Testosterone and Male Infertility

Testosterone is the key sex hormone for males and acts as an anabolic steroid. It plays a key role in the development of male reproductive organs such as testes and prostate, as well as promoting secondary sexual characters.

Why is Testosterone important?

• Sexual thoughts and motivations are testosterone-dependent aspects of male sexual behaviour.
• It helps in the production of sperm.
• It also has other important roles in the body. In men, it is thought to regulate bone mass, fat distribution, muscle mass and strength, beard and body hair and the production of red blood cells.

Why do I have low Testosterone?

• Testosterone does decline with age, but it does not affect fertility drastically.
• Hypogonadism (low sex hormones) in a man refers to a decrease in one or both of the two major functions of the testes: sperm production and testosterone production.
• These abnormalities usually result from diseases of the testes (Primary hypogonadism) or from diseases of the Pituitary / Hypothalamus (Secondary hypogonadism).
• Some causes of low testosterone include
  
  • a) Obesity: fat cells metabolise testosterone to oestrogen, and also increase certain proteins that bind to the hormone, lowering testosterone levels.
  • b) Smoking: chronic exposure to tobacco may lead to decrease in testosterone.
  • c) Underweight and malnutrition.
  • d) Excessive exercise, by disrupting the endocrine balance.
  • e) Genetic disorders: such as Klinefelter syndrome.
  • f) Pituitary disorders and tumours.
  • g) Undescended testes: if not corrected early in life.
  • h) Testicular injury or surgery: if only one testis is injured, testosterone may be normal.
  • i) Abnormally high iron levels, known as haemochromatosis.
  • j) Cancer treatment: chemotherapy and radiotherapy may temporarily or permanently cause low testosterone and impair sperm production.
  • k) Major illness or surgery: this will usually reverse in time, except for some infections like mumps.
  • l) Medical or recreational drug use.
  • m) High levels of stress.

  How is it diagnosed?

  Low testosterone is diagnosed by a blood test, when levels fall below 300 ng/dL. 300 to 1,000 ng/dL is supposed to be the normal range.

  Does low testosterone affect fertility?

  • It may cause sexual desire impairment and erectile dysfunction.
  • A decline in sperm production may be seen. Can it be treated with taking testosterone supplements?
  • Testosterone replacement therapy can bring your testosterone levels back to normal and restore your sex drive.
  • BUT, 90% of men can drop their sperm counts to zero while on testosterone.
  • By increasing testosterone, you are not going to increase fertility.

  How does high testosterone affect me?

  • Cause is more frequently due to use or abuse of anabolic steroids.
  • It occurs rarely due to other medical conditions.
  • Can cause side effects other than fertility impairment like Prostate swelling, Breast enlargement, worsening of sleep apnoea, Fluid retention, decrease in testicular size. What treatments are available for fertility issues because of low testosterone?
  • Depends on the cause.
  • Correction and treatment of secondary factors.
  • Treatment with medication like clomiphene, letrozole may help increase gonadotropins which then boost sperm and testosterone production.
  • Or direct gonadotropin supplementation may help.
  • If the cause cannot be corrected or medical treatment fails, advanced treatments like IUI or IVF/ICSI might be needed.

  May I take Testosterone if I may want to have children in the future?

  • Patients and providers should be aware that testosterone treatment causes lowered sperm counts and hormone alterations. Any man who wants to have his own children in future must abstain from any kind of testosterone treatment.

  Are there other risks to taking testosterone?

  • The long-term safety and effectiveness of testosterone supplementation are not known. Men considering treatment should discuss these risks and possible benefits with their health-care provider.
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