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How Low Testosterone Affects Fertility

You may already know that low testosterone can cause you to lose interest in having sex and to have weaker and fewer erections. But it can also affect your fertility.

“Low testosterone can cause infertility, but it also may represent a testicular problem that results in infertility,”says Harris M. Nagler, MD, chair emeritus of the Sol and Margaret Berger Department of Urology and professor of urology at the Icahn School of Medicine at Mount Sinai in New York.

One treatment for low testosterone is testosterone replacement therapy. But taking testosterone can hurt your fertility, Dr. Nagler says. Here’s why:

A part of the brain (the hypothalamus) and the pituitary gland, which sits just below it, help control male fertility. The hypothalamus produces a chemical, gonadotropin-releasing hormone (GnRH) that sends a message to the pituitary gland to tell it to produce two important fertility hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). FSH triggers the creation of sperm cells. LH tells the testes to produce testosterone, which is needed for sperm production.

When you take testosterone, your brain thinks it’s done its job and slows down the production of GnRH. Because it’s not getting the message, your pituitary gland no longer produces normal levels of the other hormones, FSH and LH, needed to make sperm. As a result, your sperm production decreases. The lower your sperm count, the less chance you have of fathering a child.

Men who have low testosterone and are struggling with infertility should see a urologist or an endocrinologist who specializes in male reproduction. After diagnosis, you and your doctor can determine the best treatment for your low testosterone based on your goals, which may be sexual function or reproductive function.

“The treatments are different and need to be tailored to your goals,” Nagler says. If fertility is an issue, your doctor may suggest gonadotropin injections to stimulate the testicles to make more testosterone and sperm.

Steps to Boost Fertility

If you have low testosterone, certain lifestyle factors may help boost your fertility. Consider these tactics:

Keep your private parts cool. “Anything that heats up the genital area for excessive amounts of time can lower sperm counts,” says Suzanne Kavic, MD, a reproductive endocrinologist at Loyola Medicine in Chicago. “Sperm don’t like warm temperatures. That’s why the testes are outside the body.” So avoid saunas, hot tubs, and hot baths. Keep your laptop (which can get warm) off of your lap.

Lose weight. Being overweight can change your hormone levels and adversely affect your sperm production. “Men who are obese may have lower testosterone levels because their belly fat converts their testosterone to estrogen,” says Jay Simhan, MD, a urologist at the Einstein Healthcare Network in Philadelphia. “Shedding those extra pounds may have a positive effect on your testosterone and on your fertility.” Even if weight loss doesn’t increase your sperm count, Nagler says, it can make you feel better about yourself and improve your outlook.

Don’t smoke. One study of Saudi Arabian men who visited infertility clinics found that those who smoked had lower reproductive hormone levels than nonsmokers. The study was published in the January-March 2015 issue of the journal Urology Annals. If you smoke, quit.

Be careful with drugs. Some drugs — like steroids and narcotics — can affect sperm production, the Endocrine Society reports. If you need these medications to treat other health concerns, talk with your doctor, Dr. Kavic says. Recreational drugs, including marijuana, also have been linked to low testosterone, according to an article published in the September/October 2014 issue of the journal Trends in Urology & Men’s Health.

Limit alcohol. Excessive alcohol consumption can decrease the amount of testosterone in a man’s body, according to the National Institute on Alcohol Abuse and Alcoholism. Alcohol impairs the secretion of the hormones LH and FSH, according to the article in the journal Trends in Urology & Men’s Health. “Everyone is encouraged to drink alcohol in moderation for their general health,” Kavic says.

Get enough vitamin D. Chinese men who had lower levels of vitamin D also had lower levels of testosterone, according to a study published in July 2015 in the journal Reproductive Biology and Endocrinology. Good sources of vitamin D include fatty fish, mushrooms, and fortified foods such as cereal. Sunlight also is a source of vitamin D, but limit your sun exposure because of the risk of cancer.

Exercise regularly. Exercise not only helps you lose weight and reduce stress, but it can also help build testosterone, Nagler says. A regular routine of aerobic exercise and strength training is considered the most effective.

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Can Testosterone Levels Affect Fertility?

While it is common knowledge that low testosterone can affect sexual performance, many may not be aware that testosterone has an impact on fertility as well. Testosterone is one of the hormones that aids in the production of sperm, so it is important that you have the correctly-balanced levels of testosterone and other hormones to maintain reproductive health.

Testosterone and Sperm Count

When testosterone levels are too low, sperm count is reduced. Conversely, when testosterone levels are too high, sperm count is often reduced. This is because an overabundance of testosterone can lead to the body decreasing production of FSH, or the follicle-stimulating hormone, which is another important hormone that serves a function in sperm production.

If you are having problems conceiving or are concerned about fertility for another reason, you may want to have your testosterone levels evaluated. If you are taking testosterone, you should stop immediately as this may be decreasing your sperm count. In most cases where synthetic hormones are not involved, it is more likely that your testosterone levels are too low.

How can I test my testosterone levels?

Testosterone levels can be measured through a simple blood test. At the Center for Male Reproductive Medicine & Vasectomy Reversal, we can perform a blood test to measure your testosterone levels.

We can also test for other issues that may be leading to a lack of fertility. If medical problems are ruled out, we can create a plan to help you increase your sperm count by balancing your testosterone levels or other treatment – it is what we do, and what has led to a reputation as being the leaders in male reproductive health.

Can male fertility be improved?

Before undergoing any special treatment, there are several actions that could aid in achieving healthy testosterone levels. Some of the issues that could lead to low testosterone levels include:
• Being overweight
• Smoking cigarettes
• Drug use
• Excessive alcohol consumption

Our male infertility surgeon may recommend that you make some lifestyle changes before establishing a custom treatment plan. Increasing exercise may be an advised step as exercise aids in weight loss and can help to trigger an increase in testosterone levels.

Lifestyle Changes

The use of alcohol, cigarettes, and any recreational drugs have an impact on fertility, and lifestyle changes may be necessary. With a healthier lifestyle, the quantity of testosterone produced by your body could increase naturally.

The Right Environment for Fertility in Men

Our male fertility surgeon may advise you to keep your genital area cool, as sperm needs cooler temperatures to stay healthy. Men trying to conceive should avoid hot tubs, saunas, “hot yoga,” or any other high-heat environment. Avoid placing your laptop on your lap, as it warms up during use and will heat the groin area.

If you have made all the recommended lifestyle changes, have ruled out other medical problems, and are still having difficulty conceiving, a treatment plan can be established to balance your testosterone level.

Treatment Options

At the Center for Male Reproductive Medicine & Vasectomy Reversal, we have many treatment options available for men with low testosterone levels. While testosterone injections will merely lead to a reduced sperm count, we also treat our male patients with hormone therapy to aid in sperm production.

Human Chorionic Gonadotropin (HCG), Follicle Stimulating Hormone (FSH), Clomid, and Arimadex are examples of hormone therapy options that may be used to improve fertility. At our Los Angeles clinic, our world-renown male fertility doctor will thoroughly assess your unique situation through testing and work with you to create a custom treatment plan to aid in your level of fertility.

There has been a lot of information about low-T and fertility on the internet and television lately.

Low-T refers to a low testosterone level which can result in a number of symptoms in men. Testosterone is a hormone that is produced primarily in a man’s testicles. When the testosterone level is low it may cause symptoms such as lower sex drive, a lack of energy or increased fatigue, reduced muscle strength or endurance, less strong erections, and male infertility.

If you have one or more of these symptoms you may want to talk to your provider about having your testosterone level checked. It is normal for testosterone levels to gradually decrease as you get older. However, if you have a low T and have the symptoms associated with low T you may want to consider your options for treatment.

Before you start treatment it is important to have a discussion about your future fertility plans because taking testosterone supplements will dramatically reduce the amount of sperm your testes produce.

There are a number of different options for testosterone replacement for men with low T.

There are testosterone gels that are rubbed into your skin daily. There are also testosterone patches you can apply to your skin. Some men prefer to receive testosterone injections every one to two weeks rather than use the daily gels or patches. The injections are usually given into your buttocks and must be given by a provider. There are also longer acting testosterone pellets which can be inserted into your hip by your provider. Lastly, there is a new oral testosterone tablet which you can apply to your gums twice a day.

Any of the treatments will restore your testosterone to a normal or high level, but they have the side effect of reducing the amount of sperm your testicles produce which can result in infertility. The longer you are on the testosterone replacement the lower your sperm count will be, and prolonged treatment may result in permanent sterility.

If you have not started or completed your childbearing it is important to discuss male infertility and testosterone supplementation with your provider before starting treatment. There are options such as freezing your sperm before starting testosterone replacement that will enable you to have healthy sperm for fertility options later. You may also consider using medications that stimulate your testicles to produce more testosterone, such as Clomid, which do not have the side effects of lowering your sperm count.

Take the first step toward reaching your goal. Call our office today and schedule a consultation with one of our male fertility physicians. We serve the Austin, San Antonio, and Houston areas with comprehensive reproductive endocrinology and infertility care.

Testosterone Effect on Sperm

Millions of men in the United States use testosterone replacement therapy (TRT) to treat low testosterone (Low T). With the rise in testosterone supplement use, fertility doctors are warning men who would like to have children in the future to reconsider starting TRT.

Testosterone’s Role in Sperm Production

The pituitary gland produces follicle stimulating hormone (FSH) and luteinizing hormone (LH). LH stimulates the testes to release testosterone. When in balance, testosterone works with follicle stimulating hormone (FSH) to help generate sperm.

Testosterone Supplements and Infertility

Men suffering from low testosterone may experience fatigue and low libido. As a result, TRT has been on the rise, with men of all ages using testosterone supplements. However, fertility doctors are seeing many of these men as their testosterone supplements may be causing azoospermia (no sperm in their ejaculates).

The pituitary gland uses testosterone levels in the blood to determine how much FSH and LH to release for both testosterone and sperm production. When a man is given exogenous testosterone (much like when a woman takes birth control pills), their hypothalamus and pituitary believe the testis is already working and FSH and LH secretion are suppressed, leading to less production of testosterone in their own testes and reduced or failed sperm production (much like a woman does not release eggs while taking birth control pills).

Treating Low Testosterone without TRT

If you wish to have children in the future but are suffering from low testosterone, consider foregoing treatment or alternative treatment options. Low testosterone does not necessarily mean low sperm count. Your fertility doctor can conduct a sperm analysis if you and your partner are having difficulty conceiving.

To treat low testosterone without supplements, you may take an HCG supplement, which will increase your testosterone levels without negatively impacting FSH levels or sperm production. You may also decide to freeze sperm prior to starting TRT to preserve the ability to have biological children.

Stopping Testosterone Supplements

If you are already taking testosterone supplements and are still wanting biological children, your fertility doctor will likely recommend you cease taking testosterone. Studies have shown that sperm production will increase in most men after discontinuing supplements, although it typically takes 6 months or longer to resolve (up to 12 months has even been reported). Do not stop taking any medication without checking with your doctor first.

While the majority of men do not have permanent effects, a small percentage of men still had low sperm production after stopping testosterone. More studies and tests need to be conducted to determine whether or not testosterone supplements led to permanent sperm production issues.

For men suffering from low testosterone who would like the opportunity to have children, avoid TRT and work with your fertility doctor if you have challenges conceiving.

Some common symptoms of low levels of testosterone:

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At Dallas – Fort Worth Fertility Associates, we have been hearing a lot about low testosterone in the media and from our patients.

Millions of men are affected by a common condition known as Low T. But how does it affect fertility? Testosterone is made in the testicles and blood levels in some men drop over time, but the low levels that cause symptoms vary individually.

  • Low libido
  • Erectile dysfunction (ED)
  • Fatigue
  • Irritability
  • Difficulty concentrating
  • Depression

The symptoms listed above can have a very gradual onset when caused by slowly decreasing testosterone levels. Andropause describes the state caused by decreased testosterone levels related to aging. This normal decline occurs over many years and may have no symptoms.

For symptomatic males however, it is very important to talk to your fertility doctor. A simple blood test can diagnose a low testosterone level. Testosterone supplements can be taken in many different forms: topical creams, oral tablets or injections are common routes of administration. These treatments cause serum testosterone levels to rise and symptoms may improve within a few weeks, but may take as long as 3 months to completely improve.

Well-meaning doctors prescribe testosterone replacement therapy (TRT) without appreciating the effect this may have on male fertility and sperm counts.

Testosterone – a Delicate Balance

Testosterone is essential for sperm production, but elevated testosterone levels caused by supplements can cause the testicles to stop producing sperm. Low libido and erectile dysfunction decrease a man’s fertility, but ironically, testosterone supplementation can decrease sperm counts!

The good news is that sperm production will usually resume once testosterone supplements have not been taken for about 72 days (the life cycle of sperm).

The fertility doctors at Dallas – Fort Worth Fertility Associates are experienced in helping men with low testosterone levels conceive. There are therapies that do not involve direct testosterone supplementation that can improve symptoms without decreasing sperm counts.

Every couple is unique and we at Dallas – Fort Worth Fertility Associates are committed to finding answers and offering fertility treatments that work, whatever the cause may be.

For more information on Male Infertility Causes and Treatments visit http://www.dallasfertility.com/causes-of-infertility/male-infertility or Contact us to schedule your appointment.

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What are the side effects of testosterone replacement therapy (TRT)?

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Testosterone replacement therapy side effects

Testosterone replacement therapy (TRT) is a common way to increase testosterone and treat the symptoms of low testosterone. But one of the most common side effects of testosterone replacement therapy is low sperm count. A risk of TRT is that artificially high testosterone levels can trick your brain into stopping LH and FSH production. And when you stop making FSH, you stop making sperm.

Testosterone and sperm production

Testosterone production is a feedback loop. When your brain senses low testosterone levels in your blood, it ramps up testosterone production in the testicles by releasing two hormones:

  • Luteinizing Hormone (LH) – Makes testosterone in the testicles
  • Follicle Stimulating Hormone (FSH) – Essential for sperm production

When you add external testosterone (from replacement therapy), your brain slows production of LH and FSH because it thinks you don’t need anymore. But FSH is directly responsible for sperm production in the testicles. Decreased FSH levels together with already low natural levels of testosterone can decrease your sperm count. A lot. In fact, men using Testosterone replacement therapy can have a sperm count in the semen of zero.

Low testosterone production in the testicles means low sperm count. But too much testosterone can mean the same thing. Many of the side effects of high testosterone—like acne and mood shifts—are reversible. But other long-term effects of TRT (particularly regarding sperm count and fertility) are unknown. Talk to a doctor to find out if testosterone replacement therapy is right for you. Then work to find the right dose to make sure your testosterone levels stay within normal levels to reduce your risk of side effects.

If “low T” is slowing down your sex drive, testosterone supplements can speed it up – and make you infertile in the process

Testosterone is a very important hormone in males. It is important for pubertal changes such as muscle and bone growth, hair growth and development of the sex organs. It plays a very important role in libido and sexual function. Finally, it is essential for sperm production.

So when testosterone levels are low, especially when this is interfering with sex drive, sexual functioning and energy level, supplements are often prescribed. This may be as an injection, gel, patch or injectable pellets. Testosterone replacement is very effective at improving these symptoms.

Marketing blitzes are propelling more men than ever before to take testosterone to combat signs of low testosterone (low T is the popular term). Men are urged to talk to their doctor about this therapy if they have possible signs of low T, such as “feeling tired.”

A 2015 Journal of the American Medical Association report indicated that since 2001, the number of older and middle-aged men prescribed such supplements has tripled. The highest increase is among men in their 40s. Since testosterone naturally decreases about 1 percent annually in men after the age of 30, that makes sense.

However, taking this hormone can result in infertility. And that’s a problem for men seeking to boost their sex drive so they can get their partner pregnant. This is something that we are seeing more of in fertility medicine.

Our Male Infertility Treatments

How testosterone therapy eats away a man’s fertility

Taking testosterone decreases production of the follicle-stimulating hormone (FSH) from the brain, which is the hormone that drives sperm production. As FSH levels drop, so does sperm production. Low T therapy can also cause testicular atrophy, which can also result in fertility problems.

So while the supplements may help with libido, they are dropping fertility. In most cases stopping the therapy will result in return of the sperm production. Generally, men recover their fertility quicker if they had been taking testosterone for a shorter period of time.

But regaining fertility may take months, and in some cases of long-term injectable testosterone that can work for six months, there may be a permanent loss in sperm production. Any manner of testosterone delivery has the potential to cause infertility.

The best practice for a man is to not have testosterone therapy until he has fathered all the children he wants. If a man wants to father children and has low testosterone, he could freeze his sperm for future use, then undergo testosterone therapy.

Short of that, treatment other than testosterone supplements is indicated. He should see a reproductive urologist to test for underlying causes of low T.

There are other medications that can be used such as clomiphene citrate or fertility injections to increase both testosterone production and sperm production. Hormone levels and sperm count should be monitored while using these medication.

Men of reproductive age desiring current fertility or at any time in the future should avoid all forms of testosterone treatment.

If you have been taking testosterone supplements for awhile, your fertility will not return right when you stop taking them. Over time the supplements build up in your bloodstream. Depending on how long a man has been taking the supplement, it could take anywhere from a few months to a few years for his own body’s testosterone production to return to normal. For a small percent of men, prolonged testosterone therapy can result in permanent sterility.

If you want to take testosterone supplements to increase your libido and energy, you should talk to your doctor about your options. If you are still wanting to have a child, it might be worth your time to plan ahead and freeze your sperm to use when you are ready to have children. Another option would be to hold off on taking testosterone supplements until you are certain you don’t want to father any children in the future.

Ways to increase testosterone levels naturally

You have good, natural options to increase your testosterone levels without taking testosterone supplements or prescribed testosterone. Consider these eight tips:

  1. Exercise and lift weights
  2. Maintain a healthy weight
  3. Minimize stress
  4. Get quality sleep
  5. Eat healthy fats
  6. Get some sun (or take vitamin D supplements)
  7. Take a multivitamin (make sure it has zinc and vitamin B)
  8. Limit excess alcohol use and only take prescribed drugs.

Before starting any supplements, such as vitamin D and zinc, it is important to talk with your doctor to learn about possible side effects.

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