Andrologist in Latviawhere to get treatment, how to verify certification, what this doctor does

An andrologist works on the structure, physiology and pathology of the male reproductive system. They diagnose and treat disease of its organs, along with disorders of the organs and structures that regulate how that system works.

• Male infertility and abnormalities of semen quality
• Hypogonadism, meaning deficiency of male sex hormones
• Erectile dysfunction
• Reduced libido
• Premature ejaculation
• Men's health questions tied to hormonal balance

A family doctor is enough for an initial assessment and first tests. An andrologist is needed when a year of regular unprotected sex has not led to pregnancy, when erection problems persist for months, or when tests show hormonal disturbance.

Andrology in Latvia has no separate sub-specialties, since it is itself an additional specialty. In practice the work divides between infertility diagnosis and treatment, male sexual health, and hormonal disorders, with some doctors also working as sexologists or urologists.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• A certificate in one of the base specialties. RSU states that the andrology programme admits doctors certified in internal medicine, endocrinology, obstetrics and gynaecology, or urology.
• Residency in the andrology additional specialty. The programme consists of seven courses combining theory and practice. Programme page: RSU residency programme.
• On completing the programme the doctor can diagnose andrological disease, judge the indications for medical and surgical treatment, and apply medical, psychotherapeutic and surgical methods within the andrologist's scope.
• The state examination consists of a research presentation plus a theory test of 50 questions and analysis of clinical cases.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points, at least 60 per cent tied to the base specialty, plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• Base specialty. Andrology is an additional specialty, so it is worth checking whether the doctor's base specialty is urology, endocrinology or something else, since that shapes which problems they handle in depth.
• Languages. Consultations run in Latvian and Russian, with individual doctors also working in English and other languages.
• Infertility or sexual health. If pregnancy is the goal, a centre with its own sperm laboratory and fertility treatment saves referrals.
• Surgery. If an operation such as varicocele repair or a sperm retrieval procedure is possible, check whether the same provider performs it.
• Second opinion. Patients may freely choose the doctor and institution.

• Blood for hormone testing should be taken as early as possible in the morning, before 9 AM, because testosterone levels fluctuate during the day.
• Besides testosterone, prolactin, FSH, LH, sex hormone binding globulin, estradiol and inhibin B may be measured as indicated.
• If a urethral swab for sexually transmitted infection is planned, do not pass urine for at least four hours beforehand.
• Bring earlier semen analysis results and other test reports, plus details of the medicines you take.
• At the visit the doctor takes a history of the symptoms and how long they have lasted, examines the patient, and orders semen analysis, ultrasound or vascular studies as needed.

Andrology in Latvia is largely a private field, though at some providers the doctor also delivers state-funded services. In the public system, with a referral, a specialist visit costs 4.00 EUR and an ultrasound 4.00 EUR, with co-payments in one calendar year capped at 570.00 EUR.

• Patient co-payment for a specialist visitPrice EUR: 4.00Source: NVD
• Patient co-payment for ultrasoundPrice EUR: 4.00Source: NVD
• State-funded and private services at one providerPrice EUR: per provider price listSource: VCA polyclinic "Vesels"
• Andrology consultation and infertility testingPrice EUR: per clinic price listSource: iVF Riga

The specialty body is the association "Latvijas andrologu biedrība" (Latvian Society of Andrologists), registration number 40008246684, registered address Acones iela 12 k-3-4, Ulbroka, Stopiņi parish, Ropaži municipality. Contact: Juris Erenpreiss, email jerenpreiss@gmail.com.

Internationally the field is standardised by the European Academy of Andrology, which sets diagnosis and treatment standards for men with fertility problems and other men's health issues.

Certificates are issued by the Certification Council of the Latvian Medical Association, founded in 1988. The sector regulator is the Health Inspectorate.

If you have doubts about the quality of care, raise them first with the institution's management, which must operate a complaints and suggestions system. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site.