Zhang ZJ, Wang JX, Wang CX, He L. Deconstructing the androgen function in active perianal infection: Investigating inflammation-driven hypogonadal state. World J Gastrointest Surg 2026; 18(9): 117029 [DOI: 10.4240/wjgs.117029]
Corresponding Author of This Article
Liang He, MD, PhD, Department of Urology, First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. lianghe9278@jlu.edu.cn
Research Domain of This Article
Andrology
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review-article
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Zhang ZJ, Wang JX, Wang CX, He L. Deconstructing the androgen function in active perianal infection: Investigating inflammation-driven hypogonadal state. World J Gastrointest Surg 2026; 18(9): 117029 [DOI: 10.4240/wjgs.117029]
World J Gastrointest Surg. Sep 27, 2026; 18(9): 117029 Published online Sep 27, 2026. doi: 10.4240/wjgs.117029
Deconstructing the androgen function in active perianal infection: Investigating inflammation-driven hypogonadal state
Ze-Jun Zhang, Ji-Xue Wang, Chun-Xi Wang, Liang He
Ze-Jun Zhang, Ji-Xue Wang, Chun-Xi Wang, Liang He, Department of Urology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Zhang ZJ drafted the manuscript; He L and Wang CX provided academic guidance and manuscript revision; Wang JX contributed to manuscript revision. All authors approved the final manuscript.
AI contribution statement: We used ChatGPT during manuscript preparation. We used it to improve language, sentence structure, and clarity. We also used ChatGPT to develop and refine the prompt for Figure 1. We then produced and revised the final figure ourselves. We did not use any AI tool to generate the whole manuscript. We also did not use any AI tool to generate any complete section of the main text without substantial human revision. We carefully reviewed and revised all parts of the manuscript. We take full responsibility for the accuracy, interpretation, and originality of the manuscript. We did not use any AI tool for data analysis. No AI tool took part in the study design. No AI tool contributed to the final interpretation of the cited study findings or the final academic conclusions.
Supported by Natural Science Foundation Project of Jilin Province, No. YDZJ202301ZYTS100.
Conflict-of-interest statement: The author declares no conflicts of interest.
Corresponding author: Liang He, MD, PhD, Department of Urology, First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. lianghe9278@jlu.edu.cn
Received: November 27, 2025 Revised: January 3, 2026 Accepted: January 14, 2026 Published online: September 27, 2026 Processing time: 293 Days and 0.3 Hours
Abstract
Emerging evidence suggests that testosterone plays a more complex role in perianal infectious diseases than traditionally assumed. While early theories proposed that higher androgen levels may predispose individuals to anal gland obstruction, recent clinical data indicate that active perianal infections are frequently accompanied by reduced circulating testosterone compared to those with hemorrhoids or fistulas. This decline appears closely linked to systemic inflammatory stress, metabolic disorders, and obesity-factors known to suppress the hypothalamic-pituitary-gonadal axis and impair steroidogenesis. Inflammatory mediators such as interleukin-6, tumor necrosis factor-α, and C-reactive protein may directly inhibit Leydig cell activity, whereas adiposity contributes additional endocrine disruption through reduced sex hormone-binding globulin and enhanced aromatization. Testosterone should be viewed as part of the inflammatory-metabolic response. This perspective provides an updated framework for understanding perianal sepsis. Future research should prioritize integration of inflammatory biomarkers and evaluation of endocrine or metabolic interventions as adjuncts to conventional surgical management.
Core Tip: Acute perianal abscess is not only a localized infection but triggers a systemic inflammatory response that rapidly suppresses testosterone production. This inflammation-driven hypogonadal state challenges the traditional assumption that high androgen levels contribute to disease initiation and highlights the importance of integrating endocrine and metabolic factors into the understanding and management of perianal infections.
