Decision Aid

When to See a Urologist

Where does the male partner go after a semen analysis? This walks the AUA/ASRM pathway: when to repeat, when hormone and genetic testing are triggered, and when referral can't wait.

How to use this

Answer two quick questions. You'll get a tailored next step plus the specific count thresholds that drive hormone and genetic testing. This supports — it does not replace — clinical judgment.

1. Has the male partner had a semen analysis?

2. Any of these present? (check all that apply)

A lump, mass, or hardness in a testicle History of undescended testicle, testicular injury, mumps after puberty, or prior chemotherapy/radiation Low-testosterone symptoms: low libido, erectile difficulty, persistent fatigue None of these

The thresholds, in one place

Finding	What it triggers (AUA/ASRM)
Any abnormal result	Repeat the semen analysis in 2–3 months before deciding anything
Low libido, ED, oligo/azoospermia, small testes	Hormone testing: FSH + total testosterone
Testosterone < 300 ng/dL	Add LH; add prolactin if low libido or hypogonadotropic picture
Azoospermia	Exam + semen volume + pH + FSH to separate obstruction from impaired production
Azoospermia or concentration < 5 million/mL (with high FSH / atrophy)	Karyotype
Azoospermia or concentration ≤ 1 million/mL (with high FSH / atrophy)	Y-chromosome microdeletion analysis
Absent vas deferens / obstructive azoospermia	CFTR mutation testing (including 5T allele)

Evidence base

Brannigan RE, Hermanson L, Kaczmarek J, et al. Updates to male infertility: AUA/ASRM guideline (2024). J Urol. 2024. doi:10.1097/JU.0000000000004180. — Current thresholds for hormone and genetic testing.
Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline parts I & II. Fertil Steril / J Urol. 2021. — Stepwise evaluation; obstructive vs. non-obstructive azoospermia.
Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. StatPearls. 2024. — Up to 6% of men evaluated have serious underlying pathology, including cancer.