Andrology is defined as the discipline dealing with the physiology and pathology of male reproduction. Basic scientists and clinicians are equally active in andrology. This document concerns the clinical practice of Andrology.

Andrological diseases are rather frequent (at least 5 % of men of reproductive age are affected by fertility problems) and the incidence of disorders such as male infertility, testicular cancer and erectile dysfunction seems to be increasing. However, andrology has not yet been recognized as an independent speciality. At present, patients with andrological diseases are treated by different specialists, e.g. urologists (surgical treatment, sterilization and refertilization, erectile dysfunction), clinical endocrinologists (hypogonadism, infertility, impotence), gynaecologists (assisted reproduction), paediatricians (cryptorchidism, intersex, delayed puberty), oncologists (testicular cancer), psychiatrists (impotence) and in some countries also dermatologists (infertility).

Notwithstanding the significant advancement of basic knowledge on male reproductive function over the past two decades facilitated by endocrinology and molecular and cell biology, the clinical aspects of andrology continue to be considered as low-priority research areas. These scientific gaps prevent important andrological problems from being solved (e.g. male infertility, efficient androgen replacement therapy, male contraception) and also prevent appropriate patient management.

Consequently, there is an urgent need for strengthening basic and clinical andrology. This reinforcement would be greatly facilitated by establishing a training programme for physicians who wish to become specialists in male reproduction, i.e. andrology and by recognition of andrology as an independent  (sub)specialty. Since only a limited number of centres exists with andrological expertise sufficient to educate andrologists, European rather than national training programmes should be established. Additionally, in order to stimulate research in the field of andrology, it s imperative that the educational programme should not only include clinical work but also basic andrological research topics. Therefore, in accordance with its statutes, the European Academy of Andrology designates Andrology Centres for training and establishes training programmes in andrology as a clinical subspecialty of other full specialities such as internal medicine, endocrinology, urology, gynaecology, paediatrics and dermatology or in addition to other medical degrees.

A prerequisite for training physicians as andrologists is the existence of recognized Andrology Centres with an appropriate training programme. The Andrology Centre may consist of a single department or of several co-operating research/clinical institutions. In addition to the director, other persons certified by the EAA may be responsible for the training programme. Upon application and examination, the EAA should certify the Andrology Centre if the following criteria are met:

2.1.The Director should be an internationally recognized and EAA certified andrologist.

2.2. Clinical activities should include at least 500 new infertile patients per year and at a given time at least 20 adolescent patients with delayed puberty, at least 20 men under treatment for secondary hypogonadism, at least 20 patients with primary hypogonadism including Klinefelter's syndrome and a minimum of 30 patients with erectile dysfunction. These figures provide a guideline and can be adjusted if circumstances require.

2.3. The structure of the Centre should include collaboration with urologists, gynaecologists, sexologists, paeditricians, geneticists, etc.

2.4. Laboratory activities include semen analysis (min. 500/year) according to the WHO Standard procedure as listed in the WHO Manual (1992), expertise in interpretation of testicular biopsies, routine determination of reproductive hormones (e.g. testosterone, estradiol, FSH, LH, prolactin) and ultrasonography of reproductive organs.

2.5. Researach activities should result in a minimum of five original papers in the field of andrology published in international scientific journals per year during the last 3 years.

2.6. Centres should collaborate in establishing a standardized curriculum for training in andrology. They should be prepared to accept trainees from other centres on a rotating basis for electives in specialities.

In order to be certified as andrologist, the following requirements must be fulfilled:

- 2-year training at an EAA certified centre. At least 1 year should be spent at one centre, the rest may be spent at other centres of which one may also be abroad.

- At least 12 months must be devoted to immediate patient care (andrology clinic), 3 months must be spent in the andrology laboratory (teaching based on the content of the WHO Manual). The remaining time should be applied to special training, electives or research on one or more areas of special interest to the andrologist, e.g. endocrinology, testicular morphology, imaging (ultrasonography), genetics, molecular biology, biochemistry, assisted reproduction, urology, gynaecology, microbiology, psychology.

- The training should enable the trainee to perform, under his own responsibility, diagnosis and treatment of men with infertility, hypogonadism and erectile dysfunction and to counsel infertile couples.

The head of the Andrology Centre will document the type and quality of training in written form.

The candidate shall provide proof of the length and content of the training required. In individual cases the EAA may make exceptions to the above-mentioned rules, e.g. by accepting training at a centre outside Europe as an equivalent for an appointment at one of the EAA-certified Andrology Centres.

Training will be concluded by an examination administered by the EAA. The examination will test the candidate's proficiency in clinical andrology and its related fields (seminology, endocrinology, microbiology, imaging, morphology, urology, gynaecology, immunology, psychology). The examination for andrologists following the training programmes should include a written as well as an oral part judged by international referees.

Upon successful completion of the examination the candidate will be awarded a certificate from the EAA.

(These criteria were accepted by the Executive Council of the European Academy of Andrology at its meeting in De Panne on 27 March 1994)

(Also found in Int. J. Androl. 20, suppl. 2, 20-21)