Andrologist vs urologist: what is the difference?
In the UK, andrology is a sub-specialty of urology. Here is what an andrologist does, when it is worth seeing one, and how to judge who to see.
If you are wondering whether you need a urologist or an andrologist, the UK answer is that they are not alternatives. Andrology is a sub-specialty within urology, so the real question is how much specialist focus your particular problem needs.
What is the difference between a urologist and an andrologist?
In the UK, an andrologist is a urologist — a surgeon — who has specialised further in male reproductive and sexual health and genital reconstruction.
The difference is one of focus rather than of kind. A general urologist deals with the whole urinary tract — bladder and prostate problems, blood in the urine, urinary infections and urological cancers — as well as common genital conditions. Andrology is a small sub-specialty, and in my experience most general urologists see only a handful of complex andrology problems in a year. An andrologist’s practice is built around them.
| In the UK | General urologist | Andrologist |
|---|---|---|
| Training | Surgical training in urology; listed as a specialist on the GMC medical register | The same urology training, plus further training in andrology, such as a fellowship in a specialist unit |
| Typical conditions | Urinary symptoms, enlarged prostate, blood in the urine, urinary infections, urological cancers | Male infertility, erectile dysfunction, Peyronie’s disease, urethral stricture, low testosterone, priapism |
| Typical procedures | Cystoscopy, prostate operations such as TURP, other endoscopic surgery | Infertility microsurgery, penile implants, penile straightening, urethroplasty |
| When to see | Most bladder, prostate and urinary problems | An abnormal semen analysis, erection problems not helped by tablets, a curved penis, a stricture that keeps coming back |
There is overlap, and an andrologist is still a urologist: the table shows where each concentrates, not a hard boundary. Not every problem needs a sub-specialist.
Is an andrologist a surgeon?
In UK hospital practice, yes: andrology sits within urology, and the consultants who practise it are generally urological surgeons who manage these conditions both medically and surgically.
The specialty’s professional home is the Section of Andrology and Genito-Urethral Surgery of the British Association of Urological Surgeons (BAUS). BAUS describes the section’s field as andrology — male reproductive and sexual health — and surgery of the male genitalia, including the medical and surgical management of erectile dysfunction, Peyronie’s disease, urethral stricture disease, male infertility and penile cancer.
NHS services are organised the same way. At Guy’s Hospital I am a consultant urologist with a special interest in andrology, male infertility and genito-urethral reconstruction, and at University College London Hospitals the andrology unit, led by consultant andrologists, is part of the urology service.
UK sources use the word in a narrower and a broader sense: a BAUS fertility-testing leaflet calls a specialist andrologist a male infertility specialist, while the BAUS andrology section also covers sexual function, genital surgery and reconstruction. If you are reading material written for another country’s health system, check what training sits behind the title.
Check the training, not the title
“Andrologist” describes a focus of practice. What matters for your care is the training behind it: whether the doctor is on the GMC specialist register, what sub-specialty training they have completed, and how regularly they manage your particular problem.
What does an andrologist do?
An andrologist investigates and treats problems of male fertility, sexual function and the genitals and urethra, using medication, minor procedures and, where needed, specialist surgery.
Much of the work is diagnostic. Male infertility and erectile dysfunction are symptoms rather than diagnoses, and the value of a specialist assessment is finding the cause: a varicocele found on examination, a hormone problem, a blockage, or a medication effect such as testosterone replacement switching off sperm production. Once the cause is clear, the options usually fall into three groups:
- Medical treatment — tablets, injection therapy, hormone treatment, and stopping drugs that are causing the problem
- Procedures — such as injection treatment into a Peyronie’s plaque, or endoscopic treatment of a urethral stricture
- Surgery — microsurgery for infertility (varicocele repair, vasectomy reversal and sperm retrieval), penile implants, straightening operations for Peyronie’s disease, and urethral reconstruction
The options also include doing nothing. A varicocele that causes no symptoms in a man who is not trying for a baby usually needs no treatment, and a mild, stable Peyronie’s curve that still allows comfortable, satisfactory sex can reasonably be left alone. A good part of my job is explaining when an operation is not the right answer. My treatments page sets out the full range.
What diseases does an andrologist treat?
Andrologists treat male infertility, erectile dysfunction, Peyronie’s disease, urethral stricture, low testosterone, priapism and other conditions of the penis, testicles and urethra.
- Fertility — male infertility and an abnormal semen analysis, azoospermia (no sperm in the ejaculate), varicocele, blockages after vasectomy or infection, and fertility preservation before cancer treatment
- Sexual function and hormones — erectile dysfunction, including after prostate cancer surgery; low testosterone; premature and delayed ejaculation; and priapism — an erection lasting more than four hours is a urological emergency that needs immediate hospital care
- Shape and structure of the penis — Peyronie’s disease and penile curvature, penile fracture, tight foreskin and lichen sclerosus
- Reconstruction — urethral stricture, hypospadias in adults, buried penis, and repair after a previous operation that has not worked
- Cancer — penile cancer falls within the remit of the BAUS andrology section
My conditions page has a detailed guide to each. Two points apply across them. Some have a cause worth finding first: erectile dysfunction can appear before a heart attack or stroke, so an erection assessment is also a cardiovascular check. And they overlap: testosterone treatment suppresses sperm production, so a man with low testosterone who still wants children needs hormones, sexual function and fertility considered together.
When should a man see an andrologist?
See an andrologist when a sexual, fertility or genital problem is complex, has not responded to first treatment, has come back, or may need specialist surgery.
Some common situations:
- An abnormal semen analysis. A BAUS patient leaflet notes that abnormal results usually lead to referral to a specialist andrologist, who looks for a treatable cause before assisted conception is considered. My guide to semen analysis results explains what the report means.
- Erection problems that tablets have not fixed. It is worth checking the tablets were taken correctly and that untreated low testosterone is not stopping them working. Beyond tablets there are effective options, including injection therapy and implant surgery.
- A bend in the penis, a lump, or pain with erections. These suggest Peyronie’s disease, where timing matters: surgery is reserved for disease that has stopped changing.
- A urethral stricture that has come back. BAUS gives a 1 in 2 (50%) risk of recurrence after a first optical urethrotomy, and a higher risk after a second or third; urethroplasty, a reconstructive operation, has a much higher success rate.
- Low testosterone when you may want children. Testosterone replacement switches off sperm production, so the plan needs to account for fertility before treatment starts.
- A previous operation that has not worked, or an operation offered without anyone explaining why it is your only option.
You do not need to have tried everything else first. If you are paying for yourself you can book directly without a GP referral; most insurers ask for a referral letter before they authorise an appointment.
Can I see an andrologist on the NHS?
Yes: andrology services exist within NHS hospital urology departments, such as at Guy’s and UCLH, and see patients on referral; availability varies between NHS areas.
For fertility problems, your GP can arrange the first tests, including a semen analysis, and refer you to a specialist if they are abnormal. Your GP can advise on what is available locally and on local funding policy for fertility treatment.
What happens at an andrology appointment?
A first appointment is a detailed conversation and an examination, after which I explain what I think is happening, which tests are needed and the options.
The history
I ask about the problem, your general health, previous operations, medication (including anything bought online or used in the gym) and, where relevant, your sexual and family history and occupation. For erection problems, whether you still have night-time or early-morning erections is a useful clue. Bring any previous semen analyses and blood tests; it saves repeating them.
The examination
Examination is an essential part of the assessment, not a formality. It is where varicoceles, an absent vas deferens, testicular changes and Peyronie’s plaques are found, and it frequently changes the diagnosis. For Peyronie’s disease, the curve is measured from photographs you take at home, or from an erection produced in clinic with an injection.
Tests
Tests are tailored rather than routine. They may include semen analysis, morning hormone blood tests, a scrotal ultrasound, or penile duplex ultrasound to measure blood flow. The hospital charges for investigations separately, and you are told the cost before anything is arranged.
The plan
By the end you should understand the likely cause, the next steps and the trade-offs of each option, including the option of waiting. If you are investigating fertility as a couple, your partner is welcome to attend. Afterwards I write a summary letter to you and, with your permission, to your GP or referring doctor.
An in-person initial consultation is £350 and lasts up to 40 minutes. A video or telephone consultation is £300 and suits initial discussions, second opinions and reviewing results, although an examination is normally needed before surgery is planned. Follow-up appointments are £250. I see patients at The Shard and Canary Wharf.
How do I choose an andrologist in London?
Choose on training, specialist registration, how often they treat your specific problem, and whether they offer the full range of options rather than one favoured treatment.
These are the questions I would ask on behalf of a family member:
- Are they on the GMC specialist register? NHS advice is to check that a surgeon is registered with the General Medical Council, listed as a specialist on the medical register on the GMC website, and holds a licence to practise.
- What andrology training have they completed? Ask what training in andrology they did after qualifying as a urologist — for example, a fellowship in a specialist unit — and where.
- Are they a member of the BAUS Section of Andrology and Genito-Urethral Surgery? Membership is a useful signal of where a urologist’s practice is focused, but it is not a qualification: BAUS members choose up to three specialist sections relevant to their areas of practice.
- How often do they treat your problem? Ask how many of the operations you need they carry out each year, and what their results are. A surgeon who does an operation regularly should be able to answer both plainly.
- Do they offer the full range of options? For Peyronie’s disease that means observation, non-surgical treatment, plication, grafting and implants; for a stricture, both endoscopic treatment and urethroplasty; for infertility, treating the cause as well as sperm retrieval. If only one treatment is ever offered, ask why.
- For fertility problems, do they work with a fertility unit? Decisions about IVF and ICSI are better made with full information about the male side than around it.
The same questions apply to me. I hold FRCS(Urol) and have been on the GMC specialist register for urology since 2011, the same year as my fellowship in andrology and genital oncology and reconstruction at the Institute of Urology, University College Hospital. I am a past National Chair of the BAUS Section of Andrology and Genito-Urethral Surgery, and my GMC number is 4435916. If you would like to discuss your situation, you can contact my team.
Sources and further reading
- BAUS: Section of Andrology and Genito-Urethral Surgery
- BAUS patient leaflet: Male fertility tests (published Mar 2024)
- BAUS patient leaflet: Urethral stricture disease (published Mar 2024)
- University College London Hospitals: Andrology services
- NHS: checking a surgeon’s GMC registration (general advice, from NHS cosmetic surgery guidance)
Frequently asked
Do andrologists treat women?
No. Andrology is the medicine and surgery of male reproductive and sexual health. When a couple is having difficulty conceiving, the female partner is assessed by gynaecology or reproductive medicine colleagues, ideally while the male partner is being investigated rather than afterwards. I liaise directly with fertility units where joint decisions are needed, and partners are welcome at my consultations.
What is an andrology laboratory?
It is a laboratory that analyses semen, not a clinic. The semen analyses I request are carried out in an accredited andrology laboratory, and the quality of the laboratory matters: a finding of no sperm, for example, should be confirmed on centrifuged samples examined by an experienced andrology laboratory, because a less rigorous one can miss very small numbers of sperm. The laboratory reports the result; the interpretation and the plan come from the clinician.
Should I see an andrologist or a fertility clinic first?
Ideally both, in parallel, because investigating both partners at once avoids months of wasted time. If the semen analysis is abnormal, an andrologist looks for a cause that can be treated, which may allow natural conception or improve the results of IVF. Where natural pregnancy is not possible, the next step takes account of your partner’s age and history, and the fertility clinic leads on assisted conception.
Is a urologist or an andrologist better for erectile dysfunction?
It depends how far along the treatment ladder you need to go, and most men do not need to climb all of it. Any first assessment should include a cardiovascular check, because erection problems can appear before heart disease. An andrologist is worth seeing when tablets have not worked despite being used correctly, when the penis is also curved, or when you are considering injection therapy or a penile implant.
Does an andrologist treat low testosterone?
Yes. Low testosterone sits where hormones, sexual function and fertility meet, the three things my practice is built around. The diagnosis should rest on two fasting morning blood tests taken before 10am, not a single afternoon result. If you may want children, testosterone replacement should not be started without a fertility discussion, because it suppresses sperm production. In secondary hypogonadism, treatment that raises your own testosterone while maintaining sperm production is often the better route for men who still want children.
Can an andrologist help if a previous treatment has not worked?
Often, yes. Complex redo surgery, where a previous operation has not worked, is part of my practice, as is seeing men in whom sperm retrieval has already failed elsewhere. A second opinion with a written report is £350. Bring the operation notes and previous results if you have them, because knowing exactly what was done shapes what is still possible.
Speak to my team
Appointments at The Shard and Canary Wharf are arranged by my PA, Jeanette Bush. Tell us briefly what the problem is and we will find the right clinic slot for you.