The Global State of Contemporary Andrology Practice: A Comprehensive Analysis of Clinical Practice, Training Pathways, and Emerging Challenges

Purpose: This study evaluates the current state of andrology practice worldwide, identifies challenges faced by clinicians, and explores training, certification, and research opportunities. It also seeks to redefine the qualifications necessary to be recognized as an andrologist and to propose areas for standardization and improvement. Materials and Methods: A global, cross-sectional survey was conducted using a 48-question online questionnaire designed by international experts. The survey, distributed in English, covered various domains of modern andrology practice. Responses from 405 participants across 59 countries were analyzed using R version 4.1.2, with categorical variables reported as frequencies and percentages. Results: Among respondents, 47.3% held medical doctor (MD) degrees, with urologists (31.1%) and clinical andrologists (25.3%) being the most represented specialties. Formal, board-certified andrological training was reported as available in only 48.1% of countries. While half of the respondents identified as andrologists based on experience, only one-third did so through certification, obtained from diverse, nationally recognized organizations. The primary areas of practice included male infertility (36.7%), male sexual dysfunction (27.2%), and sexually transmitted infections (14.5%). Many participants were actively engaged in assisted reproductive technologies, imaging, and andrological surgical emergencies. Despite strong interest in clinical, basic, and translational research, respondents highlighted significant challenges, including inconsistent training pathways, insufficient certification standards, and the complexity of managing diverse andrological conditions. Conclusions: Andrology is an evolving multidisciplinary specialty where board-certified urologists, clinical andrologists, and reproductive medicine specialists collaborate to address male reproductive and sexual health challenges. Despite their advanced competencies in medical, surgical, and laboratory interventions, specialists face significant global disparities in training and certification. This survey highlights the urgent need for standardized training, evidence-based guidelines, and unified certification to ensure consistency, enhance patient care, and advance andrology's academic and clinical excellence worldwide.