Publication Name	World Journal of Gastrointestinal Surgery
Manuscript ID	117051
Country	China

Category	Gastroenterology & Hepatology
Manuscript Type	Letter to the Editor
Article Title	Low testosterone in perianal abscesses: Towards a new paradigm of systemic endocrine-immune pathophysiology
Manuscript Source	Invited Manuscript
All Author List	Xiao-Fei Cheng
Funding Agency and Grant Number
Corresponding Author	Xiao-Fei Cheng, Associate Chief Physician, MD, PhD, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. xfcheng@zju.edu.cn
Key Words	Perianal abscess; Testosterone; Hypogonadism; Inflammation; Pathophysiology
Core Tip	This commentary outlines a paradigm shift in perianal abscess pathophysiology. Based on recent findings of low testosterone during active infection, it challenges the classic high-androgen theory by framing testosterone as suppressed by inflammation. The authors propose two integrative hypotheses - the “dynamic shift” and “inherent low testosterone” hypotheses - emphasizing systemic endocrine-immune interactions. This new perspective advocates for holistic clinical strategies and mechanism-based research to improve outcomes.
Citation	Cheng XF. Low testosterone in perianal abscesses: Towards a new paradigm of systemic endocrine-immune pathophysiology. World J Gastrointest Surg 2026; In press

Received	2025-11-26 16:16
Peer-Review Started	2025-11-27 07:34
First Decision by Editorial Office Director	2025-12-17 07:45
Return for Revision	2025-12-17 07:45
Revised	2025-12-24 14:32
Publication Fee Transferred
Second Decision by Editor	2026-02-11 02:38
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-02-11 03:27
Articles in Press	2026-02-11 03:27
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1948-9366 (online)
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