Low Testosterone & Male Infertility

Low testosterone & male fertility at a glance

• Testosterone (T) is a key male hormone. Low testosterone occurs when a man’s testosterone drops below normal levels. It can directly affect fertility by causing decreased sperm production and indirectly affect fertility by reducing his sex drive and causing erectile dysfunction.
• Men with low testosterone levels, called hypogonadism in medical terms and commonly known as low T, can still have enough of the hormone for sperm production.
• Risk factors for low T include advancing age, obesity, testicular injury, excessive alcohol consumption, chronic narcotic use, marijuana abuse, diabetes and cancer treatments such as chemotherapy.
• Lifestyle changes such as quitting smoking and losing weight may help balance testosterone levels naturally.
• Testosterone replacement therapy, a popular way to treat low levels, may actually lower sperm count and should not be used by men trying to conceive.

What is low testosterone?

When an adult male’s testosterone level falls below the normal range of around 270 to 1,070 nanograms per deciliter (ng/dL) he is said to have low testosterone. However, what is a normal testosterone level can differ for individual men.

Low testosterone is also known as hypogonadism, which can be present during fetal development or become apparent in childhood. Hypogonadism can cause a variety of problems. In adults, it can alter physical characteristics, such as decreased hair growth, and hamper normal reproduction.

Testosterone is a male sex hormone (known as an androgen) produced in the male testicles that is required for sperm production. Testosterone also affects a man’s sense of virility and sexual function. Testosterone helps in the development of muscle, bones, the penis and testicles. Both men and women have testosterone, but males have higher amounts.

The primary cause of low testosterone is age, because as men age their testosterone levels will normally drop. This generally begins around middle age. Some physicians consider low testosterone a normal part of aging and recommend doing nothing about it.

But the number of men being treated for low testosterone has increased significantly in recent years. This is because companies now market medications for low testosterone directly to men. (See section below for treatments.)

NOTE: An important side effect of the low testosterone treatment known as testosterone replacement therapy (TRT) is infertility. TRT can decrease sperm production because it also lowers the level of the follicle-stimulating hormone (FSH), which is responsible for stimulating sperm production. In many cases, the infertility caused by testosterone treatment can be reversed.

Therefore, men seeking to conceive with their partner should not use medications to treat their low testosterone.

Low testosterone’s effect on male fertility

Low testosterone does not always directly cause infertility. Men with low testosterone can still produce healthy sperm because sperm production is mainly stimulated by other hormones. However, low levels of testosterone may result in decreased production of sperm. The levels of testosterone in the testicles, where sperm is produced, is much higher than testosterone levels in the blood.

Low testosterone’s indirect effect on fertility involves a reduced sex drive that can result in a lack of desire to even have sex. It can also cause erectile dysfunction by causing a man to have fewer erections or erections that aren’t as strong as they once were. This can make it difficult to reach climax or to have sex often enough for reproduction.

Causes of low testosterone

In addition to natural aging, stress, excessive alcohol consumption, marijuana use, chronic opioid use, soy intake and hormones present in food may all affect a man’s testosterone levels. Low testosterone may also be caused by testicular cancer, early or late delayed puberty and kidney disease.

Some other risk factors for low testosterone include:

• Obesity
• Diabetes
• Injury to the testicles
• Cancer treatments such as chemotherapy and radiation.

Men can get their testosterone levels tested by their doctor. Usually this test is performed in the morning when testosterone levels are usually at their highest. Blood is drawn and analyzed for testosterone levels. We recommend that men be tested at least twice before taking any action.

How is low testosterone treated?

Whether or not a man seeks treatment should depend on how low his testosterone is and if he is experiencing bothersome degrees of symptoms, including:

• Reduced sex drive
• Fewer erections and weaker erections
• Loss of muscle mass
• Fatigue
• Mood swings

Before entering into testosterone replacement therapy (TRT), men should try lifestyle changes first.

Lifestyle changes

First, men should make sure they are taking proper care of their testicles. This includes keeping the testicles and scrotum cool. Men may need to avoid hot tubs and saunas and keep their laptop computers off of their laps.

Some other lifestyle changes that will balance testosterone levels:

• Stop smoking. Men who smoke have lower levels of varying hormones including testosterone.
• Losing weight. Overweight men can have diminished testosterone levels.
• Complementing a nutritious diet with exercise should also help improve testosterone levels.

Testosterone replacement therapy

Clinical therapies are available for men who feel as though their quality of life (sex drive, energy levels, etc.) is affected by low testosterone levels. The popular testosterone replacement therapy (TRT), involves delivering testosterone to boost levels. This can be done in several ways:

• Injections in the muscle
• Gels
• Patches
• Oral tablets
• Nasal sprays
• Implants placed under the skin.

Remember: Men who want to conceive should not undergo TRT.

For more information about male factor infertility, speak with a fertility specialist at LLU today.

Low Testosterone and Semen Parameters in Male Partners of Infertile Couples Undergoing IVF with a Total Sperm Count Greater than 5 Million

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How to determine low testosterone levels, what is affected by male hormone deficiency – December 18, 2022

Andrologist told how testosterone deficiency can worsen a man’s life in all matters

Collage: Philip Sapegin / E1.RU

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Our body is a complex system, so the slightest failure or imbalance in it can affect the work of all organs. For male health, the concentration of the hormone testosterone is extremely important. With its lack, a man will not have strength, he will not be able to fully relax, even if he gets enough sleep, and still does not want sex. That is, not enough testosterone – there is no full life.

Andrologist told how to determine the lack of “male power” and how to regain it.

Roman Viktorovich Rozhivanov — andrologist, urologist, Doctor of Medical Sciences, Chief Researcher, Professor of the Department of Endocrinology of the National Medical Research Center for Endocrinology of the Ministry of Health of Russia.

Andrology is a narrower specialization of the urologist, requiring a much deeper and more comprehensive knowledge of the male reproductive system, its diseases and possible treatments.

– First of all, it is a hormone of sexual activity: it affects the production of sperm, the ability to fertilize and sexual function, the differentiation of the genital organs (their formation in the unborn fetus. – Note ed. ). This is his classic role, but not the only one, since testosterone is also a very important anabolic hormone. That is, under its action, the development of muscles, bones, strengthening of the body, the development of endurance and strength occur.

The metabolic function is also important: regulation of the interaction of cells with other hormones and other factors of the biochemistry of our body. Here we are talking about normal carbohydrate metabolism, which does not allow obesity. A classic example of metabolic dysfunction is a neutered cat. During castration, sexual function is lost so that the cat does not have the motivation to run after the cat, while the animal becomes lethargic and inactive, and obesity develops. That is, testosterone was removed, and metabolic disorders began in the body.

The work of almost all organs and systems, even the central nervous system, depends on this hormone. It has also been found that the concentration of testosterone affects many psychological factors.

The work of almost all organs and systems depends on testosterone. With a low level of the hormone, a man can feel tired all the time. A person in the body should have a normal level of any hormone.

Low testosterone levels clearly affect health: obesity can develop, sexual dysfunction, depression, fatigue and weakness will appear, bone mineral density will decrease, and carbohydrate metabolism will worsen.

High testosterone levels, although it carries fewer health risks for men, but also has its effect. The risk of developing skin acne (acne disease. – Note ed. ), baldness, “thickening” of the blood, that is, an increase in hemoglobin and hematocrit levels, increases.

— Directly, because it is a hormone of sexual activity. There is a center in the brain that is responsible for sexual desire (libido). If there is little testosterone, then the release of nitric oxide, a neurotransmitter that is produced in neurons and due to which they interact, decreases in the neurons of this center. And when the synthesis of this substance decreases, the impulses are transmitted worse. As a result, the patient’s sexual desire decreases.

– There are no exact symptoms of testosterone deficiency. Even general weakness or deterioration in mood can signal about it. Most often, there is a decrease in sexual activity and desire, but it cannot be said for sure that the problem is always in the lack of testosterone. Any trouble in the body of a man can be associated with a deficiency of this hormone.

The man comes to the appointment, we do a screening and determine if the complaints are related to low testosterone levels or something else.

– Deficiency may be caused by congenital diseases, the boy may be born with underdeveloped testicles or with no testicles. If we are talking about an acquired deficiency, then diseases of the testicles or the pituitary gland lead to it. Also, testosterone levels can decrease with age, that is, after 30 years, its production in men decreases. But this is a gradual process, and its duration depends on many factors.

For example, if obesity develops with testosterone deficiency, then hormone production will decrease faster. If the patient has chronic diseases, such as diabetes, then this is also a catalyst for the process of lowering the hormone level.

– There are two main factors that lead to acquired testosterone deficiency – obesity and stress. Physical inactivity also has a negative effect, albeit to a lesser extent, (inactivity. – Note ed. ), smoking, taking certain medications.

With low testosterone, a man may not want sex, even if everything is in order with his beloved

Illustration: Philip Sapegin / E1.RU

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this process becomes noticeable after 30 years. But if there are concomitant diseases, such as visceral obesity, then testosterone deficiency can be diagnosed even at 20 years old.

— Globally, there are two modern diagnostic methods. The most common and affordable is enzyme immunoassay (ELISA), it has a high accuracy (about 90%). There is also a method of mass spectrometric analysis, in which chromatography is first performed: the separation of steroid hormones occurs. This is more expensive, but if the doctor has doubts or borderline testosterone levels are observed, then it is worth resorting to this option.

– Yes, in most regions a man can have his testosterone levels checked by the CHI by order of a doctor. Globally, any doctor can refer to this analysis, but it is urologists-andrologists and endocrinologists who mainly deal with the problem of testosterone deficiency.

— A man is naturally given everything to maintain normal testosterone levels. Therefore, the main task is to maintain. To do this, you need to try not to be exposed to chronic stress, observe sleep patterns, monitor nutrition and exercise. In other words, all these recommendations are related to a healthy lifestyle.

– Such products do not exist, this is a myth. It is important to monitor your diet in general, it must be balanced. People often turn to unreliable sources and begin to self-medicate. Therefore, recommendations on the Internet should be considered only in terms of obtaining information.

In this regard, I like the social project “Wild Male Nature”, which draws attention to the problem of testosterone deficiency through non-standard comparison of the symptoms of this condition with the characteristics of wild animals. In this case, a man can take a test and get a recommendation to contact an andrologist or endocrinologist. But seeing a doctor will not replace anything for you.

Reduced testosterone levels are affected by chronic stress, obesity, diabetes and other diseases. But often this process is reversible. Irreversibility is associated with complications. For example, if a patient has not treated testosterone deficiency for a long time and he has already experienced atrophy of certain tissues of the penis, erectile dysfunction has occurred, then the doctor can raise the hormone level, but the consequences must be addressed separately.

– Obesity, diabetes mellitus, erectile dysfunction (a man’s inability to maintain a sufficient level of erection for full sexual intercourse. – Note ed. ), low libido and chronic diseases of the genitourinary system (prostatitis, prostatic hyperplasia).

— If we talk about diabetes mellitus, then in medicine there is such a thing as a pathological vicious circle. This happens when one indicator worsens the other, and that, in turn, affects the first one negatively. The links of the system in a cycle begin to negatively influence each other, worsening the problem more and more. Therefore, testosterone deficiency and carbohydrate metabolism disorders form a pathological vicious circle.

If a man is deficient in testosterone, this will lead to a deterioration in tissue sensitivity to insulin. The body will try to produce more insulin, which in turn will lead to an increase in adipose tissue cells, which have an enzyme that converts testosterone into other hormones that suppress the activity of the pituitary gland (for example, female hormones). The pituitary gland reduces the amount of production of testosterone stimulants, then the body’s sensitivity to insulin decreases – and so on in a circle.

The reverse occurs when a man has normal testosterone levels but has developed visceral obesity or diabetes. Here the main point is insulin resistance, that is, the sensitivity of tissues to insulin, in which there is a violation of the production of hormones responsible for stimulating the production of testosterone. Low testosterone leads to decreased insulin sensitivity. The circle is closed.

– This decision requires an additional examination, which can only be ordered by a doctor. If he decides that the deficiency is potentially reversible, then a change in the factors affecting the patient’s life is in play. A person must lose weight, we must compensate for his carbohydrate metabolism. After that, in some patients, testosterone levels normalize.

If the situation is irreversible, then prescribe drugs that promote own production of testosterone, or, if this is not possible, substitution therapy.

– There are no statistical studies on this topic, so I would not say that testosterone deficiency among men has increased in recent years.

However, we can say that over the past few years the problem of sexual dysfunction in men has worsened, which is logical: the environment is deteriorating, more and more stress factors are appearing. All this does not contribute to normal male sexual function.

The prevalence of obesity has also increased in principle. Obesity is one of the risk factors for sexual dysfunction and testosterone deficiency. In this vein, we can talk about some kind of relationship.

Previously, a urologist told how covid affects man’s dignity and why. A new coronavirus infection also affects reproductive function. During and after the illness, the qualitative and quantitative indicators of the spermogram sharply decrease.

Self-care: Self-care: Lenta.ru

It is difficult to overestimate the influence of sex hormones on mood, endocrine processes and sexual desire. At the same time, many believe that testosterone is an exclusively male hormone. However, it is also produced in women, albeit in smaller quantities. Lenta.ru tried to answer why both sexes need testosterone and why its deficiency and excess are dangerous.

What is testosterone

Testosterone is the main male sex hormone. It plays a key role in the development and maintenance of sexual function in both sexes, and in men is directly related to reproductive function.

In the male body, this hormone is produced by the testicles and adrenal glands; in the female body, by the ovaries and adrenal glands. In both those and others, it is formed from cholesterol, and its production is regulated by the pituitary gland.

Testosterone in men

In men, testosterone is involved in the development of secondary sexual characteristics and reproductive organs. It is because of him that during puberty, the voice changes in boys, the growth of hair on the body begins. Also, this hormone contributes to an increase in muscle mass, affects the amount of fat and bone density.

Mood, vitality, intelligence, good sleep are associated with testosterone. Sexual desire, erection – also the effect of testosterone

Alexander Lubennikovurologist, andrologist, doctor of medical sciences

Testosterone in women

In women, this hormone is synthesized in a smaller amount, but it is also very important. It is involved in the processes of maturation of the egg, is responsible for the formation of the skeleton and regeneration of bone tissue, and regulates the functioning of the sebaceous glands. In addition, testosterone helps control stress and has a beneficial effect on mood.

In women, testosterone ensures the normal functioning of physiological processes occurring in the central nervous system, mammary glands and ovaries

Tamara Nuraeva obstetrician-gynecologist at the L7 Breast Center

Photo: Taisiia Shestopal / Unsplash

Testosterone affects potency 90 128

Precisely testosterone largely determines the level of male libido. A significant deficiency of this hormone (up to 80 percent of the norm) can lead to erectile dysfunction.

With low testosterone levels, sexual activity decreases, the number of erections decreases

At the same time, this is not the only factor that determines sexual desire. It can be affected, for example, by stress or depression, which can completely discourage interest in sex even with a normal level of male hormones in the body.

Libido also depends on testosterone in women

Testosterone is involved in the regulation of sexual desire in women along with estradiol, the main female sex hormone from the estrogen group.

Sexual activity, as well as the frequency and severity of orgasms in women depends on testosterone

At the same time, the results of scientific studies related to the study of the relationship between testosterone and women’s interest in intimacy are ambiguous. Some experts believe that the exacerbation of sexual desires during the period of ovulation is due to the highest level of testosterone in the body, others are sure that this effect is caused by estrogen, which prevails in the body until the middle of the menstrual cycle.

Testosterone causes aggression

Testosterone also affects behavior. It is widely believed that an increased level of this hormone makes a man more aggressive and risk-averse. Experts have different opinions about whether this is true. According to andrologist Georgy Mskhalay, a man with a high level of testosterone has more needs, more self-confidence, he is more striving for success.

I have a patient who, after normalizing testosterone levels, defended a doctoral dissertation that he could not defend before, and was still wondering if he needed it

Georgiy Mskhalaya andrologist, endocrinologist of the European Medical Center

Testosterone in bodybuilding

Testosterone accelerates the growth of muscle mass, so preparations based on it are often taken by bodybuilders. However, experts believe that this can lead to serious health problems. Unpleasant side effects are possible even after stopping the use of such drugs.

According to the therapist Elena Tikhomirova, testosterone abuse significantly increases the risk of heart attack, stroke and other cardiovascular diseases. And after the rejection of drugs with testosterone, a withdrawal syndrome occurs, against which depression can begin. Infertility is also possible.

There are men who inject themselves with extra injections, use illicit drugs and raise their testosterone levels to five, ten times the norm. Of course, their aggression is higher

Georgy Mskhalaya andrologist, endocrinologist of the European Medical Center

Photo: Steven Erixon / Unsplash

Blood testosterone level

Testosterone level depends on sex, age, time of day, physical activity and many other factors. After the age of 30, the level of this hormone in the blood in men drops by one to two percent per year. By the age of 50, testosterone deficiency reaches 25-30 percent, and this begins to affect health and cognitive abilities.

Experts recommend taking blood tests to determine testosterone levels between 7 am and 11 am, on an empty stomach, since sex hormone secretion is highest in the morning.

Testosterone begins to be produced at night, during the phase of non-REM sleep, and the longer the rest, the stronger its production. Under normal sleep and wakefulness, the concentration of the hormone reaches its maximum by 5-6 o’clock in the morning

Vera BarinovaHead of the NACFF Clinical Diagnostic Laboratory

Men’s testosterone levels

Men’s testosterone levels are 20 times higher than those of women and children, ranging from 12.15 to 37.48 nanomoles/liter.

Age	Testosterone levels (nanomoles/liter)
after 18 years	12.15 – 37.48
20-39 years old	13. 88 – 37.48
40-59 years old	12.15 – 30.88
over 60 years old	12.15 – 24.98

A drop in total testosterone below 12.1 nanomoles/liter is cause for concern. In such cases, an additional analysis for free testosterone should be taken.

Testosterone levels in women

Testosterone levels in women are significantly lower. Between the ages of 18 and 49, values ​​from 0.31 to 3.78 nanomoles / liter are considered normal. During pregnancy, this figure may increase several times, but then falls again.

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What happens when there is a lack of testosterone in childhood

In boys, low testosterone levels are associated with some congenital disorders, underdevelopment or undescended testicles. As you grow older, its deficiency is manifested by a number of characteristic symptoms: eunuchoid proportions of the body (long limbs, shortened torso), poorly developed muscles, and pale skin.

According to andrologist Alexander Lubennikov, boys with low testosterone also have breast enlargement, no pubic hair, a high pitched voice, a penis less than five centimeters long, and very small testicles.

What signs indicate a lack of testosterone

With a lack of testosterone in men, sexual desire decreases, erection problems begin, and muscle mass decreases. Up to 90 percent of men who have this problem suffer from baldness.

Here are some typical signs of testosterone deficiency:

• decreased libido,
• reduced sperm count,
• erection problems,
• body hair reduction,
• breast augmentation,
• decrease in muscle mass,
• increased risk of fractures,
• frequent mood swings,
• high fatigue,
• irritability,
• sleep disorders,
• cognitive decline,
• alopecia.

If the testosterone level goes below the norm, irritability, nervousness, and internal tension begin to rise. A man becomes more capricious, easily irritated

Georgy Mskhalayaandrologist, endocrinologist of the European Medical Center

Why testosterone levels fall

In addition to age, in adult men, testosterone levels are reduced by:

• obesity,
• damage or inflammation of the testicles,
• diabetes,
• chronic diseases of the cardiovascular and respiratory systems,
• chronic kidney pathologies,
• diseases or injuries of the hypothalamus and pituitary gland,
• taking steroids,
• alcoholism and drug use.

Low testosterone can be seen in testicular and pituitary disorders such as Klinefelter’s syndrome, Kallman’s syndrome, and in men with idiopathic, metabolic, or iatrogenic disorders leading to androgen deficiency

Alexander Sysoevdoctor urologist-andrologist of the highest category “SM-Clinic”

Lack of testosterone in women

Testosterone levels in women can fall during menopause, with diseases of the ovaries, pituitary and adrenal glands, various pathologies of the thyroid gland, with bulimia and anorexia, when switching to a low-fat diet or taking certain medications, such as glucocorticoids.

Women with low testosterone may experience:

• insomnia,
• fatigue,
• pain in bones and muscles,
• abdominal obesity,
• decreased libido,
• menstrual disorders,
• cognitive decline,
• depression.

The main manifestations of testosterone deficiency in women are a general deterioration in well-being and a decrease in sexual desire. Vaginal dryness may also appear, the menstrual cycle is disturbed. Due to the lack of a male hormone, a woman becomes less resilient, her cognitive abilities decrease, and depression may develop

Tamara Nuraeva obstetrician-gynecologist at the Breast Center L7

Photo: Klara Kulikova / Unsplash

How to increase testosterone

If the deviation from the norm is insignificant, testosterone levels can be increased simply by changing lifestyle. According to andrologist Alexander Sysoev, there are several simple means to eliminate the lack of this hormone in one to three months.

• Regular sleep for at least seven hours a day, and it is important to learn to go to bed and wake up at the same time
• Moderate and regular exercise. It is better to do gymnastics or run for half an hour every day than to do four hours of strength training once a week
• Stop smoking and alcohol, stop taking steroid supplements
• Refusal of fatty, smoked and fried foods. Also, do not get carried away with sweet desserts
• Eating fresh marine fish, seaweed or other seafood containing zinc

An increase in physical activity can lead to an increase in androgen levels in both men and women, which has been proven by numerous studies. At the same time, strength training is considered the most effective. Treatment of concomitant diseases, weight loss and dietary review will also help to adjust the level of androgens

Tamara Nuraeva obstetrician-gynecologist of the L7 Breast Center

It should be understood that such methods work only in cases where testosterone deficiency is caused by temporary problems – for example, a sharp change in the daily routine and lifestyle, stress, strong feelings.