How Does Testosterone Impact Male Fertility?

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Testosterone, a hormone primarily associated with masculinity and virility, plays a critical role in male fertility. From sperm production to libido, its influence can be seen throughout the reproductive system. But what happens when testosterone levels decrease? Dr. Philip J. Cheng, a Urologist at RMA of New Jersey, helped us dive deeper into this topic. 

What is Testosterone? 

Testosterone is primarily produced in the testes in men. The adrenal glands also produce a small amount. Testosterone is vital for sperm production and maintaining a healthy libido. 

Symptoms of Low Testosterone (Low T) 

Low testosterone, medically known as hypogonadism, often comes with noticeable symptoms. Regarding male fertility, men with low T may experience reduced sexual desire and erectile dysfunction. Other symptoms include fatigue, decreased strength and muscle mass, difficulty concentrating and sleeping, and weight gain. Most critically, for this discussion, reduced testosterone can decrease sperm production, which can impact fertility. 

Testosterone and Infertility

A delicate hormonal balance is necessary for optimum sperm production, with testosterone playing a crucial role. Having low testosterone can cause a decrease in sperm count, thereby affecting fertility. It may seem counterintuitive, but exogenous testosterone given through medication is problematic for fertility. The body will sense excess testosterone and shut down the testes, leading to lower or absent sperm production.  

Treatment Options for Low Testosterone 

Thankfully, low testosterone is treatable, but the medication depends on whether the patient wants to preserve fertility. Almost all testosterone formulations will suppress sperm production.  

  • Testosterone Injections: Regular (typically weekly) injections can replace natural testosterone levels. However, injections should be used cautiously as they almost always suppress sperm production. 
  • Transdermal (Topical) Testosterone: This involves the application of testosterone gel or patches on the skin. It’s a non-invasive method to supplement testosterone but shares the same risk of suppressing sperm production. 
  • Testosterone nasal gel: This is the only formulation of testosterone that tends to preserve sperm production because it is very short-acting. The downside is that it must be administered through each nostril two to three times daily. 
  • Testosterone Pellets: Implanted under the skin, these pellets gradually release testosterone and typically last for about four months. They provide a steady hormone release but have the same risks as injections and topical testosterone with regard to suppressing sperm production 
  • Clomiphene Citrate (Clomid), Anastrozole (Arimidex), and Human Chorionic Gonadotropin (hCG): These medications work differently from testosterone supplements. Instead of supplementing testosterone, they stimulate the body to produce more testosterone from the testes and can therefore preserve or even improve sperm production 

Low testosterone levels can impact sperm production, potentially leading to infertility. If you suspect you have low testosterone levels, consult with a fertility specialist who can guide you through the diagnosis and help determine the best course of treatment. It’s a journey that requires careful navigation, but improved fertility can be achieved with a balanced testosterone level. 

Please note: This blog is meant for informational purposes only and should not be used as a replacement for professional medical advice. Always consult your healthcare provider for any questions or concerns regarding your health. 

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