Andrology has traditionally been associated with semen analyses and treatment of male infertility and erectile dysfunction. Later it has been expanded to encompass all aspects of male reproductive health, including sexual differentiation, hypogonadism, contraception, sexually transmitted diseases, sexuality, and aging. The mile stones of andrology include the first semen analyses in the 20's, the first gonadotropin treatments of male infertility, the establishment of vasectomy as the standard method of male contraception in the 60's, intracavernous injections for the treatment of erectile dysfunction in the 80's, and finally the very recent establishment of intracytoplasmic sperm injection (ICSI) for the treatment of male infertility.

About 7% of men suffer from infertility, and in about half of them the reason is idiopathic^[1]. It was formerly a dogma that hardly anything effective could be done to help the infertile male. In recent years the situation has dramatically changed because of ICSI^[2,3]. A single sperm isolated from the semen of an oligozoospermic male, or even an immature germinal cell isolated from the testis tissue can fertilize the ovum in in vitro conditions, and give rise to normal pregnancy after transfer to the uterus. Hence, if the male has anywhere in his reproductive tract haploid germ cells, he is in principle fertile with the help of ICSI. This is one of the greatest achievements of reproductive medicine.

But ICSI also posed challenges for andrology. If even a single sperm separated from the semen or testis is sufficient for in vitro fertilization, why are the tedious and expensive andrological diagnostic procedures needed? Just do outright ICSI, and that's it! However, this practice would be in strong conflict with the principles of medicine. The treating physician has always first to reach as detailed as possible a diagnosis, and purely symptomatic treatments (such as ICSI) always carry risks. Namely, it has been observed that in idiopathic azoo- or oligoozoospermia, i.e., the standard target group for ICSI, even more than 20 % of men possess microdeletions in those areas of the Y chromosome that are essential for the maintenance of spermatogenesis^[4,5]. When the sperms of such men are used for ICSI, the ensuing baby boy will have the same deletion as their fathers, and like his father, he will be infertile. Hence, this practice will create a considerable ethical problem. Are we with ICSI transferring the burden of male infertility to the following generations, and are we creating a subclass of men that can only procreate in laboratory conditions? This reservation naturally does not apply to ICSI treatments with no risk of genetic cause of infertility, such as the presence of antisperm antibodies after reversal of vasectomy.

The above scenario thus in no way means the end of andrology—in contrast. ICSI has become an established form of treatment, and in order to guarantee fertility of the future generations, we need to improve andrological diagnostics. We have to be able to single out from men seeking ICSI those with genetic cause of infertility. The diagnostics of male infertility can be improved through intensive basic and clinical research. It is therefore natural that andrology has started exploiting the recent growing area of biomedical research, molecular genetics. It is likely that in the years to come, many mutations and polymorphisms will be found that cause male infertility or subfertility. This new information does not only satisfy our scientific curiosity, but it also helps in designing specific treatments of male infertility, or even to create new strategies for the development of male contraception.

Besides condoms and vasectomy, the male still does not have user-friendly, reliable and reversible methods of contraception. In the name of gender equality, it is natural that the man should be able to share the benefits and risks of contraception. Male contraception is needed to combat the world population overgrowth, because the available female methods have appeared insufficient. The male as a target of contraceptive design has almost totally been neglected in the recent decades. Amongst the multiple reasons are insufficient knowledge of male reproductive physiology, insufficient research funding, and common prejudice for male contraception among the public at large, health care professionals, pharmaceutical industries and funding bodies of research. The World Health Organization, despite its shrinking resources, has been the flag ship in the development of male contraception^[6,7], but it is clear that the final breakthrough in this field, be it a pill, an injection or an implant, will need active participation of the pharmaceutical industry. It is encouraging to see the first signs of awakening of this interest.

Clinically, a very important sector of andrology is the aging male. Health problems of the aging population will be, in the near future, an important medical, social, economical and ethical question. The most common health complaints of aging men, such as prostatic and cardiovascular diseases, are related to their gender and the life-long androgen exposure. For this very reason andrologists have lots to offer to investigation and treatment of diseases of aging men. They also have their say in the currently on-going debate on“male climacterium”or andropause and in its potential replacement therapy with androgens. It still is debatable whether we are dealing with a real syndrome requiring treatment or a phenomenon related with normal aging.

Even the lay population has noticed the recent reports on declining sperm counts in various populations around the world^[8,9]. The validity and meaning of these findings remain open, because of conflicting results reported from different countries^[10,11]. It still remains open whether the findings mean a real threat to male fertility caused by environmental pollution, a statistical bias, or a harmless reflection of life style changes. If we do not realize the real importance of this matter, there is a danger that initially a harmless trend may gradually grow into a real threat to survival of the human race. It would be absurd, if mankind, struggling to produce improved contraceptive methods under the threat of world's overpopulation would all of a sudden notice that men are losing their fertility because of environmental pollution. The publicity around this issue has at least made us think about male reproductive function and hopefully more widely about male health issues.