheumatoid arthritis and spondyloarthritis have also reported a loss of libido owing to poor quality of life, low functional status, and erectile dysfunction. These factors along with social and psychological factors greatly influence the development of persistent sexual ill-health. Another observation is that men who have primary infertility have a higher predisposition to developing autoimmune diseases; particularly in rheumatoid arthritis and spondyloarthritis. The morbidity that comes with pain and deformities resulting from inadequately treated disease or high disease activity, can also result in poor sexual well-being. Many of the males with inflammatory arthritis tend to be voluntarily childless due to the fear of passing the disease on to their off-springs and also a possible flare when the drug therapy is modified to facilitate conception. Male fertility in autoimmune rheumatic diseases is often a neglected topic in our practice and research. Physicians must be sensitized and receptive to the issues of infertility and sexual well-being in male patients with autoimmune rheumatic diseases.