Deconstructing the androgen function in active perianal infection: Investigating inflammation-driven hypogonadal state

Figure 1 Proposed conceptual model linking acute perianal infection, systemic inflammation, and transient testosterone suppression. Acute perianal infection may trigger a systemic inflammatory response, leading to increased circulating cytokines, including interleukin-6 and tumor necrosis factor-α. Elevated cytokines may suppress the hypothalamic-pituitary-gonadal axis. This suppression may reduce testosterone production. Obesity and metabolic factors may further modify this process by promoting chronic inflammation, reducing sex hormone-binding globulin levels, and increasing aromatase activity, thereby amplifying testosterone suppression. All pathways shown are conceptual and hypothesis-generating and should not be interpreted as established causal relationships. IL: Interleukin; TNF-α: Tumor necrosis factor-α; HPG: Hypothalamic-pituitary-gonadal; SHBG: Sex hormone-binding globulin.