Low Testosterone and Male Fertility

What not all clinics are telling you about harms of testosterone therapy on your fertility

  •  Testosterone therapy can interrupt normal production/development of sperm resulting in VERY low or complete absence of sperm in the ejaculate.       
  • After stopping testosterone therapy, amount of time to and degree of sperm recovery varies
  • Some men with infertility may never recover sperm production/development after testosterone therapy

 

The “Do’s” when it comes to low testosterone and fertility

  •     See a hormone/reproductive specialist prior to starting any testosterone therapy
  •     Talk to your specialist about AIs, HCG, and SERMs
  •     Consider cryopreservation (freezing sperm) prior to starting testosterone therapy

 

The “Don’t” when it comes to low testosterone and fertility

  •       Take testosterone while actively trying to have a child (unless under guidance by reproductive specialist and other safe measures are in place)

Testosterone therapy has many potential benefits for adult men of all ages. When considering starting testosterone therapy, healthcare providers and patients need to consider how therapy might cause harm. For men interested in having children, testosterone therapy can, in fact, be harmful. The American Urological Association guidelines published in 2018 review low testosterone, testosterone therapy, and fertility considerations.

Testosterone therapy can interrupt normal production/development of sperm resulting in VERY low or complete absence of sperm in the ejaculate. For this reason, men actively trying to conceive should not be on testosterone therapy. 

As with anything in medicine, and in life, this topic of testosterone therapy and fertility is not so black and white and this is where the art of medicine and understanding risks and benefits can be particularly important. Alternative therapies to testosterone that preserve fertility (and may improve sperm parameters and testosterone levels) include Selective Estrogen Receptor Modulators (SERMs), Aromatase Inhibitors (AIs), and Human Chorionic Gonadotropin (HCG). These therapies may also be used in combination with testosterone therapy to prevent excessive conversion of testosterone to estrogen (AIs) and to stimulate Leydig cells in the testicle to produce some testosterone (to prevent testicles from shrinking; can be used for men on testosterone therapy interested in future fertility). 

Symptoms of low testosterone can be very bothersome and have significant negative effects on quality of life. Therefore, optimizing hormones and preserving current and future fertility requires a personalized approach with consideration of risks and benefits. Importantly, even after stopping testosterone therapy, it can take a variable amount of time for sperm production and development to recover and, some men, may never recover sperm production/development after testosterone therapy.

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Benefits of testosterone therapy

Testosterone may improve:

  •     Erectile function
  •     Low sex drive
  •     Anemia
  •     Bone mineral density
  •     Lean body mass
  •     Depressive symptoms

Men with low testosterone levels may report reduced energy and/or endurance, diminished work and/or physical performance, loss of body hair/reduced beard growth, fatigue, reduced lean muscle mass, obesity, depressive symptoms, cognitive dysfunction, reduced motivation, poor concentration, poor memory, irritability, reduced sex drive and/or erectile function. These signs and symptoms can have detrimental effects on various aspects of a man’s physical and mental health. The American Urological Association guidelines published in 2018 review the benefits of testosterone therapy.

The purpose of testosterone therapy is to restore men to normal testosterone levels and improve their signs/symptoms. Research suggests that testosterone therapy for men with low testosterone levels can improve erectile function, sex drive, anemia, bone mineral density, lean body mass, and depressive symptoms. Though research is indeterminate, men with low testosterone levels on testosterone therapy may also experience improvements in cognitive function, diabetic control, energy, lipids, and quality of life measures.

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Testosterone therapy and prostate cancer

The bad news: Risk of developing low testosterone and prostate cancer increases with age

The good news: There is no evidence that testosterone therapy leads to the development of prostate cancer. Prostate cancer, when caught early, is very curable.

The topic of testosterone therapy and prostate cancer has been a hotly debated topic stemming from research published in 1941 when metastatic prostate cancer was treated by reducing levels of male hormones. The theory of testosterone increasing likelihood of developing prostate cancer has since been debunked, although FDA warnings regarding the risk of prostate cancer when taking testosterone products, still exist. The American Urological Association guidelines published in 2018 review the evidence on testosterone therapy and prostate cancer.

Equally controversial has been the topic of testosterone therapy for men with a history of prostate cancer (treated with surgery and/or radiation). And, although product labels for testosterone products warn that men with a history of prostate cancer should not be on testosterone therapy, decision to proceed with treatment should be based on shared decision making between the patient and healthcare provider, understanding that there is inadequate evidence to currently quantify the risk-benefit ratio of being on therapy. 

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Lifestyle changes to boost testosterone

  •     Weight loss (or maintaining within recommended range)
  •     Physical activity

Men with low testosterone should consider lifestyle modification to boost their own body’s ability to produce testosterone prior to starting testosterone therapy. The American Urological Association guidelines published in 2018 review the evidence on low testosterone and lifestyle modification.

Losing weight (or maintaining within recommended range) and increasing physical activity may increase testosterone levels and, perhaps more importantly, improve signs/symptoms commonly associated with low testosterone. Men on testosterone therapy should also strive for a healthy weight and regular exercise program to optimize overall health and wellness.

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