The Truth About Testosterone and Male Fertility

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Dr. Puneet Masson
Dr. Puneet Masson

When you think of testosterone, traditionally masculine images and words may come to mind: facial and body hair, toned muscles, virility.

If the idea of testosterone stirs up all things male, then what are the implications of low or no testosterone? Many might assume that less testosterone makes you less manly. Now add pregnancy to the mix. With low or no testosterone, conception would be tricky.

You might believe the most natural fix would be to take testosterone. It makes sense that added testosterone will surely boost your manliness, including your fertility, right? Well, not exactly.

Doing so can lead to problems, according to Puneet Masson, MD, assistant professor of Urology and director of the Male Fertility Program at Penn Fertility Care.

What Low Testosterone Really Means

“Hypogonadism—or low testosterone—can lead to issues with sexual desire,” Dr. Masson says. “It can alter a man’s libido. It could affect sexual functioning—namely, erections. It can also affect the development of sperm.”

In other words: “Low testosterone can definitely affect a man who’s having difficulty achieving a pregnancy,” he says.

A man’s testosterone levels fluctuate throughout the day. They’re usually highest in the morning and lowest at night; however, there are a few things that can lower testosterone levels:

Six things that can lower testosterone levels

Why Taking Testosterone Supplements for Fertility Is a Bad Idea

“Many times people feel that, ‘Oh, I have low testosterone—it affects fertility—I should take a testosterone supplement,’” Dr. Masson says. “That’s actually something we do not want them to do. If a man is taking any extra testosterone, it can basically shut off his body’s ability to make its own testosterone—and the body’s ability to make its own sperm.”

The number of men taking testosterone supplements has noticeably increased in the last decade. This growth is even among men who don’t need to because their testosterone levels are normal, according to a March 2014 study in the Journal of Endocrinology and Metabolism.

“There’s a lot of misuse of these supplements and treatments,” Dr. Masson adds. “People take them as a sort of anti-aging treatment when they have normal testosterone. Testosterone replacement therapy should be given to someone who has low testosterone and is symptomatic from it.”

Potential causes of low testosterone include:

  • Chronic diseases, such as liver or kidney disease, obesity or Type 2 diabetes
  • Underactive pituitary gland
  • Injury or disease of the hypothalamus (the part of the brain responsible for hormone production)
  • Injury or disease of the testicles
  • Non-cancerous tumor in the pituitary cells
  • Genetic conditions, such as Klinefelter syndrome
  • Certain medications, such as opiate painkillers
  • Radiation or chemotherapy
Sources: Penn Medicine Health Encyclopedia, Hormone Health Network

Low Testosterone Treatment When Trying to Get Pregnant

“When men come in with low testosterone, they may have already gone to another provider who put them on a testosterone supplement,” Dr. Masson says.

He explains, “Many times I’m taking these guys off of supplements or medications and putting them on something to get their body to make its own testosterone.”

Dr. Masson does this because the goal is “to stir up testicular testosterone production in a man with low testosterone who is interested in fatherhood,” he says.

Additionally, taking exogenous—or external testosterone— shuts off other hormones essential for sperm development. “Many times, these potential fathers have no idea that they are actually undermining their fertility by taking these medications,” adds Dr. Masson.

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