Zhang X, Zhang Q, Wang MJ, Sun YT, Lu JG. Differences in testosterone levels in perianal diseases: A comparative study of abscesses and fistulas. World J Gastrointest Surg 2026; 18(1): 114445 [DOI: 10.4240/wjgs.v18.i1.114445]
Corresponding Author of This Article
Jin-Gen Lu, Chief Physician, Professor, Department of Anorectal, Longhua Hospital, Shanghai University of Traditional Chinses Medicine, No. 725 Wanping South Road, Xuhui District, Shanghai 200032, China. jingen.lu@shutcm.edu.cn
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Gastroenterology & Hepatology
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Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 28, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zhang X, Zhang Q, Wang MJ, Sun YT, Lu JG. Differences in testosterone levels in perianal diseases: A comparative study of abscesses and fistulas. World J Gastrointest Surg 2026; 18(1): 114445 [DOI: 10.4240/wjgs.v18.i1.114445]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114445 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114445
Differences in testosterone levels in perianal diseases: A comparative study of abscesses and fistulas
Xi Zhang, Qiang Zhang, Min-Jie Wang, Yan-ting Sun, Jin-Gen Lu
Xi Zhang, Qiang Zhang, Min-Jie Wang, Yan-ting Sun, Jin-Gen Lu, Department of Anorectal, Longhua Hospital, Shanghai University of Traditional Chinses Medicine, Shanghai 200032, China
Xi Zhang, Department of Anorectal, Shanghai Putuo District Hospital of Traditional Chinese Medicine, Shanghai 200062, China
Author contributions: Zhang X and Lu JG designed research study; Wang MJ and Sun YT collected the data; Zhang X and Zhang Q analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Longhua Hospital, Shanghai University of Traditional of Chinses Medicine (No. 2020 LCSY032).
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Access to clinical data requires ethical approval. Requests can be submitted to dzx0930@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Gen Lu, Chief Physician, Professor, Department of Anorectal, Longhua Hospital, Shanghai University of Traditional Chinses Medicine, No. 725 Wanping South Road, Xuhui District, Shanghai 200032, China. jingen.lu@shutcm.edu.cn
Received: September 22, 2025 Revised: October 25, 2025 Accepted: November 13, 2025 Published online: January 27, 2026 Processing time: 124 Days and 18.4 Hours
Abstract
BACKGROUND
Anorectal abscess and cryptoglandular anal fistula are common conditions with high recurrence rates, reflecting an incomplete understanding of their pathophysiology. A classic, yet unproven hypothesis proposes that high androgen levels increase infection risk by stimulating anal gland secretion, potentially explaining the male predominance. However, direct evidence regarding sex hormone levels in patients remains scarce. We hypothesized that active perianal infection is associated with significantly altered testosterone (T) levels.
AIM
To investigate the association between perianal diseases and sex hormone levels and to identify factors associated with T levels.
METHODS
This cross-sectional study included 249 men: 64 with hemorrhoids, 64 with anorectal abscess, and 121 with anal fistula. Preoperative serum sex hormone levels were measured. Multivariate linear regression identified factors associated with T levels.
RESULTS
There were no significant differences in age among the three groups at baseline. T levels differed significantly among the groups (P < 0.001). Multivariate regression analysis revealed that in the overall study population, anorectal abscess (B = -2.999, P < 0.001) and body mass index (BMI; B = -0.368, P < 0.001) negatively correlated with T levels. In the abscess group, white blood cell count (B = -0.565, P < 0.001) and BMI (B = -0.298, P = 0.011) negatively correlated with T levels. In the fistula group, BMI (B = -3.866 P < 0.001) and internal opening above the dentate line (B = -4.479, P = 0.048) were associated with lower T levels.
CONCLUSION
Patients with active perianal infections exhibited a significantly lower T level compared to those with hemorrhoids or fistulas, which is independently associated with systemic inflammation severity and obesity.
Core Tip: This study challenges the classic high-androgen hypothesis in perianal infections by demonstrating that patients with active anorectal abscess exhibit a significantly lower testosterone (T) level compared to those with hemorrhoids or fistulas, which is independently associated with systemic inflammation and obesity. We propose two novel hypotheses, namely a dynamic shift from high to low T, and a pathogenic role of inherent low T. The new endocrinological perspective suggests that restoring T could be a future adjunctive therapeutic strategy.
