Deep Dive

Testosterone, Hormone Imbalances, and Male Fertility

Hormone imbalances account for around 10% of all male factor infertility cases, and can manifest themselves in myriad ways, ranging from sexual dysfunction to low sperm concentration. Generally speaking, hormone imbalances are both detectable and correctable.

Hormonal Pathways


Hormones are regulated in the brain: the hypothalamus detects hormone levels in the body, and messages to the pituitary gland (also in the brain), to begin producing hormones at the necessary levels. The pituitary produces Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), amongst other hormones.

LH impacts the testes' ability to produce testosterone, which dictates libido and erectile function, while FSH (along with testosterone) regulates sperm production. To complete the loop, the hypothalamus measures the body’s level of these hormones, and determines which signals to send to the pituitary to produce more, or less, of each.

Typically, when any part of the cycle is interrupted, hormone imbalances occur. For example, Kallmann’s Syndrome impacts the hypothalamus’s ability to message the pituitary. A pituitary tumor impacts the pituitary’s ability to produce LH and FSH.

Hormone Detection and Treatment


Typically, a blood draw (often done in the morning, as levels change throughout the day) will detect hormone levels, and by-and-large, this is where ranges fall:

If a hormone imbalance is detected, your urologist will likely be interested in determining the root cause, which may have important health implications (e.g. a pituitary tumor in circumstances of elevated prolactin) beyond your ability to conceive. When there is an FSH or LH deficit, it’s customary to prescribe hormones that mimic the function of naturally-made FSH and LH.

Testosterone


After the age of 30, levels of testosterone in men drop roughly 1% per year and the physical and emotional impact can be hard to absorb: libidos diminish and fat replaces muscle mass. It’s become incredibly common for men to take testosterone supplements (which say a doubling of sales between 2006 and 2015) to compensate for this, and the effects these supplements have on male fertility are devastating. Stunningly, 25% of urologists wrongly believe taking testosterone supplements helps improve male fertility. If your urologists suggests or condones taking exogenuous testosterone, we suggest getting a second opinion.

Artificially raised levels of testosterone signal to the hypothalamus, and thus the pituitary, that there’s no need to produce hormones like LH and FSH. When those hormone levels drop, so too does the testes’ ability to produce sperm.

Typically, many urologists will want to taper a man off hormone therapy, rather than pull him off all at once, since a dramatic drop in testosterone levels raise the risk of depression. In these cases, it can take months, or years, before normal sperm production resumes. Typically 60% of men will see sperm levels recover within six months and nearly 90% within 12 months, depending on the age (younger is better) and duration of time the patient was on testosterone.

One alternative worth noting is that when men take clomiphene citrate (clomid) and aromatase inhibitors this often raises the level of serum testosterone without negatively affecting sperm parameters.