A 26-Year-Old Man Comes to the Office with His Wife

A 26-year-old man comes to the office with his wife due to inability to conceive after a year of regular unprotected intercourse.  His wife has a child from a previous marriage.  The patient reports decreased libido but has no trouble achieving or maintaining erection.  Temperature is 37 C (98.6 F) , blood pressure is 116/70 mm Hg, and pulse is 60/min.  His height is 185 cm (6 ft 1 in) , weight is 70 kg (154 lb) , and BMI is 20 kg/m².  Physical examination shows intact sense of smell and visual fields.  He has bilateral gynecomastia and sparse facial and body hair.  Genital examination shows normal penis morphology, but the testes are firm and about 6 mL in volume (normal: 18-25 mL) .  Which of the following is the most likely cause of this patient's infertility?

A) Complete androgen receptor insensitivity
B) Congenital gonadotropin-releasing hormone deficiency
C) Dysgenesis of the seminiferous tubules
D) Excess endogenous glucocorticoid production
E) Prolonged high testicular temperature
F) Use of exogenous androgenic substances

Correct Answer:

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